This is a great discussion and very important. I work for World Vision and we are a generalist NGO but looking to do better on supporting persons with disabilities. I am most familiar with the wheelchair sector, serving on the founding Board of the International Society of Wheelchair Professionals. I am shocked by how a wheelchair in many contexts is not seen as a medical service but as some kind of charitable donation. As a result, wheelchairs are often inappropriate, don’t last and don’t address mobility issues for that person. The chairs themselves are not maintained or replaced per guidelines. Even in countries like Colombia, that have approved payment for WHO assistive devices through medical insurance, they haven’t approved wheelchairs. You still need to complain to the court who will then grant you a chair. There seem to be several other constraints around improved wheelchair provision, largely stemming from the lack of a human rights understanding of the importance of access to wheelchair services:
- A lack of wheelchair professionals embedded into health systems – this means that wheelchair provision is not seen as being part of the health system and this limits referrals from the health and rehabilitation providers to wheelchair providers. This also limits the quality of wheelchairs and the functionality of those chairs.
- A failure to understand the cost-benefit of appropriate wheelchairs – by governments, NGOs and individuals. Wheelchairs are often cited as being too expensive but this calculation is not made against the cost of a child’s inability to learn or an adult’s ability to work or be productive. It may also lead to the provision only of the cheapest wheelchairs which don’t provide the mobility needed to enable school attendance or productivity.
- Low supply and demand – because wheelchairs are not in high demand from government, NGO or private buyers, supply is limited and most countries don’t have a manufacturer or assembler of wheelchairs. This increases costs for manufacture and delivery.
Our current focus at World Vision is on supporting advocacy by organizations of persons with disabilities to national governments to enhance wheelchair provision, supporting referral to existing free assistive device provision where available and budgeting adequately for assistive devices in World Vision programs where free provision is not available. I am also pleased to support the ISWP’s work to train wheelchair professionals, promote wheelchair standards and to enhance the function of the industry as a whole.