Barriers to Effective Delivery of Prosthetics and Orthotics Rehabilitation Services in Meru County, Kenya

Abstract

Background: Access to prosthetic and orthotic (P&O) rehabilitation services is essential for restoring mobility, independence, and quality of life among persons with physical impairments. In Meru County, Kenya, evidence on the availability of P&O devices and the service-delivery barriers affecting rehabilitation remains limited. Objective: This study assessed barriers to the effective delivery of P&O rehabilitation services in Meru County. Methods: A hospital-based cross-sectional study was conducted at Meru Teaching and Referral Hospital using the CIPP evaluation model. A total of 223 healthcare workers were included. Quantitative data were analysed using IBM SPSS® v25 through descriptive statistics and chi-square tests, while qualitative responses were examined thematically. Results: Transhumeral prostheses (34.2%) and through-knee prostheses (27.6%) were the most frequently reported prosthetic devices, while ankle-foot orthoses (57.8%) predominated among orthotic devices. The findings showed substantial service gaps, including device non-availability or limited availability (68.1%), limited clinical services (41.6%), physical support (37.2%), fabrication and fitting services (40.7%), and weak adherence to standards and guidelines (71.7%). Significant associations were observed between service delivery and education level (χ² = 35.117, p = 0.004), age and standards compliance (χ² = 22.038, p = 0.037), and employment terms and quality perception (χ² = 16.307, p = 0.038). Conclusion: P&O service delivery in Meru County is constrained by limited device availability, inadequate service components, and weak standards implementation. Strengthening procurement, staff training, standards adherence, and referral linkages may improve rehabilitation outcomes.