Procurement architecture as a determinant of rehabilitation system performance: insights from Ukraine's prosthetics sector.

Access to assistive products remains highly uneven across health systems. Policy discussions in rehabilitation frequently emphasize workforce development, service delivery models, and clinical standards. Less attention has been given to the institutional mechanisms through which assistive products are procured and supplied. Ukraine's prosthetics sector provides a contemporary illustration of how procurement systems influence rehabilitation service delivery. Following the escalation of armed conflict in 2022, Ukraine experienced a sharp increase in demand for prosthetic services. National programmes expanded rapidly to support individuals requiring rehabilitation and assistive technologies. In this context, procurement arrangements - including decentralized purchasing across multiple providers and reliance on imported prosthetic components, have highlighted structural challenges affecting supply chain coordination, pricing transparency, and system scalability. This paper argues that procurement architecture represents an under-recognized determinant of rehabilitation system performance. Drawing on insights from Ukraine's prosthetics sector, the paper explores how fragmented procurement arrangements can reduce cost efficiency in access to assistive technologies even when financing and service delivery capacity expand. It further outlines procurement reform principles that may strengthen rehabilitation systems, including pooled purchasing mechanisms, framework agreements, demand forecasting integration, and digital procurement platforms.