Catalysing AT access: Scaling rehabilitative services and increasing access to AT in Kenya
Under Cluster 3: Country Implementation of the AT2030 programme, AT2030 partners are working with country governments to identify opportunities to drive availability and affordability of AT. CHAI and the AT2030 programme published a case study on work happening in Kenya to expand access to rehabilitative and AT services.
The case study describes the pathway towards national scale up by developing a “National Strategy for Scaling Rehabilitative Services and Increase Access to Assistive Technology”. At the request of Kenya’s Ministry of Health, a comprehensive situational analysis was conducted that involved a mapping of service capacity in 238 public health facilities – 47 county referral hospitals and 191 sub-county hospitals. Findings were discussed with all government stakeholders via a series of video conferences and a follow up two-week workshop.
Kenyan context on disability and rehabilitative services
According to the national census, almost one million Kenyans – or 2.2% of the 47.6 million population - aged five years and above have at least one form of disability. Approximately 400,000 people in the country have mobility impairment; therefore, the need for rehabilitative services and appropriate assistive products such as wheelchairs is high. It is estimated that about 100,000 people need a wheelchair in Kenya annually.
In Kenya, disability matters are handled by the Ministry of Health and the Ministry of Labour and Social Protection. The Ministry of Health is responsible for the provision of medical rehabilitation services while the Ministry of Labour and the Social Protection is responsible for handling social-economic matters related to persons with disabilities, such as reducing stigma, registration and providing or advocating for support packages such as income tax exemption on portion of income made by persons with disabilities and periodic cash transfer to vulnerable people in the society.
Following the devolution of health care system in Kenya, county governments are responsible for the provision of, and for investing in rehabilitative services, while the Ministry of Health at the national level is responsible for formulating national policies and facilitating and regulating practice through several state agencies.
Across the 47 counties in Kenya, anecdotal evidence showed that health centres and access points for rehabilitative services are not evenly distributed, appropriately staffed, and sufficiently equipped. During preliminary discussion, non-governmental organizations (NGOs) involved in the delivery of wheelchair services estimated that unmet need for wheelchairs was greater than 95%. However, there was limited visibility on the current level of provision and delivery challenges within the public sector to prioritize actions needed by the Ministry of Health to increase access to wheelchairs and other assistive devices.
The situational analysis highlighted gaps and challenges with access to rehabilitative and AT services in Kenya. The assessment confirmed that the current provision of wheelchairs by both the public and private sector in the country is 5,000 units annually, indicating that 95% of the need is not met.
The situational analysis showed that Kenya’s access challenges are driven by the following factors:
- Policy gap: there are no policies on rehabilitative services and provision of AT in the country.
- Limited service points with few trained personnel: few health facilities provide wheelchairs and few rehabilitative officials in counties are trained on appropriate provision of wheelchairs.
- Fragmented delivery landscape: Historically, NGOs and faith-based organizations have been the main providers of wheelchairs and other assistive devices in the country with limited coordination among the different actors.
- No national specifications, standards or supply chain exist: gaps in specifications and standards for wheelchairs has led to importation, supply and provision of products of unknown or questionable quality.
- Limited financing of rehabilitative services and wheelchairs: 55% of facilities had no budget allocation for rehabilitative services in the 2019-2020 financial year.