Enabling Access Locally: A Systems Approach to Wheelchair Provisioning in Low-Resource Contexts (Nepal)

Considering that 2.2% of Nepal's population faces disabilities, improving access to assistive technology is both a moral obligation and a priority for sustainable development. At the governmental level, efforts are underway to integrate essential assistive devices into the healthcare system aligning with WHO guidelines. However, there remain significant challenges in implementing these policies, despite constitutional guarantees of free and equitable access to assistive technology. This thesis proposes a collaborative approach to establish sustainable wheelchair provision in Nepal. This approach involves bringing together global manufacturer, national service providers, and local makers in a synergistic alliance where global partners would contribute expertise in quality control, research and development, and training, while local partners would focus on customization, repair, and context-appropriate design. The research findings, based on qualitative interviews with 14 wheelchair stakeholders, reveal challenges such as product scarcity, reliance on charitable models, maintenance issues, and barriers to rural accessibility. A tangible demonstration of 3D-printed wheelchair spare parts validates the feasibility of localized production but suggests the need for further testing to scale up cross-sector distributed manufacturing, using both digital and conventional local technologies. In response to these challenges, a globally connected Circular Local Distributed Manufacturing model (CLDM) is proposed. This model combines global quality and scale with local customization, capacity building, and sustainability. It fosters collaboration among users, communities, governments, manufacturers, and makers to create accessible, affordable, and user-centered assistive technology. Favorable policies such as tax incentives for spare parts and raw material imports, free vocational training through national programs, and collaborative publicprivate partnerships stimulate the ecosystem to fully. While this research offers a roadmap for improving access to assistive technology, it acknowledges that a broader transition of systems requires further exploration.