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An AT Innovator case study: Amparo

WILLIAMS, Rhys
OLDFREY, Ben
HOLLOWAY, Catherine
December 2020

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An interview is reported with Lucas Paes de Melo, the CEO of Amparo, to discuss the journey so far of prosthetics company, Amparo. Rather than focus on the product, this insights paper provides an honest reflection of the journey to establishing an assistive technology company and delves into transferable insights. In doing so, they aim to provide insights to help current and future AT entrepreneurs to see behind the curtain of working in this space.

Product Narrative: Prostheses. A market landscape and strategic approach to increasing access to prosthetic devices and related services in Low- and Middle-Income Countries

LIAO, Cynthia
SEGHERS, Frederick
SAVAGE, Margaret
FINEBERG, Alison
AUSTIN, Vicki
HOLLOWAY, Catherine
OLDFREY, Ben
April 2020

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While about 1.5 million people undergo amputations every year, WHO estimates that only 5-15% of amputees who need prosthetic devices in LMICs have access to them. High prices of prosthetic services in lower- and middle-income countries (LMICs), combined with high indirect costs for users (for example to travel to service points), make prosthetic services unaffordable to many of the people who need them. 

Prosthetic services can be made more affordable by: 1) increasing the number of service units (in particular, by leveraging decentralised service models and the innovative technologies that enable them); 2) establishing reimbursement schemes that encapsulate all costs to the user; and 3) leveraging alternative forms of financing for both capacity-building and user financing.

An opportunity exists to transform access to prosthetic services and products in LMICs, but this will require a coordinated effort between: 1) governments to expand service capacity; 2) global stakeholders to provide guidance on products and technologies; 3) suppliers to expand market presence and offerings; and 4) donors to support these activities. 

Five strategic objectives are proposed to accelerate access to prosthetic services in LMIC

Politically disabled: barriers and facilitating factors affecting people with disabilities in political life within the European Union

WALTZ, Mitzi
SCHIPPERS, Alice
2020

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Diversity is a current buzzword in politics, but in the EU, people with disabilities are not achieving the gains made by women and ethnic minorities. This research examined barriers and facilitating factors through a literature review and interviews with politicians and political activists in five European countries. Six categories of barriers and facilitating factors were found: networks, recruitment and mentoring, resources (money, time and energy), the “hierarchy of impairments,” accessibility of political spaces and activities, and laws and policies. Key recommendations include removing access barriers to political participation, from voting to holding office, including physical and procedural barriers in political spaces; ensuring that equalities legislation covers politicians; eliminating barriers imposed by benefits systems; promoting direct support for political activists, candidates and office-holders with disabilities, including access to necessary services and supports; encouraging parties to recruit and mentor disabled people with leadership potential; and considering quotas and job-sharing.

  • Not many disabled people are active in politics. In the EU, about 15% of people have an impairment, but only around 1% of politicians do.
  • Inclusion at school and in social groups makes it easier to get into political jobs or to try to get elected.
  • Some disabled political activists, volunteers, candidates and office-holders don’t get the support they need.
  • Political parties can help by finding disabled people, supporting them, and helping them get involved in politics.
  • Our article provides several ideas about how to make it easier for disabled people to run for office and work in politics.

Accessibility of Public Buildings in Khulna, Bangladesh, for Wheelchair Users

FARZANA, Fawzia
2019

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Purpose: Physical accessibility is one of the fundamental rights of wheelchair users in order to ensure their integration into society. After Bangladesh ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) on November 30, 2007, there has been a paradigm shift in the government’s approach to ensure the welfare and rights of persons with disabilities through legislative and policy actions. This study assesses how accommodative the public buildings are for wheelchair users in Khulna, Bangladesh.

 

Method: All the public buildings in Khulna city - including government offices, public schools, colleges and universities, hospitals, libraries, post offices and court buildings -  were visited to assess the presence and suitability of facilities for wheelchair users, such as accessible parking, ramps, elevators, doors, and essential interior facilities like water closets and drinking-water fountains.  Bangladesh has no specific accessibility guidelines document, but accessibility requirements have been included in the Bangladesh National Building Code (BNBC) 2008. The study made its assessment using an abridged form of the Americans with Disabilities Act Accessibility Guidelines (ADAAG) and BNBC 2008.

 

Results: Only 6.7% (5) of the 75 public buildings were found suitable for wheelchair users. There is scope for modifications to be made in 28% (21) of the buildings which are currently unsuitable for wheelchair users.

 

Conclusion: The study revealed that public buildings are, in general, not very accommodative of wheelchair users. There is a need for modifications in infrastructure to ensure inclusive development of these individuals.

Disability and global health: Special issue of International Journal of Environmental Research and Public Health

KUPER, Hannah
POLAK, Sarah
Eds
2019

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Papers included in this special issue are:

 

Nationwide implementation of a national policy for evidence-based rehabilitation with focus on facilitating return to work: a survey of perceived use, facilitators, and barriers

BJORK BRAMBERG, Elisabeth
JENSEN, Irene
KWAK, Lydia
October 2018

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Aim: The aim is to assess whether the national policy for evidence-based rehabilitation with a focus on facilitating return-to-work is being implemented in health-care units in Sweden and which factors influence its implementation.

 

Methods: A survey design was used to investigate the implementation. Data were collected at county council management level (process leaders) and clinical level (clinicians in primary and secondary care) using web surveys. Data were analyzed using SPSS, presented as descriptive statistics.

 

Results: The response rate among the process leaders was 88% (n = 30). Twenty-eight percent reported that they had already introduced workplace interventions. A majority of the county councils’ process leaders responded that the national policy was not clearly defined. The response rate among clinicians was 72% (n = 580). Few clinicians working with patients with common mental disorders or musculoskeletal disorders responded that they were in contact with a patient’s employer, the occupational health services or the employment office (9–18%). Nearly, all clinicians responded that they often/always discuss work-related problems with their patients.

 

Conclusions: The policy had been implemented or was to be implemented before the end of 2015. Lack of clearly stated goals, training, and guidelines were, however, barriers to implementation.

Adolescents with disabilities: Enhancing resilience and delivering inclusive development

JONES, Nicola
PRESLER-MARSHALL, Elizabeth
STAVROPOLULOU, Maria
July 2018

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This report takes stock of evidence from LMICs, drawing on findings from a thematic evidence review combined with emerging findings from the Gender and Adolescence: Global Evidence (GAGE) survey and qualitative research baseline studies in Bangladesh, Ethiopia, Jordan and Palestine. These interviews involved more than 6,000 adolescents and their caregivers – including approximately 600 girls and boys with physical, visual, hearing or intellectual impairments, alongside service providers and policy actors. The report draws attention to the multiple and intersecting capabilities that need to be supported in order for adolescents with disabilities in LMICs to reach their full potential. It goes beyond a focus on their access to education and health services, and also considers their rights to psychosocial wellbeing, protection from violence, mobility and opportunities to participate within their communities, as well the skills, assets and support they need to become economically independent once they transition into adulthood. 

African Journal of Disability Vol 7 (2018)

2018

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This journal provides

  • Nineteen original research articles on a variety of topics including the cost of raising a child with autism, experiences of care givers to stroke survivors, dyslexic's learning experiences, communication rehabilitation, disability and food security, hearing children of deaf parents and rehabilitation of stroke survivors, disability policy, learning for deaf learners, aquatic based interventions for children with cerebral palsy, evaluation of community based rehabilitation programmes, the impact of stroke and barriers to the implementation of inclusive education.
  • Seven review articles: Intellectual disability rights and inclusive citizenship in South Africa: What can a scoping review tell us?; The benefits of hydrotherapy to patients with spinal cord injuries; Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities; The relationship between social support and participation in stroke: A systematic review; Parents of children with disabilities: A systematic review of parenting interventions and self-efficacy; Implementation of the 2006 Convention on the Rights of Persons with Disabilities in Zimbabwe: A review; Part 1: A review of using photovoice as a disability research method: Implications for eliciting the experiences of persons with disabilities on the Community Based Rehabilitation programme in Namibia
  • There is an opinion paper entitled - Deafening silence on a vital issue: The World Health Organization has ignored the sexuality of persons with disabilities
  •  There is a case study - Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa

Participation of persons with disabilities in political activities in Cameroon

OPOKUA, Maxwell Peprah
MPRAH, Wisdom Kwadwo
SAKA, Bernard Nsaidzedze
2016

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The right to participate in political activities is a fundamental human right for every citizen in a country, but this right is often not available to persons with disabilities. This study investigated the level of and barriers to political participation of persons with disabilities in the Buea municipality in Cameroon. A qualitative data collection method, consisting of three focus group discussions with 36 persons with disabilities was conducted. Participants were selected from three categories of persons with disabilities- visually impaired, hearing impaired and physically impaired- who were residing in the Buea municipality. The study found that the involvement of persons with disabilities in politics in the area was minimal as socio-economic, cultural and physical barriers hindered their participation in political activities at both local and national levels. The study concludes that there should be conscious efforts though affirmative actions to promote and respect the rights of persons with disabilities and make the political environment more accessible to persons with disabilities in Cameroon.

 

Disability & the Global South (DGS), 2016, Vol. 3 No. 2

Community based rehabilitation for people with disabilities in low and middle income countries : a systematic review

IEMMI, Valentina
et al
September 2015

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This Campbell Collaboration systematic review assesses the effectiveness and cost-effectiveness of community-based rehabilitation (CBR) for people with physical and mental disabilities in low- and middle-income countries, and/or their family, their carers, and their community. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). The authors conclude that the evidence on the effectiveness of CBR for people with disabilities in low- and middle-income countries suggests that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer and recommend future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations

Campbell Systematic Reviews 2015:15

Disability Inclusion in Primary Health Care in Nepal: An Explorative Study of Perceived Barriers to Access Governmental Health Services

VAN HEES, S
CORNIELJE, H
WAGLE, P
VELDMAN, E
2015

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Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary healthcare services by persons with disabilities in the Western region of Nepal.

 

Methods: 10 primary healthcare providers and 11 persons with disabilities (physically or visually impaired) were selected by non-governmental organisations from the hilly and lower areas. Based on the International Classification of Functioning and the health accessibility model of Institute of Medicine, semi-structured interviews were conducted and analysed using analytical induction.

 

Results: In general, healthcare providers and persons with disabilities reported similar barriers. Transportation and the attitude of family members and the community were the main environmental barriers. Even with assistive devices, people still depend on their families. Financial barriers were lack of funds for health expenses, problems in generating an income by persons with disabilities themselves, and the low socio-economic status of their families. Personal barriers, which affect help-seeking behaviour in a major way, were most often mentioned in relation to financial and socio-environmental barriers. Low self-esteem of the person with disability determines the family’s attitude and the motivation to seek out healthcare. Lastly, poor public awareness about the needs of persons with disabilities was reported.

 

Conclusions: Besides the known physical environmental barriers, this study found several environmental, financial and personal barriers that also affect access to primary healthcare. In particular, the attitudes of families and poor financial conditions seem to be interrelated and greatly influence help-seeking behaviour.

Victim assistance in the context of mines and explosive remnants of war

HOTTENTOT, Elke
July 2014

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This policy paper presents background information on victim assistance in the context of landmines and cluster munitions. It describes how it is rooted in two instruments of international humanitarian law and guided by the CRPD, and reviews the current situation in terms of Handicap International’s day-to-day interventions and outlines a vision of VA that is in line with their 2011 – 2015 strategy. Overall, it aims to contribute to a common position and coherent communication on VA among Handicap International staff, whether at the operational, advocacy, communication or campaigning level and to instigate new ways of operating in order to capitalize on the opportunity presented by VA at this point in time
PP 1

Giving with one hand...evaluation of post-earthquake physical rehabilitation response in Haiti, 2010 : a systems analysis

TATARYN, Myroslava
BLANCHET, Karl
2012

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This report presents the evaluation of the post-emergency rehabilitation response in Haiti in order to assess what had been achieved, to learn from good and not-so-good practice, and to promote the development of an effective rehabilitation sector in the future.This evaluation provides evidence, to inform humanitarian organisations, about what must be done in a post-disaster situation so that people with disabilities have access to relief and protection on an equal basis with others, and what is required in the long-term to develop a good rehabilitation service

Miss landmine Cambodia pageant : provocative art or pejorative ‘project’?

MOMAYA, Masum
2012

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In 2007, a Norwegian theatre director Morten Traavik arrived in Cambodia to stage a beauty pageant, with funding from the government of Norway, for girls and women who had lost limbs in landmine explosions. This opinion article analyses the project which "continues to raise questions about what it means for a foreign project to offer 'freedom' and 'opportunity' to women with disabilities in Cambodia and stoke debates about the sexualisation of women with disabilities from the global South"

Armed violence and disability : the untold story

THAPA, Rashmi
THALER, Kai
2012

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"This study aims to understand the links between armed violence and impairments that can lead to disabilities. It focuses on individuals who sustain impairments resulting from incidents of armed violence. The Disability Creation Process is adapted to analyse the combination of health problems, discrimination and socio- economic exclusion that can lead to disability for people who have sustained serious injury and/or lasting impairments as a result of armed violence...This report is written in a linear progression keeping the research project’s goals, objectives and approach as its backdrop. Chapter 1 (introduction) gives an overview of armed violence along with the justification of this research and its methods. Chapter 2 presents the findings from the four case study regions in countries, situated within its contextual analysis. Each case study draws on its discussion and summary of findings. Chapter 3 presents the discussion and lessons learned from this research, placing assistance and people at the centre of armed violence initiatives. Finally, a glossary, Annexes and references as endnotes are at the end of the report with notes at the end of every page"

Accessibility standards : a practical guide to create a barrier-free physical environment in Uganda

UGANDA NATIONAL ACTION ON PHYSICAL DISABILITY (UNAPD)
Ministry of Gender
Labour and Social Development
2010

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This guide promotes better accessibility for persons with physical disabilities in Uganda by providing information for constructors or developers to build accessible environments. It presents information about how to construct standard ramps, toilets, lifts, road in addition to wells, furniture and more. These accessibility standards are useful for Architects, policy makers and implementers on accessibility requirements during the design and implementation of construction projects

Victim assistance in the context of the AP mine ban convention : priorities and challenges during the period 2010-2014|Element 7.1

THE STANDING COMMITTEE ON VICTIM ASSISTANCE AND SOCIO-ECONOMIC REINTEGRATION
May 2009

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This paper presents the priorities and challenges during the period 2010-2014 of Victim assistance in the context of the AP Mine Ban Convention. It provides a brief introduction, outlines the evolution of the status of victim assistance in the context of the Convention, applies the understandings and framework for strategic action, and presents the challenges and actions to address the challenges in fulfilling the Convention’s promise to survivors

A guide of understanding victim assistance in the context of AP Mine Ban Convention

THE IMPLEMENTATION SUPPORT UNIT OF THE ANTI-PERSONNEL MINE BAN CONVENTION
October 2008

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This guide highlights the strategic approach on victim assistance adopted by the States Parties and assists relevant States Parties in applying it. It provides information about a broader view of victim assistance and guidance for each state party to develop a national strategic approach by offering relevant help for landmine victims through emergency first-aid care, rehabilitation services, psychological assistance and economic reintegration. It recommends that each State to complete a situation analysis to take specific, measurable, achievable, relevant steps in a set time frame to raise efficiency and promote sustainability of services
Note: this guide is a companion to "Victim Assistance in the Context of the AP Mine Ban Convention: Checklist"

Victim assistance in the context of the AP Mine Ban Treaty : checklist

THE IMPLEMENTATION SUPPORT UNIT OF THE ANTI-PERSONNEL MINE BAN CONVENTION
October 2008

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This checklist is a tool to be used by States Parties in developing a comprehensive victim assistance response in the context of broader efforts concerning healthcare, rehabilitation, reintegration and human rights and achieving the aims of the Nairobi Action Plan in the six thematic areas of victim assistance
Note: This is a companion piece to "A Guide to Understanding Victim Assistance in the Context of the AP Mine Ban Convention"

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