The Scoping Report sought to unpick the multi-layered and multi-faceted ways in which economic, social, and political factors interact to create barriers to AT for those who need it the most. The team used a mixed-methods approach which was necessarily flexible and iterative, bringing in expertise from the broad partnership. The data showed that the challenge of AT access represents a complex web of market and system failures, compounded by a lack of participation from AT users, that results in a supply/demand mismatch affecting almost a billion people. This making AT access one of the most pressing global challenges. Because of poor data on use, need and impact this ‘wicked problem’ is largely hidden from view to all but those facing the daily struggles its absence creates. Yet at an individual, family and community level there is no doubt at all about the implications of lack of access to appropriate AT; isolation, economic and social exclusion, poor physical and mental health, and reduced life expectancy. Our evidence suggests that barriers to AT access are about far more than just cost. Issues such as undeveloped policy frameworks, inefficient or non-existent markets, poorly resourced services, stigma and discrimination all play a role, often with a gender impact.
The Scoping Report proposed that the resulting global programme (AT2030) trial strategic interventions based on the principles of: building a global mission-led approach; generating better research and data; piloting market-shaping activity; delivering system strengthening interventions; harnessing innovation; and building community participating and capacity. Findings from the first ten months of delivery have reinforced and confirmed the need for a mission-led approach to AT, embedded within a normative framework of social development. ‘Amazing early results’ have resulted in a slightly tightened impact framework (theory of change) along with doubled investment. The programme is still in its early stages, but the working assumption is still that the participation of AT users is a necessary factor in the design of innovative solutions, and moreover that the availability of AT products alone is not sufficient to ‘enable a lifetime of potential’ without a systematic approach to inclusion.