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Preventing lifelong impairment: Access to clubfoot treatment in low and middle income countries

CLINTON HEALTH ACCESS INITIATIVE (CHAI)
July 2021

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Congenital talipes equinovarus (CTEV), commonly known as clubfoot is one of the most common congenital conditions, affecting 1 in 800 births. Left untreated, it can lead to life-long impairment, impacting participation in society, education, and employment. Most children with clubfoot can be successfully treated with the Ponseti method, a low-cost, cost-effective, and minimally invasive treatment protocol. Despite progress, less than 1 in 5 children born with clubfoot in low- and middle-income countries (LMICs) currently receive treatment

Clubfoot services require coordination and leadership between different departments within health ministries. Both are often missing

 

“Give us the chance to be part of you, We want our voices to be heard”: Assistive Technology as a mediator of participation in (formal and informal) citizenship activities for persons with disabilities who are slum dwellers in Freetown, Sierra Leone

AUSTIN, Vicki
HOLLOWAY, Cathy
OSSUL VERMEHREN, Ignacia
DUMBAYA, ABS
BARBARESCHI, Giulia
WALKER, Julian
May 2021

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The importance of assistive technology (AT) is gaining recognition, with the World Health Organisation (WHO) set to publish a Global Report in 2022. Yet little is understood about access for the poorest, or the potential of AT to enable this group to participate in the activities of citizenship; both formal and informal. The aim of this qualitative study was to explore AT as mediator of participation in citizenship for persons with disabilities who live in two informal settlements in Freetown, Sierra Leone (SL). The paper presents evidence from 16 participant and 5 stakeholder interviews; 5 focus groups and 4 events; combining this with the findings of a house-to-house AT survey; and two national studies—a country capacity assessment and an informal markets deep-dive. Despite citizenship activities being valued, a lack of AT was consistently reported and hindered participation. Stigma was also found to be a major barrier. AT access for the poorest must be addressed if citizenship participation for persons with disabilities is a genuine global intention and disability justice is to become a reality.

 

International Journal of Environmental Research and Public Health, Int. J. Environ. Res. Public Health 2021, 18(11)

https://doi.org/10.3390/ijerph18115547

Catalysing AT access: Scaling rehabilitative services and increasing access to AT in Kenya

CLINTON HEALTH ACCESS INITIATIVE (CHAI)
January 2021

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It is estimated that about 100,000 people need a wheelchair in Kenya annually. 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. The situational analysis showed that Kenya’s access challenges are driven by a policy gap, limited service points with few trained personnel, fragmented delivery landscape, no national specifications, standards or supply chain and limited financing of rehabilitative services and wheelchairs.

Barriers to access and retain formal employment for persons with disabilities in Bangladesh and Kenya

JAHAN, Nusrat
HOLLOWAY, Catherine
January 2021

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The aim of this paper, based on desk research, is to analyse the barriers to access and retain formal employment of persons with disabilities which are framed in three categories according to where the barriers primarily manifest:

1. In the workplace among employers and co-workers without disabilities

2. Among persons with disabilities seeking or engaged in formal employment

3. In the wider social, physical and policy environment.

Although the study mainly focuses on Kenya and Bangladesh other countries’ literature on access to and retention of employment of persons with disabilities were reviewed where relevant. In the context where the global COVID-19 pandemic is breaking barriers to remote working one part of the solution will be to empower persons with disabilities with appropriate access to Information and Communication Technology, assistive devices and services, digital skills, creating more accessible and inclusive digital platforms for persons with disabilities which also hold the potential to improve working conditions and productivity for the whole workforce as well as enhancing resilience to potential future shocks.

 

GDI Hub Working Paper Series Issue 01
 

Digital fabrication of lower limb prosthetic sockets

OLDFREY, Ben
BARBARESCHI, Giulia
WILLIAMS, Rhys
HOLLOWAY, Catherine
December 2020

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This innovation insight discusses current approaches to digital fabrication of lower limb prosthetics (LLP) sockets aimed at low resourced settings. Digital fabrication of LLPs sockets has been researched for a number of decades, yet these technologies are not widely adopted, and most of the activities within this domain reside in high-income settings. However, the majority of amputees are in LMICs where there is a severe lack of access to services. It is in LMICs then, that the advantages that digital technologies offer could be of particular benefit however little to no progress in digital workflow adoption has been made to date.

An AT Innovator case study: Amparo

WILLIAMS, Rhys
OLDFREY, Ben
HOLLOWAY, Catherine
December 2020

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An interview is reported with Lucas Paes de Melo, the CEO of Amparo, to discuss the journey so far of prosthetics company, Amparo. Rather than focus on the product, this insights paper provides an honest reflection of the journey to establishing an assistive technology company and delves into transferable insights. In doing so, they aim to provide insights to help current and future AT entrepreneurs to see behind the curtain of working in this space.

Product Narrative: Digital Assistive Technology. A market landscape and strategic approach to increasing access to digital assistive technology in low- and middle- income countries

SAVAGE, Margaret
LIAO, Cynthia
CHAUDRON, Matilde
BOYER, Jeffrey
BHATNAGAR, Tigmanshu
LAURENTIUS, Dennis
TORRENS, George
PERRY, Katherine
MORJARIA, Priya
BARAJAS, Felipe Ramos
GOEDDE, Barbara
November 2020

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This document is the final in a series of in-depth analyses that identify key barriers and promising market interventions. The previous four documents focused on wheelchairs, hearings aids, prostheses, and eyeglasses.

The report provides market landscapes of 3 areas of digital AT: mobile phones; screen readers; and augmentative and alternative communication (AAC) devices.

A common set of recommendations focused on improving access emerged from the individual product landscapes:

  • Develop and adopt policies, including legislation, regulations, minimum product standards, and guidelines to support accessibility and uptake of digital AT at the global and country levels.
  • Support governments of low- and middle-income countries (LMICs) to increase awareness of digital AT by including digital assistive products such as smartphones and augmentative and alternative communication (AAC) devices on national assistive product lists.
  • Support innovative financing schemes or negotiate pricing agreements to reduce the cost of digital AT to end users.
  • Increase availability of training programmes for users, suppliers, and service providers on the availability of digital AT and digital literacy skills.

Inclusive Design: What if we built a world that was accessible to all?

McKINNON, Iain
CARR, Peter
PATRICK, Mikaela
MONGOLIA RESEARCH TEAM
ASTERINA, Nina
October 2020

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This webinar, hosted by Global Disability Innovation (GDI) hub, brings together a diverse panel of experts to discuss what inclusive design looks like in practice for them, who benefits and how it can offer methods to build a more accessible world that benefits all of us.

 

Speakers presentations were:

  • What inclusive design means to GDI Hub and why it matters, drawing on our experience working in both the UK and globally
  • An overview of inclusive design of the built environment in the UK and Kenya, including the role of access panels to embed the views of disabled people in planning and decision-making
  • An introduction to GDI Hub’s AT2030 programme including our Inclusive Infrastructure research sub-programme that is conducting six global case studies in LMIC cities around the world over the next 2-3 years.
  • The challenges and opportunities for an accessible Mongolia and the importance of Disabled People’s Organisations (DPO) engagement in decision-making
  • The importance of inclusive planning processes for accessible cities in Indonesia

Inclusive design research in a pandemic: Working remotely in Ulaanbaatar, Mongolia

PATRICK, Michaela
NARANGEREL, Tamirkhuu
October 2020

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The Inclusive Infrastructure sub-programme of the AT2030 programme began in March 2020, right out the outset of the COVID-19 pandemic.

Over three years this part of the AT2030 programme will be conducting case studies in six cities on the current state of accessibility and inclusion of the built environment in each of those places. 

The first case study took place in Ulaanbaatar, Mongolia. In March 2020, research was about to begin, Mongolia closed its border as the Coronavirus pandemic escalated. This meant to travel to Ulaanbaatar to conduct research was not possible and new ways of working remotely had to be adopted.

Research was carried out by collaborating with a local team based in Ulaanbaatar: AIFO, an Italian NGO that has been working in Mongolia since 1993 and two Disabled Persons’ Organisations: ‘Universal Progress’ Independent Living Center and Tegsh Niigem.

Perspectives on working together, collaborating remotely and why this research is relevant to the country are shared.

The Liberia Evidence Lab: A new scalable model to deliver School Eye Health

EYElliance & Clinton Health Access Initiative (CHAI)
October 2020

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The case study highlights how school eye health programs can be successfully scaled in under-resourced and under-capacitated contexts, and ultimately supported through a sustainable financing mechanism. The case study shows how school eye health is an entry point and critical building block to comprehensive national eye health coverage. Through a pilot of the school eye health model, approximately 50,000 children received eye screenings across three counties in Liberia

Product Narratives: the challenges of supply and demand-side barriers for priority AT

HOLLOWAY, Cathy
OLDFREY, Ben
END FINEBURG, Alison
SEGHERS, Frederic
SOENDERGAARD, Dennis
September 2020

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This Disability Innovation Live session, looked at the Assistive Technology (AT) Product Narratives (PNs). The Product Narratives were developed by the Clinton Health Access Initiative (CHAI) under the FCDO funded AT2030 programme, led by GDI Hub, in support of the ATscale Strategy.

These PNs set out what we know about the state of the global market for each AT product, and identify global recommendations for how to address some of the barriers to access currently experienced in low and middle-income countries. In this session, we hear from the experts about what the PNs are, how they will inform global policy, and how we hope they will help us reach more people with life-changing AT

Inclusive design and accessibility of the built environment in Ulaanbaatar, Mongolia

PATRICK, Michaela
McKINNON, Iain
AUSTIN, Vicki
September 2020

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This case study on inclusive infrastructure in Ulaanbaatar, Mongolia is the first part of a series of six global case studies. The series is being developed to understand global priorities for inclusive design within the Inclusive Infrastructure work of the AT2030 programme; to build evidence on the awareness, understanding, acceptance, application and experience of Inclusive Design and accessible environments globally, particularly in lower and middle-income countries

Disability, stigma & the role of innovation - Disability innovation live

AUSTIN, Vicki
CAREW, Matthew
MIRZOYANTS, Anastasia
BARBARESCHI, Giulia
August 2020

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This webinar focussed on the role of stigma in preventing disability inclusion, and what enables it to be overcome, focused on innovative and creative methods

The speakers talked about:

  • Culture, Paralympic legacy & how innovation can change mindsets
  • Stigma research incorporating the perspectives of persons with disabilities & disability inclusive research processes
  • Kenyan youth & the perception of people with disabilities
  • Assistive technology, identity & the role of innovation

COVID-19 and Disability; Exploring a new innovation landscape

HOLLOWAY, Catherine
OLDFREY, Ben
CHIIRA, Bernard
KETT, Maria
July 2020

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This webinar explored the impact of, and learnings from COVID-19 on Disability Innovation. We heard from those shifting their work in response to the pandemic. We also looked at how learnings from Assistive Technology (AT) are being applied to this unprecedented global environment.

Finally, there was an overview of how knowledge was captured during Ebola can support the response to this latest threat

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