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, prosthetics, and personal communication devices. Assistive products are defined by the WHO as “any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual's functioning and independence, and thereby promote their well-being.” Today, over 1 billion people require AT to achieve their full potential, but 90% do not have access to the AT that they need. This unmet need for AT 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 AT with the wider aim of ensuring improved social, health and economic outcomes for people who require AT. 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 2011,1 or doubling the number of women receiving contraceptive implants in 4 years while saving donors and governments $240 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 (Figure 1). Successful interventions are tailored to specific markets after robust analysis of barriers and look to coordinate action on both 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.
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Demand side engagement is outlined on the left of the figure and involves work with governments, DPOs, CSOs and others to: (1) build and consolidate demand around optimal products in terms of efficacy, specifications, quality and price, (2) strengthen procurement processes and programmes to utilise optimal products and (3) improve financing and service delivery. Interlinking with this is supply side engagement which is detailed on the right of the figure and involves work with manufacturers and suppliers to: (1) reduce the cost of production, (2) enhance competition, (3) enhance coordination, (4) encourage adoption of stringent quality standards, (5) optimise product design and (6) accelerate entry and uptake of new and better products.
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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 AT, was launched in 2018 with an ambitious goal to catalyse action to ensure that 500 million more people globally are reached with life-changing AT by 2030. To achieve this goal, ATscale aims to mobilise global stakeholders to develop an enabling environment 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 prioritised to identify interventions needed to overcome supply- and demand-side barriers for five priority products.
In support of Objective 2: Identify interventions required to shape markets and overcome supply and demand-side barriers for priority AT of ATscale's Strategy Overview, 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), funded by UK aid. What follows is a detailed analysis of wheelchairs, the first priority product that is being evaluated.