Product Narrative: Wheelchairs

6. Proposed Strategic Approach to Market Building and Market Shaping for Wheelchairs

To overcome these market challenges and build and shape the market for wheelchairs, a multi-pronged approach that is informed by a long-term vision towards a sustainable market for appropriate wheelchairs and their provision in LMICs is required. This section describes the proposed strategic objectives and long-term target outcomes to achieve this. For each strategic objective, an initial set of activities is proposed that would deliver the outputs required to support the target outcomes. Many of the activities are interconnected.

STRATEGIC OBJECTIVE 1: Build and stimulate demand through the integration of wheelchair services, including procurement & provision, into healthcare systems

BARRIER ADDRESSED	Low and erratic demand in LMICs with limited government engagement and funding.
RATIONALE	There is limited awareness within government on the need for and return on investment for appropriate wheelchairs. Integrating the provision of wheelchair services into the health sector could drive regular purchases from government, leveraging existing infrastructure and capacity for service provision, product distribution and procurement. Health systems are well suited to support user identification, service delivery and procurement in particular for remote settings in LMICs. Buying appropriate wheelchairs and pressure relief cushions can be cost-saving overall to the health system by offsetting negative health outcomes.
PROPOSED ACTIVITIES	Support the integration of wheelchair provision into the health system at country-level: In a sub-set of identified countries [selection process to be developed], increase provision through integration, expanding and further developing proven models for delivery. This includes: 1) mapping the provision landscape and need, where appropriate; 2) developing a roadmap or strategy to integrate wheelchair services into the national health system; 3) developing or expanding personnel and capacity for service provision, including follow-up and maintenance. Document learnings to inform the global toolkit. Develop advocacy and implementation toolkit to be used by decision-makers to integrate wheelchair provision into the health system: Develop and disseminate tools to support the implementation and advocacy at government level, including: 1) tools to model the need; 2) investment case for integration of wheelchairs, including financial and societal return on investment (ROI); 3) a road map template including policy, guideline development, procurement guidelines and operational management guidance that can support countries with the integration of services; and 4) a sample budget impact model for scale-up.
TARGET OUTPUTS	Unmet need better understood and quantified Improved awareness of the need for, and value of, appropriate wheelchairs Demand generated (sustainably and predictably) in a number of countries Model for integration tested and evaluated for scaling to meet need that: Improves ownership and coordination Provides quality-assured product through services
LONG-TERM OUTCOME	Predictable, sustainable and sufficient demand for appropriate, quality wheelchairs which leads to positive outcomes for wheelchair users.

STRATEGIC OBJECTIVE 2: Pool resources to catalyse increases in funded demand and to limit fragmentation in the market

BARRIER ADDRESSED	Fragmented market driven by a lack of coordination among buyers of wheelchairs for LRS and a limited focus on deploying the available resources to effectively support the development of a public sector market.
RATIONALE	Across various LMICs, donors operate parallel delivery systems that often lack coordination with the government. Successes in other health areas show that viable LMIC markets can be developed through partnering with governments, and with targeted support from donors. Opportunities exist to expand domestic expenditure and catalyse government participation for both product procurement and service delivery, potentially using innovative financing mechanism (e.g. results-based financing & co-financing). Pooling the available resources - both donor and government - allows for the channelling of resources to a single payer, thereby strengthening purchasing power, increasing market visibility to suppliers and predictability in funded demand.
PROPOSED ACTIVITIES	Test model(s) to pool resources from key donors: Facilitate and test innovative models with select donor(s) to leverage available resources. This may include, match funding, subsidy, product purchasing support, etc. Leverage donor funds (e.g. from FBOs) to activate government purchasing and unlock additional resources: Work with donors and government to commit resources (in line with innovative funding model, such as match funding) towards wheelchair purchasing or provision, supporting integration into government-owned supply chain.
TARGET OUTPUTS	Government payer activated Purchaser landscape consolidated and buyer power strengthened Increased funding predictability Increased market visibility Key donors commit to taking proven innovative funding approach to scale
LONG-TERM OUTCOME	Donor funding is effectively deployed to catalyse funded public demand and strengthen systems for the provision for appropriate wheelchairs

STRATEGIC OBJECTIVE 3: Strengthen procurement via adoption of specifications and standards, improved tendering and increased market information

BARRIER ADDRESSED	Proliferation of low-quality products that do not meet end-user needs Inability to support value-based negotiations Opaque market environment with limited information available to suppliers and buyers
RATIONALE	Aligning on product specifications and/or a PPP that establishes product quality standards, specifications and target pricing can increase transparency for purchasers, such as government programmes, and suppliers. Thus, making procurement easier for governments, potentially supporting value-based price negotiations, centralised contracting or donor co-financing. A procurement or distribution hub that rationalises supply and negotiates directly with suppliers may serve as a step toward centralised contracting.
PROPOSED ACTIVITIES	Develop PPP to be adopted into countries' procurement: Establish baseline set of standards and specifications for products in LRS; Develop key strategic document that communicates PPP requirements for products that fulfil priority needs. The PPP includes desired specifications and requirements, including on environmental conditions, quality and cost; Develop standards in line with PPP that would be applied to support quality testing and implement testing body with easy to access testing centres. Promote the adoption of new wheelchair standards by ISO; Advocacy with donors/funders (donors, UNICEF SD, governments, NGOs, FBOs, etc.) should be targeted to emphasise buying only products meeting the minimum requirements and specifications as outlined in the PPP. Increase market visibility: Develop a market intelligence platform that tracks supply and buyer landscape, including data from UNICEF, CLASP, ATscale and AT2030 initiatives, and other field practitioners and NGOs. Strengthen procurement and distribution mechanisms to ensure the ability to meet market needs: Work to increase market information, including upcoming tenders and volumes, available to procurement mechanisms, such as UNICEF SD, CLASP and others; Include products meeting PPP specifications (and future products meeting PPPs) within global procurement mechanisms, such as UNICEF Supply Division catalogue; increase country knowledge on product availability; Assess and further develop distribution hub models, such as CLASP, by increasing its independence, diversifying its funding base, reducing product acquisition cost and supporting capacity to increase scale, product range, reach and responsiveness.
TARGET OUTPUTS	Increased visibility of quality suppliers in the market with products that meet PPPs Demand rationalised as the requirements of buyers are standardised Buyers have adopted standardised product specifications and standards (in line with PPP) and implemented procurement principles to adopt quality, appropriate product
LONG-TERM OUTCOME	Transparent flow of information on demand and supply enables the market to grow in a cost-effective manner.

STRATEGIC OBJECTIVE 4: Identify and support cost-effective supply systems

BARRIER ADDRESSED	Unfavourable manufacturing economics and high shipping costs significantly increase the cost to LMIC payers. Governments may prefer ‘local products’, therefore limiting international supply and uptake of international distribution mechanisms (e.g. CLASP).
RATIONALE	Proven models of affordable, quality, localised supply exist. Manufacturers of quality, low-cost wheelchairs or wheelchair components exist that could meet LMIC market needs. Increasing the use of globally recognised minimum quality standards may help filter out lower quality manufacturing in support of new mechanisms for cost-effective supply.
PROPOSED ACTIVITIES	Improve understanding of the economics of local manufacturing versus local assembly: Conduct detailed analysis on the economics of local assembly versus local production in specific countries to support government decision makers and private sector business development units. Test models for localised cost-effective supply systems: Work with (local) suppliers already operating in LMICs and/or with large global suppliers to test approaches for the supply of products that meet quality and price goals. This may include – for example – facilitating a joint venture, supporting licensing agreements between social enterprises and contract manufacturers or supporting the development of a (regional) distribution network.
TARGET OUTPUTS	Governments have the tools and information required to make informed investment and procurement decisions regarding localised production Proven model for a responsive and cost-effective supply of appropriate wheelchairs in country
LONG-TERM OUTCOME	A healthy supplier base of quality, appropriate products for LMICs that are delivered at optimal prices that can efficiently service market needs.

It is recommended that some of the activities outlined above occur prior to others, while some may standalone as discrete pieces of work:

On the demand side, by first testing the integration of provision into the public health system, demand will be generated in a few countries (Strategic Objective 1). This could be supported by parallel engagement with donors to pool available resources (Strategic Objective 2); however, the testing of innovative financing mechanisms could follow-on later, either in the countries targeted by Strategic Objective 1 or in a different set of countries that already have some level of provision in place.
On the supply side, analysing the cost structure of a wheelchair and establishing the economics of local manufacturing versus local assembly will inform decision-makers who see complete local manufacturing of wheelchairs as the most viable option (Strategic Objective 4). Cost information can support the development of the PPPs, which will be a longer consensus process as stakeholders will need to agree on the ideal specifications, supporting standards, and testing process for each wheelchair category (Strategic Objective 3). Other activities on the supply side, such as the development of a market intelligence dashboard, and targeted support to procurement hubs, may occur at any time and are less influenced by the other activities (Strategic Objective 3).