Project Summary: Drive Affordability and Availability

A project summary of Sub-Programme 6: Drive Affordability and Availability under Cluster 3: Country Implementation

Background:

The AT2030 programme tests ‘what works’ to improve access to Assistive Technology (AT) and is investing £20 million over five years to support solutions with a focus on innovative products, new service models, and global capacity support. The programme is funded by UK aid and led by the Global Disability Innovation Hub (GDI Hub). Under Cluster 3, the Clinton Health Access Initiative (CHAI) partnered with country governments to identify opportunities to drive AT availability and affordability.

Key Achievements:

Under AT2030, CHAI has demonstrated how market shaping can drive better access to AT. Key achievements include (see Annex for more details):

• Improving transparency to direct investments in AT: There is limited comprehensive data and information on the market barriers to access AT in low-and middle-income countries (LMICs). As a result, structural issues are not tackled in a coordinated manner. Under AT2030, CHAI developed global market reports – referred to as Product Narratives – for five priority assistive products: wheelchairs, hearing aids, prostheses, spectacles, and personal digital devices. Through a combination of global- and country-level analysis, these reports identified key barriers and proposed a pathway to address those. CHAI also authored a report on clubfoot with the goal of better aligning the work of global stakeholder for better integration and mainstreaming of clubfoot in public health systems.
• Catalyzing change through assessing and building in-country public sector capacity for AT: In most countries, the provision of AT has been fragmented with a lack of collaboration between stakeholders involved, such as ministries and NGOs. Under AT2030, CHAI helped establish a concerted effort and strengthen government leadership. In Indonesia and Kenya, CHAI worked with governments to conduct a situational analysis, which laid the basis for the CCAs. In several countries that completed CCAs, CHAI then partnered with governments on the rapid implementation of recommendations from the CCA, accelerating new AT policies and creating a foundation for systems strengthening. For example, Malawi developed a National Medical Rehabilitation Policy in a record time of 14 months.
• Ensuring more efficient and sustainable AT provision: the delivery of AT services has not been well integrated into existing government systems. In Liberia, CHAI partnered with EYElliance to test a government-led and systematic approach for scaling up provision of spectacles, integrated with health and education systems. This approach embeds this service in existing structures for staff training and school health programs. In South Africa, CHAI partnered with provincial departments of health to set up a new model for cheaper and more efficient provision of spectacles in the public sector. This included a ‘hub and spoke’ delivery model which reduced the cost of custom-made spectacles by 50% to less than GBP 10. CHAI also developed and deployed a new app-based mobile ordering system.
• Unlocking government financing for AT: AT provision has traditionally been un(der)funded by LMIC governments, making most products and services unaffordable to many. Using actual, available data on the needs and costs, CHAI worked with governments to motivate for additional budgets. For example, the government in South Africa ringfenced ~GBP 2 million for spectacle provision, ensuring the continuation of the program. In Ethiopia, ~GBP 720,000 was allocated by the government for the renovation of the National Rehabilitation Center in Addis Adaba.
• Creating tools to replicate ‘what works’: Few publications and implementation tools exist that discuss practical approaches to successfully build government capacity. Under AT2030, CHAI documented learnings for replication by other partners. CHAI has worked with GDI Hub and the WHO to finalize the AT-Assessment Capacity tool and a suite of supportive resources, which was published by the WHO in November 2020. CHAI also developed costing tools, for instance on spectacles, hearing aids and prostheses, to help policy makers make evidence-based decisions for investing in AT. CHAI also developed case studies that document the processes and lessons learned from the pilot testing of market interventions.

Read the full summary report here.