What works to increase access to assistive technology in southern Africa
Access to assistive technologies (AT) is necessary to achieving all 17 sustainable development goals. Yet for most people who need AT in Southern Africa, AT is unaffordable, unavailable, and often inappropriate. My PhD research was guided by the core question: What works to increase access to assistive technology in Southern Africa? Organized into three sub-studies, my research aimed to identify and describe the facilitators and barriers to access AT and develop a theoretical model to inform strategies to increase AT access in Southern Africa. The first two sub-studies listed below were previously published and the full manuscripts are included as separate chapters within the thesis. The three sub-studies included: • Sub-study 1: A scoping review that characterized existing evidence on AT from resource limited environments. Evidence identified was limited in quantity and quality, and primarily focused on mobility and vision types of AT. • Sub-study 2: A secondary analysis (i.e., bivariate regressions) of national survey data from Botswana and Swaziland served to examine factors associated with higher levels of AT access. The type of disability (i.e., mobility vs. non-mobility) was found to be the most important factor in determining AT access in both countries. • Sub-study 3: A regional qualitative sub-study was conducted to increase the understanding of how a multitude of interrelated factors operate to increase the supply of and access to AT. An adapted health systems framework was applied to analyse multiple data sources including stakeholder interviews, documentation review and observations. The thesis is organized into seven chapters. In Chapter 1, I provide background information and conceptual framing of the research topic, assistive technology access within Southern Africa. The research questions and overview of the three sub-studies are included in this introductory chapter. Chapter 2 covers the research methods of all three sub-studies. For the first two sub-studies, a brief overview of data collection and analysis methods are included that reference the more detailed methods presented within each published manuscript. The first two sub-studies are presented as Chapter 3 (scoping review) and Chapter 4 (secondary analysis) within the thesis. The third sub-study (qualitative) provided the most comprehensive data of the three sub-studies and comprises findings presented in Chapter 5 and Chapter 6. In the final chapter, Chapter 7, I synthesize findings from all three sub-studies to identify prominent patterns and present models that aim to explain constraints within the AT sector. The synthesis of evidence showed that AT in Southern Africa does not operate as a sector but as a constellation of uncoordinated parts. The low prioritization of AT and high level of fragmentation within the system emerged as pervasive patterns. The combination of these two patterns result in a wasteful sector. This means that the limited resources invested in funding products and services, and in strengthening the national AT procurement and provision system are not used effectively to increase the supply of and access to appropriate AT. In my further interpretation of data to respond to the core research question: What works to increase access to assistive technology in Southern Africa? I then identify strategic levers to increase AT access. Strategic levers aim to increase resources invested in the AT sector while reducing system-wide inefficiencies. Finally, study limitations and conclusions are presented at the end of this final chapter.
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Department of Public Health and Family Medicine