Introduction
1. Assistive Technology and Market Shaping
Assistive technology (AT) is an umbrella term covering the systems and services related to the delivery of assistive products such as wheelchairs, eyeglasses, hearing aids, prostheses, and assistive digital devices and software. Today, over 1 billion people require assistive technology to achieve their full potential, but 90% do not have access to the assistive technology that they need. This unmet need for assistive technology is driven by a lack of awareness of this need, discrimination and stigma, a weak enabling environment, lack of political prioritisation, limited investment, and market barriers on the demand and supply side. Narrowing in on the market shortcomings that limit the availability of assistive products, market shaping is proposed to address the root causes that limit availability, affordability, and access of appropriate assistive technology, with the wider aim of ensuring improved social, health, and economic outcomes for people who require assistive technology. Increased access to assistive technology is critical to achieve many global commitments, including universal health coverage (UHC), the ideals of the United Nations Convention on the Rights of Persons with Disabilities, and the ambitious Sustainable Development Goals. To accelerate access to assistive technology, the global community needs to leverage the capabilities and resources of the public, private, and non-profit sectors to harness innovation and break down market barriers.
Whether by reducing the cost of antiretroviral drugs for HIV by 99% in 10 years, increasing the number of people receiving malaria treatment from 11 million in 2005 to 331 million in 2011,1 or doubling the number of women receiving contraceptive implants in 4 years while saving donors and governments USD240 million,2 market shaping has addressed market barriers at scale. Market-shaping interventions can play a role in enhancing market efficiencies, improving information transparency, and coordinating and incentivising the numerous stakeholders involved in both demand- and supply-side activities. Examples of market-shaping interventions include: pooled procurement, de-risking demand, bringing lower cost and high-quality manufacturers into global markets, developing demand forecasts and market intelligence reports, standardising specifications across markets, establishing differential pricing agreements, and improving service delivery and supply chains.
Market-shaping interventions often require coordinated engagement on the demand and supply side (see Figure 1). Successful interventions are tailored to specific markets after robust analysis of barriers and look to coordinate action on both the demand and supply side. These interventions are catalytic and time-bound, with a focus on sustainability, and are implemented by a coalition of aligned partners providing support where each has comparative advantages.
Historically, assistive technology has been an under-resourced and fragmented sector and initial analysis indicated that a new approach was required. ATscale, the Global Partnership for Assistive Technology, was launched in 2018 with an ambitious goal to provide 500 million people with the assistive technology that they need by 2030. To achieve this goal, ATscale aims to mobilise global stakeholders to develop an enabling ecosystem for access to assistive technology and to shape markets to overcome supply- and demand-side barriers, in line with a unified strategy (https://atscale2030.org/strategy). While the scope of assistive technology is broad, ATscale has focused on identifying interventions needed to overcome these barriers for five priority products: wheelchairs, hearing aids, eyeglasses, prosthetic devices, and assistive digital devices and software.
Clinton Health Access Initiative (CHAI) is delivering a detailed analysis of the market for each of the priority products under the AT2030 programme (https://at2030.org/global-partnerships/), funded by UK aid from the UK government, in support of the ATscale Strategy. The AT2030 programme is led by the GDI Hub. What follows is a detailed analysis of eyeglasses, one of the five priority products to be evaluated.
2. Product Narrative
The product narrative defines the approach, identified by CHAI, to sustainably increase access to high-quality, low-cost assistive technology in LMICs. The goals of this narrative are to: 1) propose long-term strategic objectives for a market-shaping approach; and 2) identify immediate opportunities for investments to influence the accessibility, availability, and affordability of eyeglasses.
This report has been informed by desk research, market analysis, key informant interviews, and site visits with relevant partners and governments to develop a robust understanding of the market landscape and the viability of the proposed interventions. A list of all individuals interviewed or consulted during the development process can be found in Appendix A. This document is divided into two chapters:
Chapter 1: Market Landscape, including market context, the current product landscape, state of access and provision, supply chain analysis, and stakeholders’ current engagement, as well as key market challenges and barriers to access on both the demand and supply side.
Chapter 2: Strategic Approach to Market Shaping, including strategic objectives highlighting the long-term outcomes required to shape the market. A series of immediate next steps or actions to support achieving each strategic objective are proposed. For any given objective, the interventions are discrete testable opportunities that support the development of longer-term scalable interventions and investments.
Note
The use of the terms ‘spectacles’ and ‘eyeglasses’ varies regionally as well as according to context: whether the term is being used in academic writing or by providers, suppliers, or manufacturers, amongst others. In Europe and by manufacturers, ‘spectacles’ is commonly used when referring to a complete pair of frames and lenses. This document uses ‘eyeglasses’ throughout to refer to the complete product of frames and lenses (both ready-made and prescription) for distance and near vision correction.