Sustainable and equitable provision of wheelchairs in low- and middle-income countries: an economic assessment of the models for wheelchair provision in Tajikistan

Abstract

Introduction

Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Tajikistan has recently adopted several policies and national strategies to strengthen the rights of people with disabilities and improve the provision of assistive products. However, Tajikistan faces a number of challenges, including ensuring sustainable funding for the provision of wheelchairs in the medium and long term.

Methods

This study presents the results of a recent analysis of the economic aspects of the provision of wheelchairs in Tajikistan to inform policy making in other low- and middle-income countries. The study draws on several sources of information, including local cost data, consultations with national and international experts and stakeholders, and reviews of the existing evidence.

Results

Countries are advised to adopt an incremental approach to wheelchair provision. In the short term, countries may wish to import wheelchairs to move towards universal coverage. In the medium-to-long term, countries may wish to invest in national capacities for local production.

Conclusion

Countries will need to continue implementing strategies to ensure universal access to wheelchairs without the risk of financial hardship for users, regardless of the approach to provision that has been chosen.

Implication for Rehabilitation

• Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries.

• Countries are advised to adopt an incremental approach to wheelchair provision.

• The model of wheelchair importation may be a realistic model over the short- to medium-term for many LMICs countries to ensure effective and equitable provision of wheelchairs.

• In this article, we identify that sufficient funding needs to be allocated to the provision of wheelchairs regardless of the model of provision.

Keywords:

• Wheelchair
• provision
• financing
• Tajikistan

Acknowledgements

The work of WHO in Tajikistan is ongoing and is financially supported by the United States Agency for International Development (USAID). The full report (Provision of wheelchairs in Tajikistan: Economic assessment of alternative options) of this work contains more detail (10). The authors would like to acknowledge the contributions made to this study by all people who were interviewed and shared their experiences and knowledge about using wheelchairs in Tajikistan and about the provision of wheelchairs in LMICs more generally. The authors would also like to acknowledge the Ministry of Health and Social Protection, Republic of Tajikistan who collaborated and requested WHO to take lead in the assessment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

BE and SM conceived and wrote the paper, AP, CK, MA and MH commented on drafts of the paper. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. All authors read and approved the final manuscript.