Applying systems thinking in the prosthetics and orthotics sector: investigating the common challenges in Iran

Abstract

Purpose: We sought to explore the common challenges across stakeholder groups and also to recognize interactions among them to improve the Iranian prosthetics and orthotics (P&O) sector. Materials and methods: Interviews were performed from January to June 2019. Participants, including 13 prosthetists/orthotists and six P&O faculty members, were selected using purposive and snowball sampling. The collected data were analyzed using the framework analysis method. Additionally, a systems thinking approach was applied to theorize potential leverage points to improve P&O services in Iran. Results: Challenges in leadership and governance included lack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers. Financing challenges included high out-of-pocket payments, inadequate insurance coverage, and insufficient governmental funding. Service delivery challenges included lack of prosthetists and orthotists in hospitals and medical centers, corrupt activities and a weak referral system. Human resource challenges included insufficient practical skills of graduates, misalignment of theoretical and clinical training, and inadequacy of continuing education courses. Conclusions: This study provides the groundwork to develop and implement national strategies to address modifiable barriers and improve prosthetic and orthotic services.Implications for rehabilitation Lack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers are the governance challenges of prosthetics and orthotics (P&O) and must be managed by the government. Government resources allocated to P&O services should increase, and P&O insurance coverage should improve. P&O services should be incorporated in health benefits packages to lessen the reliance on out-of-pocket payments. Planning should be done toward inclusion of P&O services in universal health coverage. Up-to-date scientific training and high-quality evidence are needed to enhance the practical skills of P&O graduates and consequently improve the quality of P&O services. Effective continuing training courses for P&O graduates are recommended. It is advantageous to provide P&O services in hospitals. © 2022 Informa UK Limited, trading as Taylor & Francis Group.