# Annual Review 2023

United Nations Children's Fund (UNICEF)

# Annual Review 2023

ATscale logo

A school boy is expressing his joy sitting on a wheel chair and a natural landscape is being shown at his back

Cover photo: Arturo, 11, Paraguay.© UNICEF/UN0425691/Sokol

# Contents

A group of children with and without disabilities are enjoying playing time with their teachers

© ONEPASS Productions and Shonaquip Social Enterprise

# Introduction

Assistive technology (AT) enables people to live healthier, more productive, independent, and dignified lives and to participate in education, the labour market, and their communities.

Today 2.5 billion people globally need to use at least one type of assistive product, such as

wheelchairs
hearing aids
prostheses
eyeglasses
digital services

In low-income countries only 10% of people have the assistive technology they need, in stark contrast to the 90% of people in need in high-income countries who do.

ATscale, the Global Partnership for Assistive Technology, is a cross-sector global partnership with a mission to transform people's lives through assistive technology.

It catalyzes action to ensure that, by 2030, an additional 500 million people in lowand middle-income countries get the life-changing assistive technology they need.

2023 was the second year of full operations for ATscale. The partnership finalized the start up phase, further expanded country investments, made progress on global public goods interventions, and continued to advocate transformative assistive technology.

# Foreword

# Mussa Chiwaula

Photo of Mussa Chiwaula

Director General at Southern Africa Federation of the Disabled (SAFOD) and ATscale Board member

It is entirely unjust that poor families across the world cannot afford to pay the high prices of assistive technology. Speaking from experience, if a person is given the right type of wheelchair, his or her life will change considerably with the independence it brings. Wheelchairs, and other forms of assistive technology such as hearing aids, eyeglasses, prosthetic limbs, and digital devices, are a catalyst for empowerment.

Strategic and coordinated actions by governments, development partners, NGOs, and the private sector can ensure that assistive technology reaches the poorest people in the world. ATscale plays a vital role to promote national systems for assistive technology, and the enhancement of markets for assistive products.

I commend ATscale for its achievements in 2023 to raise political awareness, support country programmes, and provide global public goods.

> “ATscale brings together different stakeholders to ensure that assistive technology reaches people not by chance but because a system responds to their need.”

# Pascal Bijleveld

Photo of Pascal Bijleveld

CEO, ATscale

ATscale's core values of collaboration, trust, and continuous learning are embedded in all its approaches to working in partnership with others.

The invaluable work and contribution of AT users and partners at global and country levels are fundamental for establishing transformation in systems, and in people's lives. ATscale is proud to act in solidarity with others.

In 2023, ATscale has demonstrated its energy and ambition to firmly put assistive technology at the top of national and international agendas. We are raising political will, helping bring stakeholders together in a coordinated approach, investing in systems and are beginning to see impact in countries, and in access to assistive technology. This is just the beginning, and we welcome all who want to join us.

# ATscale progress

ATscale is moving from its start-up phase to the scale-up phase

2023 was the second year of full operations for ATscale. The partnership finalized the start-up phase, further expanded country investments, made progress on global public goods interventions, and continued to advocate transformative assistive technology.

This graphic shows a growing progress over time in ATscale's budget of US$ 3m in 2018 to US$ 200m in 2030

# Key achievements

A boy in smiling face, is running over a road with a prosthetic leg

Refan, age 13, Indonesia© A Leg To Stand On (ALTSO)

In 2023, the second year of full operations, ATscale and partners have collaborated to build stronger systems to improve the lives of people in need of AT.

8 partner countries are receiving programme support from ATscale, and expect to reach almost 700,000 people who need assistive technology over 3 years.

US$ 1.6 million is supporting 12 additional countries to identify assistive technology context and needs, and build the foundation for larger, national investments for AT systems.

Over 50,000 people received AT as a result of ATscale's investment in 2023, and now have greater potential for independence.

US$ 41 million was mobilized to double ATscale's funding base and increased ATscale's ability to collaborate across sectors, and build stronger systems.

9 global public goods are underway that bridge important gaps in knowledge and evidence.

450% increase in page and profile impressions across social media platforms, improving visibility and promoting AT.

16 global events helped raise the profile of AT, with ATscale hosting, participating, or presenting.

# ATscale works with 20 low- and middle-income countries

ATscale's investment in country programmes will allow people to benefit directly from AT over the next three years, and crucially will build strong AT systems and sustainable infrastructure for future generations.

This map shows ATscale's working network in 20 low- and middle-income countries some of these countries are as follows: in Senegal - US$ 3.3 million and AT users to benefit: 78,500; in Rwanda - US$ 1.2 million, AT users to benefit: 1,200 and People screened: 10,000; in Zambia - US$ 2.5 million, AT users to benefit: 8,000 and People screened: 300,000; in Kenya - US$ 7.5 million and AT users to benefit: 300,000; in Cambodia - US$ 3.2 million and AT users to benefit: 274,000; in Azerbaijan, Georgia, Tajikistan - US$ 2.7 million, AT users to benefit: 24,000 and Families and carers to benefit: 1,747,000

# Country approaches

An aged woman with disabilities is sitting on a wheel chair

Nearly 70% of people over the age of 60 need assistive technology.© Walkabout Foundation, Kenya

Strengthening policy, systems, and service delivery

In 2023, ATscale provided investment to two additional countries - Rwanda and Zambia - making a total of eight partner countries with ongoing ATscale-supported programmes.

Working with multiple stakeholders at the national level, each country programme is tailored according to the level of maturity of their assistive technology system. In 2023, all supported countries made substantial progress, establishing national coordination structures, training personnel, targeting people at the last mile, and launching the procurement of prioritized AT.

ATscale is also working with USAID on a ‘pipeline’ initiative to support 12 additional countries at the start of their journey to strengthen AT systems, which will provide lessons learned and identify areas ripe for future investment.

ATscale will identify, analyze, and apply lessons learned to future work in these countries and elsewhere across the world.

ATscale stimulates political will and demand at the national level by convening stakeholders to invest in and support assistive technology.

# Investing in national systems

Two girls with prosthetic hands are sitting on a bench in smiling faces

In Yemen, Malk, 7, and Abrar, 7, are at a prosthetics centre in Aden.© UNICEF/UN0539874/Noman

> “The stigma that people with disabilities and older people are burdens on their families should be completely discarded. Their potential sometimes exceeds the capacities and abilities of others in general.”

> Hj. Yuli Hastuti, S.H, Vice-Head of the District of Purworejo, Indonesia which is working to strengthen its AT system.

Funded by USAID, in support of ATscale, administered by UNOPS, 12 countries are conducting activities for 1 year to build the foundation for larger, national investments for AT systems. This means creating a conducive environment for long-term investment including building political will and commitment to increase access to AT; deeper understandings of the current AT context; and consensus on the most appropriate long-term strategies and activities. Not all countries where foundational investments are made will ultimately receive broader investment from ATscale, but the approach helps identify those countries with the greatest opportunity for long-term sustainability.

Four partners are implementing these activities

- 1. Clinton Health Access Initiative - Democratic Republic of the Congo, Lesotho, Mozambique, Zimbabwe
- 2. Momentum Wheels for Humanity - Peru, EI Salvador, Guatemala, Honduras
- 3. HelpAge International - Indonesia, United Republic of Tanzania
- 4. Helen Keller International - Bangladesh, Nepal

# Country impact

# Cambodia

A girl with visual disabilities is studying at her school

Sri Sros, 14 years old.© The Fred Hollows Foundation Cambodia

> “At school I had difficulty seeing things at a distance since I was 12. It was so blurry when I was looking at the whiteboard. One day a teacher came to screen us and then an eye care professional visited and performed eye exams. They confirmed I have myopia and provided me with eyeglasses to wear. If I didn't have glasses, I couldn't study well.”

Sros is one of 300,000 children and adults in Cambodia who benefited from a project called ‘Scaling up Refractive Error Services in Cambodia’ or ‘SURES Project’ implemented in partnership by The Fred Hollows Foundation, funded by USAID, in support of ATscale.

This demonstration project has established evidence and learning needed to further strengthen the eye health system in Cambodia and in other countries where ATscale is present.

In October 2023, with support from ATscale, and underpinned by a comprehensive national work plan, the Government of Cambodia launched a three-year programme that aims to reach 275,000 Cambodians with assistive technology such as prosthetics, wheelchairs and eyeglasses.

# Rwanda

A boy with hearing disabilities is using a hearing aid

Boy receives hearing aid as part of the Ear and Hearing Care Programme in Rwanda© Innocent Murengezi/UNICEF

> “We are thrilled to support the specific needs of children and adolescents with hearing impairments by providing digital assistive technology, which opens doors to communication, education, and a brighter future.”

> Julianna Lindsey, UNICEF Representative in Rwanda.

In eight districts across Rwanda, children and young people will soon be able to visit disability-inclusive primary health care services, enabling access to assistive technology such as digital hearing aids and other services. In December 2023, the Rwanda Biomedical Centre, ATscale, and UNICEF Rwanda launched the ‘Ear and Hearing Care Programme’ meaning an estimated 9,400 children will be screened, and 1,200 children provided with digital hearing aids.

# Caucasus and Central Asia

A woman is giving a lecture to a group of persons with disabilities, beside her some prosthetic limbs are scattered on the table

Exchange visit to the Ken Walker Clinic in Tbilisi, Georgia.© Dimitri Mikeladze

> “The experience of Georgia demonstrates that if the right direction is taken to develop a range of rehabilitation professionals, along with the necessary political decisions to provide assistive technology, in a relatively short time, it should also be possible to achieve significant results in Tajikistan.”

> Umeda, Training coordinator at Caritas, Tajikistan.

A regional joint investment plan, supported by ATscale, covers Georgia, Tajikistan, and Azerbaijan, and aims to strengthen delivery systems to increase access rapidly to assistive technology. In June 2023, a learning exchange took place between Georgia and Tajikistan to share knowledge on how to develop the rehabilitation workforce, and to expand access to assistive technology. Together with the ATscale Board, participants from Tajikistan visited the Ken Walker Clinic in Tbilisi, Georgia to learn lessons.\

# Global approaches

Global Public Goods (GPGs) exist in the public domain for the benefit of all citizens globally. ATscale supports the development of GPGs for the assistive technology sector in the form of tools and guidance that are globally relevant and applicable for national policy and implementation in countries.

ATscale aims to fill global knowledge gaps and to design tools and guidance for assistive technology by supporting the work of WHO, UNICEF and others and commissioning them directly. ATscale also works with stakeholders, including the private sector, to consolidate market information about demand and supply for priority products.

Convening professionals at multi-stakeholder meetings provides the opportunity to share knowledge, guidance and tools, and to promote policy change and systems strengthening at the national level.

ATscale works across six interdependent global public goods areas to:

A group of of iconic images express ATscale works across six interdependent global public goods areas which are as such:

Generate data and evidence; Spark innovation and new solutions; Drive market-shaping strategies; Enable policies, systems, and services; Strengthen AT financing; Expand capacity and participation

Generate data and evidence

Spark innovation and new solutions

Drive market-shaping strategies

Enable policies, systems, and services

Strengthen AT financing

Expand capacity and participation

# Examples of ATscale's Global Public Goods

Generate data and evidence

A two-year smartphone study in Kenya, India and Brazil, in collaboration with the Global Disability Innovation Hub (GDI Hub) and Google, is gathering evidence to make smartphones more accessible and empowering to people who need digital assistive devices. This will help inform smartphone-based AT development, and advocacy to governments that smartphones are useful forms of AT.

Spark innovation and new solutions

ATscale supported WHO to develop a service delivery approach for provision and maintenance of hearing aids and information materials to facilitate hearing aid adoption, especially in low- and middleincome countries. The approach envisages the use of simple-to-fit hearing aids and is based on a task sharing strategy from highly trained audiologists to trained health workers.

Strengthen global AT sector

National implementation

Drive market-shaping strategies

ATscale started work on developing a Market Analysis Report that includes eyeglasses, hearing aids, prosthetics and wheelchairs. The report will provide information including the supplier landscape, market trends and influencers, technological advancements, demographic of users, and regulatory changes and their impact on the market.

Expand capacity and participation

ATscale supported two regional workshops organized by WHO and UNICEF in Indonesia and Brazil that convened stakeholders to disseminate and discuss global tools and guidance to accelerate access to assistive technology nationally. Participants shared experiences and perspectives and learned about resources available on their platforms.

# Increasing visibility for assistive technology

ATscale continues to build a solid foundation for political will to build stronger assistive technology systems and has increased visibility with a growing digital presence, a diverse set of international events with assistive technology users firmly at the centre of conversations, and better coordination with partners.

A series of short thematic briefs highlights the links between assistive technology and topics such as inclusive education, early childhood development, universal health coverage, healthy ageing, livelihoods, humanitarian crises, and climate action.

A page shows Sustainable Development Goals (SDGs) infographics

A Sustainable Development Goals (SDGs) infographic explains the link between assistive technology and the most relevant SDGs to firmly situate ATscale within the sustainable development landscape, and advocate assistive technology as crucial to meet all 17 SDGs.

Cover pages of a series of short thematic briefs

Photo of Pascal Bijleveld's TEDx talk

Pascal Bijleveld's TEDx talk received over 6,000 views on YouTube.

ATscale's social media presence has grown significantly over the year, with 450% increase in page and profile impressions across all channels: Instagram, LinkedIn, X, and Facebook.

ATscale held four social media ‘themed weeks’ on hearing aids, digital assistive technology, wheelchairs, and prosthetics and orthotics.

# Global events

A group of persons with and without disabilities have gathered together at the World Health Summit

Cara Yar Khan, Nayem Molla, and Aïssatou Cissé share personal insights about AT and the SDGs.© Alex Mora, DOK Productions

ATscale has raised the profile of assistive technology and AT users by proactively engaging a wide variety of stakeholders at a series of 16 well-attended, high impact global events including at Davos during the World Economic Forum, COSP 16, the SDG Summit, the Remarkable Tech Summit, the World Health Summit, and COP28.

ATscale is proudly committed to meaningfully include and engage AT users from low- and middle-income countries in all its discussions and this has been visible during global events. Thoughtful and thought-provoking assistive technology-using panellists, speakers, moderators, and facilitators made invaluable contributions to ATscale events and during the year, 13 AT users participated in this way.

Two women and a man are sharing their personal insights about AT and the SDGs at the World Health Summit

Members of the disability-inclusive health consortium at the World Health Summit.© Steffen Kugler

# Event highlights

ATscale and UNICEF, in partnership with IDA and USAID, hosted a side event at the SDG Summit in September 2023 to highlight the relevance of assistive technology for achieving the SDGs. It showcased the power of collective action and strong multi-sectoral and multi-stakeholder partnerships in achieving this shared ambition.

At the World Health Summit in October 2023, ATscale was one of several partners organizing the first-ever disability- and assistive technology-focused session at the World Health Summit. Participants discussed why health equity for persons with disabilities and access to assistive technology is a key driver for universal health coverage, and the concrete actions that can make health systems more inclusive.

# ATscale composition

This graphic shows ATscale users in 3 levels. In 1st level there are ATscale Board, ATscale Secretariat, Advisory Technical Group and AT Private Sector Providers Network; in 2nd level there are Strategic partners; in 3rd level there are Specialized partners, Technical partners and Implementing partners.

ATscale is hosted by the United Nations Office for Project Services (UNOPS).

ATscale is governed by a Board comprising three unaffiliated members and representatives from donors, multilateral organizations, programme countries, organizations of persons with disabilities, non-governmental organizations, the private sector, and two ex officio members.

The ATscale Secretariat manages the day-to-day operations of the partnership.

ATscale strives to meaningfully engage users of assistive technology in all its work.

In partnership with the International Disability Alliance (IDA) and others, ATscale engages users of assistive technology at all steps and facets of its operating model to ensure the relevance and appropriateness of all interventions.

ATscale strategic partners are engaged across the assistive technology sector and engage frequently with the Secretariat at both the strategic and operational levels.

ATscale's specialized, technical, and implementing partners are integral to ATscale's work at many levels. Technical and specialized partners are those who work on one of ATscale's priority products or a narrow aspect of assistive technology. Implementing partners work on the basis of a contract or a grant.

The Advisory Technical Group is a multidisciplinary group of people with a range of experience, including those with lived experience of using assistive technology. The group provides independent advice on ATscale's priority setting, annual work plan, country engagements, visibility and global public goods interventions.

The Assistive Technology Private Sector Providers Network is a dynamic hub where private sector companies can connect, interact, and share ideas and resources towards market shaping and market development in low- and middle-income countries. Through regular online and face-to-face meetings, members can connect with like-minded industry experts.

# Income, resource mobilization, and spending

In 2023, the budget was US$12.5m and the expenditure was US$10.3m.*

In 2023, ATscale received multi-year pledges of US$41m from 3 new funding sources. This will allow us to significantly expand our 2024 budget.

*The official Certified Financial Statement from UNOPS for 2023 was not finalized at the time of printing so final numbers may differ.

ATscale would like to thank its partners on the Board: Government of Kenya, International Disability Alliance, Southern Africa Federation of the Disabled, UNICEF, UNOPS, World Health Organization, China Disabled Persons' Federation, the donor representatives USAID and UK Foreign, Commonwealth and Development Office, and the private sector board member, as well as our three unaffiliated board members.

# Share of approved annual budget

Distribution of budget between country support, global public good interventions, and global operations.

These 2 pie charts show ATscale's share of approved annual budget in years 2023 and 2024, which are as follow: Country level programme support - 51% in 2023 and 64% in 2024; Global public goods interventions - 22% in 2023 and 17% in 2024; Secretariat Costs - 22% in 2023 and 15% in 2024; Indirect Costs - 5% in 2023 and 4% in 2024.

# What next for 2024?

A girl is wearing a pair of refractive error devices

A girl in Cambodia receives refractive error services.© The Fred Hollows Foundation

ATscale is moving at pace and with dedication to further expand its strategic activities.

# Country level

ATscale is ensuring impact in countries through programmatic work, learning from experiences and sharing lessons across the sector. In 2024, it will expand investments to 7-10 additional partner countries focusing on scaling up vision and hearing screening and provision of assistive technology to school-age children in low- and middle-income countries.

# Global level

ATscale will launch the first AT market report for low- and middle-income countries and learn from the use of some ATscale-supported global public goods. This includes text-to-speech voices for under-represented languages and the new WHO service delivery approach for hearing aids in low-resource settings to ensure access and quality care. New priority gaps will be tackled, such as understanding the role that tariffs and taxes play in the price of assistive products, and guidance on market entry to enable wider availability in more countries.

# Increasing visibility for assistive technology

ATscale will launch a far-reaching and ambitious global campaign to raise awareness of the life-changing impact of assistive technology. It will continue to engage multiple stakeholders through high-level global events and support leading member states towards the adoption of a UN General Assembly resolution on assistive technology.

# Building the movement for assistive technology

As ATscale moves towards its funding goal of US$400 million, it seeks to build strong partnerships with donors and implementers to help demonstrate the transformative power of AT and its importance for achieving the Sustainable Development Goals. ATscale invites you to join this global effort to enable millions of people to live healthier, and more productive, independent, and dignified lives.

A young man with visual disabilities is using a digital device to access information and communicate online

Muhammetmyrat Orazov, 24 years, from Ashgabat, Turkmenistan uses a digital device to access information and communicate online.© UNICEF Turkmenistan

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