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, prosthetic devices, and assistive digital devices and software. Today, over 1 billion people require AT to achieve their full potential, but 90% do not have access to the AT that they need.6 This unmet need for AT is driven by a lack of awareness of this need, discrimination and stigma, a weak enabling ecosystem, 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 the availability and affordability of and access to appropriate AT, with the wider aim of ensuring improved social, health, and economic outcomes for people who require AT. Increased access to AT is critical to achieve many global commitments, including universal health coverage, the obligations of the United Nations Convention on the Rights of Persons with Disabilities, and the ambitious Sustainable Development Goals. To accelerate access to AT, 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 2011,7 or doubling the number of women receiving contraceptive implants in 4 years while saving donors and governments USD 240 million,8 market shaping has addressed market barriers at scale. Market-shaping interventions 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 seek 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.

Figure 1: ENGAGING BOTH DEMAND AND SUPPLY SIDE FOR MARKET SHAPING

Image Description

Figure showing that demand side engagement and supply side engagement are interlinked.

Demand side engagement:

Work with governments, DPOs, CSOs, and others to:

Build and consolidate demand around optimal products in terms of efficacy, specifications, quality, and price.
Strengthen procurement processes and programmes to utilise optimal products.
Improve financing and service delivery.

Supply side engagement:

Work with manufacturers and suppliers to:

Reduce the costs of production
Enhance competition
Enhance coordination
Encourage adoption of stringent quality standards
Optimise product design
Accelerate entry and uptake of new and better products

End of Image Description

Historically, AT 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 AT that they need by 2030. To achieve this goal, ATscale aims to mobilise global stakeholders to develop an enabling ecosystem for access to AT 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 AT 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 these detailed analyses, called product narratives, of the markets for each of the priority products under the AT2030 programme (https://at2030.org/at2030-partnership/), which is led by GDI Hub and funded by UK aid from the UK government, in support of the ATscale Strategy.

The product narratives are meant to define the approach, identified by CHAI, to sustainably increase access to high-quality, low-cost AT in LMICs. The goals of these product 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 the assistive product and its related service areas.

While the previous product narratives have focused on one singular product category, such as wheelchairs, assistive digital devices and software, also known as digital AT, is a complicated, interconnected, and multi-faceted space that does not lend itself well to being summarised as a single product area. Guided by the understanding that the product scoping should be: 1) actionable (i.e. drive specific investment and activities); 2) practical; and 3) accessible, this product narrative is organised differently from the previously published narratives (wheelchairs, eyeglasses, hearing aids, and prostheses). What follows is an analysis of three product areas that are representative of the digital AT ecosystem (see next section) and are of interest to AT2030 and ATscale partners:

Mobile phones
Screen-reading software (screen readers)
Augmented and alternative communication (AAC) devices

Each product area chapter highlights the market landscape, key access challenges, and potential interventions that are needed to be implemented by a wide variety of stakeholders to increase access to the specific digital product category. When taken together, the interventions increase the potential for individuals to acquire accessible hardware solutions, accessible and usable applications, and appropriate content to improve their daily living activities and inclusion in the community, workforce, and in education.

The following report has been informed by desk research, market analysis, and key informant interviews to develop a robust understanding of the market landscape and the viability of market-shaping and market-building interventions. A list of all individuals interviewed during the development process can be found in Appendix A.

2. Framing the Digital AT Ecosystem

Digital AT is a broad category, but can be defined as assistive products that contain electronic information and communication technologies (ICT). These products can be organised into two categories: (1) accessible technologies, which refers to products, equipment and systems that have been inclusively designed so as to provide people with disabilities access to all available content within the technology, and can also be used by the general population; and (2) assistive technologies, which refers to specific products, equipment and systems designed to improve function and enhance activities of daily living specifically for people with disabilities.9 Therefore, built-in speech-to-text applications on smartphones such as Google Live Transcribe are accessible technologies, while dedicated speech-to-text software such as Microsoft’s Adaptive Controller are assistive technologies. 10 The intersection of these two areas is known as Disability Interaction.11

The digital AT ecosystem (Figure 2) is made up of four interconnected components that are necessary for digital AT to be effective:

ACCESSIBLE DEVICES, such as mobile phones and tablets, and accessories, such as switches or braille readers that make communication with the device more accessible; these are hardware products that enable access to digital platforms, applications and content.
ACCESSIBLE PLATFORMS or operating systems allow individuals to consume what is on the device. Universal design and accessibility features allow the system to adjust to the abilities of any individual needs so that they are able to consume what is on the device, regardless of age, disability, functional limitations, or impairment. By considering all the operations that are essential to access content early in the design process, universal design creates products and environments that are useable and convenient for all, regardless of ability. 12, 13
ACCESSIBLE SOFTWARE AND APPLICATIONS are standalone programmes that fulfil a particular purpose or activity of the user – for example, typing notes and using a smartphone camera as a magnifier. Often, connectivity to the internet is needed to download cloud-based assistive software and applications that serve as AT onto a device. However, not all software and applications require an internet connection to operate.
ACCESSIBLE CONTENT, such as text, native language, and pictograms that are digital or print-based. Content needs to be culturally appropriate, comprehensible in the local language or dialect, and adapted to the needs of the user. Content requires appropriate layout or presentation via suitable formats that can be changed (such as voiceover, sign language, or pictograms) so as to be easily understood and navigated. Content creators need to be trained in understanding accessibility features and creating accessible content, especially for websites and web-based services such as internet banking.

Adoption of the digital ecosystem is supported by four cross-cutting enablers: 1) awareness of digital AT and its accessibility by users, developers, suppliers, providers, and policymakers; 2) availability of mobile network and internet connectivity; 3) the inclusion of universal design and accessibility features; and 4) appropriate training in digital AT.

FIGURE 2: THE DIGITAL AT ECOSYSTEM: COMPONENTS AND ENABLERS

Figure showing how Devices, Platforms, Application and Content are built on one another in the ecosystem. The four areas are then held together by cross-cutting enablers of universal design, cellular networks, digital literacy and public awareness.

The digital AT areas described in this report represent different components of the digital AT ecosystem:

Chapter (1) on mobile phones and smartphones is representative of the challenges and potential interventions related to accessible devices and accessible platforms.
Chapters (2) and (3) on screen readers and AAC solutions highlight the challenges associated with accessible software, applications, and accessible content.

Access challenges in one component area will impact the others. For example, limited access to devices and/or the internet may prevent the uptake of AAC solutions as individuals cannot access low-cost AAC applications. Improving awareness of and training in digital AT will be common themes across all three chapters.