Eka and Vindi from Indonesian NGOs Kaki Kota and Kota Kita doing fieldwork for the "Country Capacity Assessment for Assistive Technology: Informal Markets Study" in Banjarmasin, Indonesia. Photo credit: Angus Stewart.
From 2023 to 2024, ATscale invested in 12 countries to set them on the path towards stronger policy, systems and service delivery for assistive technology (AT) to support their readiness for future investment. Over the course of one year, ATscale supported the creation of conducive environments to increase access, deepen understanding of the context and gain consensus on future strategies. ATscale named these countries their ‘foundational countries’, as they were the first steps toward creating long-term, sustainable access to assistive technology.
What are foundational countries?
The countries chosen for investment faced challenges such as limited data on assistive technology, disability, unclear policies or a lack of coordination among stakeholders. ATscale provided short-term funding (12-24 months) to implement essential activities to create a solid foundation for future growth.
“Limited allocation of government resources, insufficient technical and local implementing partners, and limited service provision capacity in low and middle-income countries (LMICs) leads to low political willingness and know-how on scaling-up assistive technology programmes,” explains Dr. Satisha Mishra, Head of Programmes at ATscale. “Recognizing these challenges, ATscale provided this initial support to generate evidence-based policy environments, mobilize political-will, and build the capacity of governments and local partners to prepare for larger-scale programmes.”
Breaking down barriers, building capacity
Accessibility begins with affordability. In Zimbabwe, a significant milestone was achieved with the amendment of Value Added Tax (VAT) regulations. The removal of import tax on essential AT such as hearing aids, braille materials and crutches has made these devices more accessible and affordable for those who need them most. This policy change directly impacts individuals and families, easing the financial burden and providing crucial support.
In Mozambique, the Orthopedic Centre of Hospital Central in Maputo invested in new equipment to boost local production of customized mobility products. This strengthened local capacity and resulted in a more sustainable supply of assistive products. Local production not only reduced costs, but also fostered self-reliance and created job opportunities. This is just the first step; ensuring proper maintenance and repair of assistive products is equally vital.
In Lesotho, a major leap forward was taken with the certification of seven instructors in wheelchair service provision. These instructors are now training others, and are establishing a vital assistive technology training programme at technical and vocational education training schools. Local expertise is building which will result in long-term sustainability of AT services.
The power of community action: Mzee Mtoi's story
Tanzania is one of the foundational countries where we are seeing remarkable change. Take the story of Mzee Fredrick Mtoi, a 78-year-old man from Vugiri village. Mzee Mtoi serves as the Chairperson of the Older People Council of Vugiri Ward and the Korogwe District Council. In December 2023, after participating in assistive technology training for community health workers (CHWs), he took immediate action.
"I walked on foot through all seven villages tirelessly, across hills and valleys despite my old age, to ensure we identify people in need of assistive technology and help them,” said Mzee. “ It was not an easy task, but I am happy that some people, especially my fellow older people, have started receiving assistance. Thank you very much for this project; we hope it will go further by distributing more assistive products.”
Mzee Mtoi worked with local government leaders and the Older People Council to identify 149 people in need of assistive technology across seven villages. Through collaboration with the District Commissioner’s Office, they secured ten wheelchairs, supported by the Lottery Lions Club National Microfinance Bank through Help Age International. These wheelchairs were distributed to people, including older people, from six villages.
Expanding reach and impact
Originally focused on physical impairments and disabilities, the programme in Nepal successfully expanded its scope to cover six functional domains, including hearing, vision, communication, speech, cognition and self-care, thanks to effective advocacy and government buy-in. This expansion ensures that a wider range of individuals with diverse needs can access the AT they require. Whether it is visual, auditory, cognitive or any other type of disabilities, everyone deserves equal access to support.
In Peru, the Ministry of Health medical staff benefited from an "Introduction to AT" course, with 320 participants completing at least 80% of the sessions. This training programme equipped healthcare professionals with the knowledge and skills needed to provide better AT provision and support. Informed healthcare workers play a crucial role in identifying needs and recommending appropriate AT solutions.
Data collection efforts using tools like ATA-C and rATA proved invaluable in engaging stakeholders and establishing buy-in from both government and private organizations. In Indonesia, this data collection was largely conducted by persons with disabilities, fostering strong community ownership of the programme activities. When individuals in need of assistive technology are actively involved in the process, the solutions are more likely to be effective and sustainable.
Strengthening policy and strategy
While some countries initially lacked legislation on AT, significant progress was made in policy development. Technical Working Groups (TWGs) played a crucial role, facilitating collaboration among diverse stakeholders and driving progress in nine countries. These groups were instrumental in drafting and finalizing Assistive Products Lists (APLs) and strategies. Clear policies and strategies provide a framework for sustainable AT provision.
Overcoming obstacles and learning lessons
These achievements did not come without challenges. As Mzee Mtoi discovered, the identification exercise was physically demanding. "There were high expectations from people during the identification exercise, as they understandably wanted immediate solutions to their situation such as getting assistive products. We learned that there are many people in need of assistive technology whose special needs are not yet fully understood".
We also learned that even where AT is available, it isn’t always suitable. “For example, one of the wheelchairs allocated to a young girl was too big for her, which meant that it did not give her full independence and did not adequately support her posture. Additionally, we realized that there are existing stakeholders who are willing to support people in need of assistive technology but have not been engaged” said Mzee Mtoi.
These initiatives have provided invaluable lessons. Data collection and evidence gathering are essential for advocacy and generating buy-in. Disaggregated data is crucial for understanding the needs of underrepresented groups. Sharing resources in local languages and cross-country learning opportunities proved beneficial. Clear communication, strong stakeholder engagement and government ownership are vital for sustainability.
Looking ahead
While the achievements of foundational countries are impressive, challenges remain. These challenges present valuable learning opportunities. Adaptability, clear communication and stakeholder engagement are critical in overcoming hurdles and ensuring the sustainability of initiatives.
The experiences of these countries offer a blueprint for others. By prioritizing policy changes, capacity building and community-driven efforts, we can collectively break down barriers and create a world where everyone has the opportunity to thrive.
"The progress of foundational countries in enhancing access to assistive technology is a testament to the power of collaboration, innovation and community-driven efforts,” says Dr Mishra. ” By learning from experiences and continuing to support such initiatives, we take another step forward towards a world where assistive technology is accessible to all, ensuring that no one is left behind”.
ATscale worked with four partners in the 12 countries
1. Clinton Health Access Initiative - Democratic Republic of the Congo, Lesotho, Mozambique, Zimbabwe
2. Momentum Wheels for Humanity - Peru, EI Salvador, Guatemala, Honduras
3. HelpAge International - Indonesia, United Republic of Tanzania
4. Helen Keller International - Bangladesh, Nepal