Malawi – Lilongwe

The centre at LION

In March 2009, 500 miles opened its doors to a brand-new prosthetics and orthotics (P&O) service in Lilongwe for central region. Our service was originally located at Kamuzu Central Hospital (KCH), but in January 2024, 500 miles’ P&O service moved to LION – the Lilongwe Institute of Orthopaedics and Neurosurgery – which is now the main orthopaedic tertiary care hospital for central region. This P&O service was managed and funded by 500 miles as part of the Malawi government’s national health service from March 2009 until the 31st of March 2025 when we handed over full administrative and fiscal control to the LION Trust which is a joint venture between the Malawi Ministry of Health (MoH) and a Norwegian consortium, with continuing support (see below).

A group of guests at the handover celebration for our clinic in Lilongwe

In line with Malawi government policy, the P&O service at LION is a “paying service”.  The charging policy is that everyone should contribute whatever they can afford towards the bare cost of production of their device(s) without causing hardship. It is necessary for the Lion Trust to continue always to ask for an affordable contribution to try to secure the future sustainability of the service, but 500 miles is supporting the LION Trust to meet or subsidise the cost of devices for those who cannot afford to pay.

Premises

The Prosthetics and Orthotics Department at LION occupies the whole of the ground floor of LION’s rehabilitation building, with physiotherapy, occupational therapy and hand therapy upstairs on the first floor. The P&O premises are spacious (600 sqm), fit for purpose, laid out to an ideal specification and generally spectacular!

Personnel

The team at LION

Benadeta Singini (in white) was the manager of 500 miles’ P&O service in Lilongwe from July 2023 until its handover in March 2025 and she continues to manage what is now the P&O department at LION for the LION Trust. Benadeta is a Malawian, fully qualified prosthetist/orthotist. 500 miles sponsored Benadeta’s diploma in orthopaedic technology (2012) and her degree in prosthetics and orthotics (June 2019). Benadeta previously worked at the 500 miles prosthetics and orthotics centre in Mzuzu where, after qualifying with her degree from Mahidol University, she received two years of extensive management training from 500 miles’ expatriate managers there before taking over from them as the manager herself. Read more about Benadeta here.

The department has three additional qualified Prosthetic and Orthotic Technicians (Samuel, George and Peter) and four Prosthetic and Orthotic Assistants (Dominic, Mike, Charles and Clinstone) – and the receptionist, Maggie, who will welcome you on arrival.

Quality Management System

Before the handover of its P&O service at LION in March 2025, 500 miles completed the installation of the quality management system (QMS) created for 500 miles by internationally recognised prosthetist/orthotist, Sandra Sexton. 500 miles commissioned the QMS to secure and sustain the quality of every aspect of the product and service by systematising it. The thorough implementation and ongoing internal and external auditing of a QMS is crucial for the sustainability of a high-quality service for the patients of LION’s P&O Department for the long term.

We are grateful to Strathclyde University for releasing Alana Stevenson and Christine McMonagle, employees of the National Centre for Prosthetics and Orthotics, for three visits to 500 miles’ P&O service at LION during 2024 to work on the installation and embedding of Sandra’s QMS. Alana and Christine reviewed and adjusted our practices so that the system operated smoothly at our new premises, making sure our staff were complying with the requirements of the QMS, implemented the quality audit process which is a crucial part of the QMS, taught P&O skills wherever possible and advised on where and how the QMS manual should be updated.

500 miles has put in place a process for the ongoing regular internal and external auditing of the QMS so that any weaknesses in quality will be quickly picked up and addressed.

Patients

From when 500 miles first opened its service in Lilongwe in March 2009 until its handover in March 2025, 500 miles carried out 16,229 fittings for a register of over 10,339 patients. Our usual production rate was over 120 devices each month.

Partners

A patient being treated by the outreach service

Many patients of the P&O service in Lilongwe “walk-in” because they hear about it and many are referred by LION itself or by other local medical services but from when 500 miles first opened in Lilongwe in March 2009, we developed strong relationships with a number of partners, many of them operating further afield in central region. They include all of the District Hospitals in central region and:

At handover, 500 miles transferred its working agreements with these partners to LION and the P&O Department at LION will continue to work closely with them.

Future support

Through One Smile, 500 miles intends to continue to support the P&O Department at LION for four years after handover, but this is contingent on LION continuing to operate the P&O service along the same principles as those on which 500 miles was running it – which essentially means that all-comers must be given the P&O devices they need, regardless of their ability to pay. Our future support is also conditional on LION continuing to meet certain levels of (1) production, (2) quality and (3) in-country income which are all essential for the long-term sustainability of the department.

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