Prothea Kenya

According to estimates by the World Health Organization, there are roughly 40 million amputees in the developing world[1], of whom an estimated 82.3% do not have access to any form of prosthetic care[2]. Common causes of amputations are traffic accidents, infections and diabetes, and especially due to this latter cause, the number of afflicted patients is expected to continue to rise in the coming years[3]. The challenges faced by amputees in low and middle income countries are multifaceted and often involve a combination of social, economic, and healthcare-related issues. An amputation is a life-altering experience that leads to psychological as well as physical challenges. Patients who suffered an amputation often face discrimination in the job market, limiting their employment opportunities and perpetuating a cycle of poverty. Societal attitudes and misconceptions about disabilities can lead to stigmatization and isolation, affecting the mental health and well-being of patients. Furthermore, poorly designed infrastructure and lack of accessibility to public spaces make mobility challenging for amputees, further limiting their ability to participate in daily activities. Currently, there is limited access to prosthetic devices due to cost barriers and lack of insurance coverage. Prosthetic limbs can be expensive, and many amputees in low and middle income countries do not have the financial means to afford them. Furthermore, the available rehabilitation services are scarce. Additionally, there is a problem with reliance on international humanitarian aid for prosthetic devices and rehabilitation services, creating a dependence that is not sustainable in the long term. We believe that addressing the challenges faced by amputees in developing countries requires a holistic approach that involves improving healthcare infrastructure, increasing accessibility to prosthetic devices, providing rehabilitation services and promoting employment opportunities for local prosthetists.

1.            World Health Organisation. World report on disability. WHO Press vol. 105 (2011). doi: 10.1111/j.1741-1130.2011.00320.x.

2.            World Health Organisation and the United Nations Children’s Fund (UNICEF). Global Report on Assistive Devices. WHO Press (2022).

3.            Walicka, M. et al. Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality. J. Diabetes Res. 1–8 (2021) doi:10.1155/2021/8866126 doi: 10.1155/2021/8866126.

At Prothea Kenya we are dedicated to making high-quality but affordable prosthetic legs for patients who suffered an amputation, using innovative 3D-scanning, modeling and printing technologies. Traditionally, prosthetics are made through multiple steps of casting negative and then positive molds and involves expensive equipment and a lot of time by skilled professionals. Our solution drastically simplifies this fabrication process by using modern technologies.

We use regular smartphones with built-in precise 3D scanners, providing an affordable mobile device that can scan patients even in the world’s most remote areas. For 3D modelling, we developed a custom open-source software called uFit, with which you can create a printable model of a prosthetic socket in a few simple steps. For 3D printing, we use simple commercially available 3D printers, which cost around 1,000 USD per printer and have a power consumption comparable to a desktop computer.

Through this innovative workflow, we can offer a prosthetic leg and the necessary physical therapy to regain mobility at a cost of 300-600 USD per patient, depending on the type of amputation. These prices are a huge reduction of the market price for prosthetics, which are sold for 1,000-7,000 USD per device.

While our main goal is to enable access to prosthetic care for our patients, we aim to impact their lives in more than one way. We want to ensure that as patients regain mobility, they can fully reintegrate into society. We work together with partners to help patients in their job search where necessary, and we work on awareness campaigns to help destigmatization of people with physical disabilities. Using this holistic approach we aim to increase the quality of life for our patients, focusing on both physical and mental well-being.

Existing centers for prosthetic and orthotic devices in Kenya cater to the upper class, but are not available to the majority of citizens, due to cost barriers and issues with mobility. Although Kenya has experienced a lot of economic growth in recent years, there is still a very large group of people who are able to buy food for the day, but cannot afford to save up money in case of unexpected health issues or other calamities. Therefore, people who suffer an amputation are often suddenly faced with a financial burden beyond what they can afford, forcing them to go through life without any assistive device at all. Moreover, as mobility is challenging for these patients, many patients living in rural areas often are not able to travel to the big cities in order to visit a prosthetics center, even if they had the financial means to purchase a device.

At Prothea Kenya we aim to serve people form all different backgrounds. Currently, our prosthetic devices are sold for 300-600 USD per patient, depending on the type of amputation (transtibial or transfemoral). This price includes the device, the consultations, fitting, and physical therapy needed for the patient to regain mobility. This is up to five times cheaper than traditionally fabricated prosthetics. Moreover, due to our portable scanners, our prosthetists can scan and fit the patients even in the most remote areas of the country, ensuring that patients who are not able to travel to the city, can also benefit from this health care solution.

Although our prices are a huge reduction of the market price for prosthetics, we are always looking for ways to reduce our prices further, to make prosthetic care accessible to all. Some of the major drivers of cost are the components which we order from external sources to assemble the devices, such as feet and pylons. However, we have a partnership with Legs4Africa, who regularly send us these components for free from second hand sources in Europe. This allows us to reduce the cost further for those patients who do not have the financial means to pay the full price.

Most of the patients that we have helped so far, otherwise had no access to prosthetic care at all. For them the impact of our solution is undeniable, as they gained or regained the ability to walk, enabling them to go back to work or school and fully participate in society.

One of the key success factors here is that we are a grassroots organization of local prosthetists, engineers and entrepreneurs. The team leader, Faith Njoki, is trained in business administration and was in charge of a large COVID center in Nairobi before joining the team. She grew up in the outskirts of Kibera, the biggest, largest and poorest slum in Africa. Due to the dense overpopulation in this area and the absence of a sewer system, infections occur frequently and can cause gangrene and ultimately lead to limb loss if left untreated. Being a personal witness to the living conditions of these people and the vast absence of accessible healthcare, Faith is motivated to help Prothea Kenya fulfil its potential and make affordable prosthetic and orthotic care available to all.

Furthermore, our community outreach officer, Belinda Adhiambo, has suffered an amputation herself and wears a transfemoral prosthetic leg manufactured by Prothea Kenya. Due to her personal experience with undergoing an amputation and regaining mobility with a prosthetic solution, she is in a good position to talk to potential customers and maintain communications with the patient community through What’s App groups and other social media.

The team in charge of manufacturing the prosthetics consists of three prosthetists and one engineer, who are all Kenyan citizens with a lot of knowledge and experience in the field of prosthetics, aside from having the inherent benefit of understanding the dynamics of the Kenyan markets. Furthermore, to assist with the implementation of the 3D-scanning and printing technologies, engineers from Ugani Prosthetics, based in Belgium, frequently visit for a couple of months at a time to collaborate and share knowledge to further increase our impact.

We have launched our prosthetics workshop here in Nairobi, Kenya in April 2023. In these first 9 months we have helped almost 100 patients, making us one of the biggest prosthetic centers in East Africa. We have assessed patient satisfaction using the QUEST 2.0 questionnaire, which includes questions about comfort, safety and durability. Patients have scored their satisfaction with our devices with an average of 4.7 out of 5.

Furthermore, our low prices have disrupted the local market of prosthetics in Kenya. In response to our offer, we have forced commercial competitors to lower their prices by up to 50%. We are now collaborating with these competitors by giving them free training and scanners, enabling them to partake in the benefits of our workflow, further scaling our operations with minimal investment. 

Our major technical milestone was the creation of the uFit software. This tool represents the bridge between having a digital scan of the residual limb, and having an actual 3D-printable model of a prosthetic socket. The software is very user-friendly and due to its open-source publication is already changing the way prosthetists work all over the world. To this date over 150 prosthetists worldwide have registered to use the software and due to this, patients are walking around with a uFit created prosthetic not only in Kenya, but in numerous other countries as well such as such as Ghana, DRC and Namibia.

Finally, we have invested a lot of time in optimizing the materials and settings of the 3D printing, to make the most durable devices possible. Together with the Thomas More university in Geel, Belgium, we tested the durability by artificially walking a prosthetic on a robotic gait simulator. So far, it has walked 2.5 million steps (simulating 4 years of walking by a patient) and has not broken down yet.

Now that we have established our first successes in Kenya, we are planning to drastically expand our impact by providing training sessions for prosthetists on using our 3D-scanning and modeling technologies. Each training will last one week and can house up to 5 trainees. Following the training, the prosthetists will start to work for us on a freelance basis, scanning and fitting patients remotely, while relying on our 3D-printing hub in Nairobi for manufacturing the devices. This rapid expansion is expected to lead to an increase of about 300 more patients in the next year, and 600 more in the year after, due to more training sessions for prosthetists not only based in Kenya but in neighboring countries as well.

With these expansions in mind, we would be greatly benefited by a mentorship program where we can get some advice on legal and regulatory matters that we may need to consider for these expansions. Moreover, pitching to investors would be a very helpful skill to be trained in. Unfortunately, as a female team leader in Kenya, you often need to work twice as hard to gain respect and be taken seriously. Learning how to pitch effectively and make a clear and convincing case for potential investors, would help us overcome this hurdle. Moreover, in Nairobi and outskirts there is a general awareness about our solution, and many patients come in as a result of word-of-mouth promotion, or a referral from their orthopedic surgeon. However, targeting the underserved population of patients who suffered an amputation in rural areas of Kenya has proven to be a bit more difficult. These patients sometimes don’t even know about the existence of prosthetic devices at all, and aside from having an amputation, our target population does not necessarily have that much in common. Learning how to improve our marketing strategies in order to reach more awareness amongst patients, would be another very useful support that we hope to gain from this application. Finally, we plan to do a systematic study on the impact we have on patients lives, including keeping track of their mental and physical well-being and the rates of employment. For the execution of this study, we would benefit from attending courses in data collection and analysis.

In Europe and the U.S., there is a longstanding tradition of manufacturing prosthetics, which typically relies on the most expensive state-of-the-art equipment and materials for producing light-weight devices. These devices often end up taking weeks to produce and are sold for thousands of dollars. This has worked well in the West, because insurance companies usually cover the costs of prosthetics as they are seen as a medical necessity. However, due to these expensive and time-consuming procedures, most patients in low and middle income countries have thus far not been able to benefit from assistive devices at all.

Our solution is innovative, because it drastically reduces the costs for the patients, largely scales up the number of prosthetics that can be produced in a month, and enables access to prosthetic care in the most rural areas as well.

Ultimately, we aim to improve the inclusion of people with a physical disability. We provide prosthetic and orthotic solutions to improve mobility for these people, and we work on awareness campaigns on social media with the goal of destigmatizing physical disabilities. Furthermore, we help patients in their job search where necessary with the goal of breaking the cycle of poverty and helping them reintegrate into society.

By providing our customers with a prosthetic device and physical therapy, we provide them with the ability to walk again, where before many patients were skipping or even crawling in the case of a double amputation. Through the ability to walk, they gain access to certain public spaces that were previously difficult to access due to stairs or uneven walkways. Furthermore, their position in the job market becomes more favorable as they suffer from less discrimination in the hiring process. Being able to participate in simple daily activities that were previously restricted, improves the mental well-being and social acceptance of people and through these life changing events we hope to break the negative spiral and positively impact people’s lives on all these different fronts.

Firstly, there are two impact goals that we are measuring already, which are related to how many people we help and how satisfied they are with the devices and service. In the first 9 months we have helped almost 100 patients, and their satisfaction was rated with a 4.7 out of 5. For the next year, as we are expanding our operations, we aim to help 300 patients while maintaining a similarly high satisfaction score.

Secondly, we would like to elucidate how the services impact our patients’ lives beyond obtaining the device. For this reason, we have recently hired a full-time community outreach officer who will keep in contact with the patients and follow-up where needed. We will assess (1) how many patients managed to find a job who were unemployed before or went back to finish their education, (2) how patients are coping with their situation in terms of mental well-being compared to before and (3) how the feeling of isolation or stigmatization may have changed over time.

By keeping track of these quantitative and qualitative variables, we will assess our impact after one year and adjust our strategies where necessary. 

We rely on two main technologies. The first is our 3D-modeling software, which was developed in-house. It is built within the Blender environment and scripted with Python. It consists of the core software component, a transtibial module, transfemoral module and free sculpting module. For each patient who receives a prosthetic or orthotic device, the prosthetists start by making a scan of the (residual) limb. They mark the limb with red and green markers, indicating areas which should be relieved and pressured, respectively. These scans are then processed in the software manually by pushing and pulling the color coded areas. In the future, we plan to leverage machine learning to automatize this process. The collective database of 3D-scans can be used to improve the software’s functionality, by training a model to detect the areas which need to be relieved and pressured automatically, leading to a faster and more robust mechanism of fabricating the prosthetic sockets and orthotic devices. We also plan to add additional modules to the software such as a module specialized for ankle-foot orthotics and insoles.

The second technology is 3D printing. 3D printing technology has evolved tremendously in recent years and has found applications in various fields since its inception, such as prototyping and product development, education, dental applications, art and fashion, military components and many more. We are not the first team to apply 3D printing technologies to prosthetics fabrication, but we have managed to use it in a far more cost-effective way than others, producing very comfortable and durable devices with affordable printers (approximately 1,000 dollars per printer). We decided to print with polypropylene, which is the same material used in traditional prosthetic sockets, and has proven to result in very durable devices.

We have 5 full-time staff members, including the manager, community outreach officer, two prosthetists and one 3D engineer.

We have 2 part-time staff members, including a person who does marketing and an orthopedic surgeon who is part of the executive team and involved in patient referrals.

Furthermore, we have prosthetists who work for us on a freelance basis, scanning patients in rural areas and sending us the digital files to be printed at Prothea Kenya. So far we have two freelance prosthetists working for us, and we expect to hire many more in the coming year.

The idea for our solution started in 2021 with the launch of our partner company Ugani Prosthetics. After two years of prototyping and ensuring the highest quality and durability of the devices, we started Prothea Kenya, the first prosthetics workshop to implement this solution and treat the patients, in April 2023.

We strive to be a diverse and inclusive environment which welcomes people from all different backgrounds. Currently, out of the 5 full-time team members, two are female and three are male. We were also happy to welcome our newest team member who has suffered an amputation herself and is therefore well suited to manage our community outreach program.

As we are hiring more freelance prosthetists in the coming years, we will continue to adhere to the principles of diversity, equity, and inclusion in our hiring process.

All of our revenue comes from patients who need a prosthetic or orthotic solution. For patients who suffered an amputation, or patients who are missing a limb due to congenital diseases, our prosthetists provide extensive physiotherapy so they can learn how to walk again in a safe and comfortable way. Our prosthetics center is equipped with parallel bars and other materials to provide these trainings in house, but it is also possible to administer rehabilitation in the patients’ own homes. The patients pay roughly 300 dollars for a transtibial prosthetic (below the knee) and 600 dollars for a transfemoral prosthetic (above the knee), and this price includes the device, and all consultations and therapy needed for the patient to regain mobility.

Aside from our prosthetics, we manufacture orthotic devices to improve stability and posture and encourage development, or to support to weakened or weakening joints. Patients may need orthotic devices to address conditions such as arthritis, joint pain, or misalignments, for injury rehabilitation, foot problems or posture correction. We sell the orthotic devices between 50 and 180 USD, depending on the type of device. All of our devices come with a one-year warrantee so that patients can come back for a new device if something should break or prove less comfortable than initially thought.

For patients who have a larger budget, we will also start to sell premium products such as carbon-fiber knees and silicone fingers. The larger profit margin on these products will help us to boost the company’s revenue. Last year, the sales of transtibial prosthetics accounted for 58% of the incoming revenue, transfemoral prosthetics for 20%, and the remaining 22% came from the sales of orthotic devices and separate components. Any profits we will make this year will be invested directly back into the company by buying materials to train freelance prosthetists to work for us in remote areas, thereby scaling our business and further increasing our impact.

Our low material costs and high production rates ensure a steady stream of revenue from paying patients. Due to this, we managed to break even after only 3 months of operations. All expenses, such as salaries, rent and materials are directly paid for by the revenue from paying patients. This ensures that our operations remain stable even without any external grants or financing.

While our prosthetics are affordable for many patients, paying a lump-sum of 300 dollars can still be a challenge for some. Therefore, we co-finance the prosthetics with free components from second hand sources in Europe for patients who are unable to pay the full price through our partnership with Legs4Africa. We are also currently doing fundraising rounds for the most vulnerable people such as children, elderly people and marginalized groups.

Many of our competitors in the field are NGOs who provide all their prosthetics for free. We believe that giving away devices for free is not a sustainable business model for long-term operations, and can lead to improper conduct by patients, such as mistreatment or resale of the devices, or seeking to receive a prosthetic device despite already possessing one. Therefore, our business model revolves around selling cost effective prosthetic devices and maintaining self-sufficiency while striving to cater to the most vulnerable people. Due to our portable scanning devices and timely workflow, we are able to help patients in the most remote areas, who otherwise did not have access to any form of assistive devices and bring the technology to them, while also providing employment opportunities for prosthetists and boosting the local economy.