This study was conducted as part of the AT2030 Research Programme, which is funded by FCDO and delivered by the Global Disability Innovation Hub (GDI Hub). It was carried out by a team from the Sierra Leonean Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA), the Sierra Leone Federation of the Urban and Rural Poor (FEDURP), the Sierra Leone Urban Research Centre (SLURC), and the Bartlett Development Planning Unit (DPU) at University College London (UCL). The study supplements the Country Capacity Assessment for Sierra Leone undertaken by the Clinton Health Access Initiative (CHAI), using the World Health Organization (WHO) Assistive Technology Assessment – Capacity (ATA-C) tool, which was developed with support from the GDI Hub.
The ATA-C tool assesses the capacity within countries to make the most effective, high-quality assistive technology (AT) available at affordable yet sustainable prices. The focus of this supplementary informal markets study is to understand existing practices of AT provision through informal markets and social institutions, and the experiences of AT users on low incomes living in informal settlements. We examine how such informal markets can be supported and improved and how formal sector actors working in AT provision can best work with and influence informal AT markets. The research was conducted in two urban areas: Freetown and Bo.
It included data from a household survey that reached approximately 2,000 individuals in the settlements of Thompson Bay and Dwarzarck in Freetown, as well as focus groups discussions (FGDs) with AT users and semi-structured interviews with AT users, Disabled People’s Organisations (DPOs), informal and formal AT enterprises, and state stakeholders in the AT sector. Our study suggests that there is an extremely limited level of AT coverage amongst low-income citizens in Sierra Leone, and that existing formal policy commitments to address AT needs are rarely substantiated in practice, largely due to resource constraints and lack of institutional capacity.
In this context, informal providers—including NGOs, DPOs, and religious organisations—play a key role in providing basic AT. These are formal institutions insofar as most are legally registered as CSOs, but they are informal AT providers since they do not conform with regulations for registering with medical bodies or professional qualifications for staff. In addition, they do not meet minimum AT standards, which is also the case for the formal AT sector in Sierra Leone. Other key informal AT providers are large, usually imported second-hand goods traders and tradespeople such as carpenters and motor mechanics who produce and repair basic assistive products (APs). Again, whilst most of these businesses are formally registered, they are not regulated as AT providers and lack formal skills and knowledge for this role. The final provider is AT users themselves, who operate in a complete state of informality but outside the domain of regulation since their products and services do not pass through AT markets.
Relying on informal providers has a range of disadvantages for those in need of AT. These include providers’ inability to produce, prescribe, or fit more complex APs, such as hearing aids or prostheses, issues with the quality of AP, inconsistent supply, and the lack of associated services including training on use. These providers nonetheless remain the principal source of AT for most low-income users and users’ relatively high level of satisfaction with informal AT providers, captured in the rATA survey and our focus group discussions (FGDs), reflects advantages of informal AT providers for users: these providers are more widely accessible suppliers; they also more affordable for users who are unable to access free or donated ATs from charities, hospitals, or rehabilitation centres; and they are often more willing or able to customise and fit APs to specific users’ needs.
This context raises challenges for efforts to expand access to AT in Sierra Leone:
• How can the benefits of informal AT providers in providing broad and less expensive access to otherwise unserved populations be promoted whilst protecting AT users from unsafe products and services?
• What is a realistic role for under-resourced government agencies in this task?
• How can regulations improve quality without pushing more providers into the informal market, increasing costs, and reducing accessibility?
In the absence of state capacity for regulating informal AT markets and providers, what other forms of non-state regulation could fill this gap?
• How can more formal and informal private AT providers be encouraged to sell AT consistently and affordably?
In response to these challenges, we highlight recommendations or avenues for future investigation, which we group into two areas: regulation and incentives and knowledge and information sharing.
To cite this publication please use the following reference: Walker, Julian, Nada Sallam, Samuel Sesay and Ibrahim Gandi (2020), Country Capacity Assessment for Assistive Technologies: Informal Markets Study, Sierra Leone, Global Disability Innovation Hub Report, AT 2030 Programme, GDI Hub, London