Understanding the Assistive Technology Landscape in 7 African Countries
By Novia Afdhila, Clinton Health Access Initiative (CHAI).
On November 5th, 2019, representatives from seven countries convened in Johannesburg, South Africa to discuss the rollout and initial findings from the Assistive Technology Country Capacity Assessments (CCA). This included the focal persons from Ethiopia, Liberia, Malawi, Nigeria, Rwanda, Sierra Leone, and Uganda who are carrying out the CCA in partnership with government ministries.
What is a Country Capacity Assessment (CCA)?
The CCA is a system-level assessment of a country’s capacity to appropriately provide Assistive Technology (AT) to meet its population needs.
The CCAs are a joint initiative of the World Health Organization (WHO), Clinton Health Access Initiative (CHAI), and the Global Disability Innovation Hub (GDI Hub) under AT2030’s Programme Cluster 3 – Country Implementation.
Through a rapid landscape analysis and data collection on the country’s capacity to finance, procure, and provide Assistive Technology, the CCA aims to support stakeholders in understanding and raising awareness around the state of AT needs and delivery systems within the country.
This includes the challenges, opportunities, and barriers to increasing access to Assistive Technology, as well as in identifying a set of prioritized actions to increase access to these products. Additionally, the CCA seeks to obtain inputs regarding the usability of a new WHO tool, the Assistive Technology Assessment-Capacity (ATA-C), which is being used in this assessment.
Which were the main findings?
At the working session, focal persons from each country team shared findings captured through the CCA thus far. While some enablers to increase access exist, significant gaps and barriers to access remain.
Enablers to support access included:
- Existence of a legal framework that supports access to Assistive Technology, often under the umbrella of disability;
- Exemption of assistive products from tax and duty, which ultimately improves product affordability;
- Some systems and provision of Assistive Technology within government facilities, although often centralized in the capital.
Which gaps are present across countries?
The gaps identified included:
- Poor/limited data availability to accurately estimate the need of AT and current access to AT;
- Lack of a unified national strategy for Assistive Technology resulting in poorly defined roles among government entities and no coordination mechanism, and no programs and budget allocation for AT;
- Fragmented procurement with heavy reliance on contributions from donors, charities and non-governmental organizations;
- Lack of or weak standards and regulation for Assistive Technology products and service provision; and
- Insufficient workforce availability and capacity to provide Assistive Technology.
Which opportunities are present?
The following cross-cutting opportunities to increase access to Assistive Technology were identified:
- Development of a national AT strategy;
- Conducting population-based survey to quantify the needs for Assistive technology;
- Including assistive products in the national essential list;
- Supporting the local assembly of priority products.
Teams highlighted that these opportunities can only be realized if barriers, such as product affordability, awareness on the importance of appropriate Assistive Technology amongst users, service providers, and policy makers, and stigma against people with disabilities, are appropriately addressed.
During the working session, teams also shared importance of identifying and engaging stakeholders across the Assistive Technology ecosystem at the onset of the CCA process.
For example, in Sierra Leone, a technical working group (TWG) to bring together key stakeholders, including the Ministry of Health, the Ministry of Social Affairs, the National Commission on Disabilities, the WHO, and several civil society organizations, was formed at the start of the assessment process. The TWG has been instrumental in supporting additional stakeholder engagement and guiding data collection, validation and development of recommendations based on the CCA’s findings.
CCA experience and findings from Ethiopia
The CHAI Ethiopia Assistive Technology team secured the full engagement and leadership of the Ethiopian Ministry of Health (MOH) in the AT assessment process.
This included the process during the early phase of ATA-C tool adoption. A high-level political commitment has been lately demonstrated by the country’s most senior leadership, Prime Minster Abiy Ahmed, the 2019 Nobel Peace Prize recipient. The Prime Minister Abiy has been championing wheelchair availability following an unfortunate bombing incident in one of his public rallies.
A team of engineers at the Ministry of Innovation in collaboration with the Department of Orthopedics and Traumatology of Addis Ababa University has been working on powered bionic foot products. Furthermore, the MOH has recently assumed the role of national coordination of Assistive Technology and to this effect, it has established a dedicated team in the Clinical Services Directorate. In spite of this however, the Assistive Technology system in country remains under-developed.
Following the working session, teams look forward to continuing the CCA process. Next steps include further analysis of the findings, development of and consensus on recommendations for priority actions to increase access to Assistive Technology with country stakeholders. We expect that the assessments will be completed in these seven countries by the end of 2019. We also are excited to see how findings and recommendations from the CCAs drive improved access to Assistive Technology in 2020.