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EDITOR†S COMMENTS

Editor’s Comments

Fisk, John R. MD; Simpson, Sam PhD

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Journal of Prosthetics and Orthotics: January 2020 - Volume 32 - Issue 1 - p 1-2
doi: 10.1097/JPO.0000000000000297
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John R. Fisk, MD

In the United States, there are around 7500 prothetists-orthotists (POs) for a population of 350 million people. In Southeast Asia, there are around 800 POs for a population of 650 million people. Eighty percent of those who need P&O services do not have access to them, over 3 million in Southeast Asia alone. Exceed Worldwide has worked in South and Southeast Asia since 1989 to address this little-known global health challenge, a dearth of much needed prosthetic and orthotic (P&O) services for the disabled community.

At least 12 of the 17 United Nations Sustainable Development Goals cannot be achieved without addressing the needs of people with disabilities. Exceed Worldwide has been rising to the need through education, treatment, community-based services, and research. With foundation grants and other partners, Exceed has founded five P&O schools in Cambodia, Sri Lanka, Indonesia, the Philippines, and Myanmar, effectively establishing a regional P&O sector from a zero base. Six hundred internationally qualified POs have been trained, and Exceed is recognized as a pioneer and leader in P&O education.

People with disabilities who live in poverty access P&O treatment on a charitable basis at eight physical rehabilitation clinics linked to these P&O schools. A total of 10,000 to 12,000 children and adults per year receive treatment; 13% of these are new patients. In Cambodia, community teams identify people who need P&O support, arrange treatment, and provide support to access education, vocational training, and establishment of new businesses. About 300 to 400 children and adults each year access education and training. Over 1000 small businesses have been established. In addition, Exceed founded and coordinates the Exceed Research Network (ERN), a new, unique, multinational disability research consortium partnering universities in the United States, Europe, and Asia, bringing together eminent researchers, nongovernmental organizations (NGOs), and businesses.

New thinking is needed to address the P&O health challenge on a sustainable scale, and Exceed Social Enterprises (ESE) has been established as a unique vehicle to dramatically scale-up the sector. Exceed Worldwide's network of P&O schools and physical rehabilitation clinics have delivered an enormous level of social impact in Southeast and South Asia. The organization has trained some 600 P&O professionals, supplied people with disabilities who live in poverty with more than 52,000 custom-made devices, and maintained over 200,000 devices. However, much more is needed to provide access to the millions who need access to P&O services in Southeast Asia and other regions.

The obvious question is how can this challenge be addressed, especially when many governments seem unable or unwilling to invest in P&O services? Exceed believes that the solution lies in thinking innovatively and embracing new multisector models, which include resources from the charitable, private, trust/foundation, and public sectors. ESE was founded as a potential solution to the P&O Health Challenge in Southeast Asia. The thinking behind it is simple—the enterprise aims to “capture” local resources and use them for social good. ESE's initial aims are to support Exceed Worldwide's charitable activities and, in the longer term, generate resources to scale up the regional P&O sector. It also aims to create an employment path for graduates from P&O schools, so that these skills will remain in the region and make P&O services more widely available.

ESE has two divisions. The first is Exceed supply and distribution (S&D), and the second is Exceed private P&O clinics. Exceed S&D trades ethically and supplies customers in South Asia, Southeast Asia, and Asian Pacific with P&O components and materials. State-of-the-art devices are provided to those who can afford them, the profits from which are channeled back into the charity work of Exceed. Exceed Social Enterprise is still in its early stages but has passed through the most dangerous development phase and is poised for growth. High-end private clinics have been developed in the Philippines and Sri Lanka, while a slightly different model is being tested in Cambodia, in partnership with the Cambodian Government.

ESE has been piloted and has reached the stage where it is self-sustaining, despite limited seed funding and operational resources. Although the business has passed through the most dangerous development phase and is ready for growth, it does need additional investment.

The model, which Exceed Social Enterprises is pioneering, is in essence quite simple. Funders and/or investors with a philanthropic outlook provide funds that will be used to take what is now a tried and established business model to the next level by investing in capital, human, technical, and marketing resources. This will allow Exceed management to use the huge amount of knowledge gained over the last few years to grow the business in existing and new markets.

As the business grows and becomes more profitable, it will be able to finance future growth by normal business methods and generate much larger profits. These will be used to support Exceed Worldwide charitable services, fund the further development of ESE, and, where appropriate, return funds to social investors, allowing these organizations to “re-use” these funds for social good.

It is believed that a multi-track approach, which involves Exceed Worldwide, Exceed Social Enterprises, and support from others—including trusts, foundations, and governments—will address the P&O health challenge by enabling the entire P&O sector in Southeast Asia to grow on a self-sustaining basis, so that a range of paid-for and free P&O services becomes available on a much larger scale and not leaving the poor behind.

In short, we aim to develop a highly successful social enterprise to produce recurring, significant, and independent profits, and use these profits for social good. Working with Exceed Worldwide has given me an opportunity to support the P&O profession and their care of the disabled in a region of the world having a great need.

John R. Fisk, MD
Chair of Exceed Worldwide Board of Trustees 27 Long Pond Drive, Beaufort, SC [email protected]
Sam Simpson, PhD
Research and Business Development Exceed Worldwide PO Box 429, Hillsborough, Northern Ireland

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