Due to country diversity, the current situation may not fit exactly into an overall defined development stage. That is, a same country may have different levels of development in each of the 5P’s. For instance, one country can have low development in national policies but some development in provision services due to the work done by international NGO’s. In this specific case, the strategy can be to scale-up and scale-out the local strategies. There may be countries where provincial policies surpass, or lag behind, national policies in various categories. For example, a national-level policy may be comprehensive with respect to health insurance coverage for wheelchairs, while on a provincial-level lack clear pathways to access to provision services. Figure 4 illustrates the Wheelchair Sector Development Stages related to: people, policy, provision, personnel, and products. The classification provides a framework to rapidly identify where a context is to later inform the next steps that need to be followed to promote the improvement of the wheelchair sector in that context.
Consider the following areas when gathering the information for the situational analysis [18]:
- Conducting a review of how wheelchair services have developed over time within the context. This could include a historical overview, legislation and current service systems.
- Identify who (key stakeholders) is involved in the wheelchair provision process to be able to engage them in a following collective dialogue to discuss the current situation and how it links to international standards in relation to WHO 8 Steps and the UNCRPD.”
LOW
National information on the number of people with mobility impairment is not available. There is a weak disability movement with some DPOs and NGOs working in disability but work is not coordinated or impactful. PWDs are largely excluded.
MEDIUM
Limited information on the number of people with mobility impairment is available. (e.g. local disability registries, specific programs databases). Growing disability movement with increasing DPO strength. PWDs included in some aspects of life and awareness is increasing of their rights aligned with the CRPD.
HIGH
National up-to-date information on the number of people with mobility impairments that need wheelchairs and their characteristics. Vibrant disability movement with strong OPDs structure. PWDs involved in wheelchair service delivery and their rights in line with CRPD are recognized in most areas.
LOW
CRPD has not been signed or ratified. None to little commitment to people with disabilities. No policies or some general policies/plans related to assistive technology exist but not aligned with the CRPD or Wheelchair Guidelines.
MEDIUM
CRPD has been signed and ratified but knowledge and monitoring of it is weak. Policies/plans are in place and are known by most stakeholders. They are to some extent in line with the Wheelchair Guidelines and CRPD but are not enforced.
HIGH
Country has signed and ratified the CRPD and has strong monitoring mechanisms in place to evaluate progress. Policies/plans are in place, in line with CRPD and Wheelchair Guidelines.
LOW
Country is poorly organized and resourced and structures are weak. Rehabilitation is not prioritized and efforts are not coordinated. Most rehabilitation efforts and funding is provided by INGOs/ International organizations. No public services or funding for wheelchairs. Reliance on sporadic mass distributions by NGOs without assessment and prescription services according to Guidelines. Poor referral and follow up.
MEDIUM
Rehabilitation infrastructure in place: services and staff exist but services are not well coordinated or resourced and are limited in quality, volume, level of services, and reach. NGOs often continue to play important role in provision of wheelchairs. Modest level of funding is available for both services and products but is inadequate for needs.
HIGH
There is a network of trained rehabilitation and CBR professionals covering all or most regions and a high number of people who have been trained in skills of wheelchair delivery. Wheelchair specific personnel generally available and a certification in place. Regular courses in line with Wheelchair Guidelines are offered and integrated into curricula of rehabilitation professionals. Comprehensive wheelchair user training.
LOW
Country does not have, or limited, rehabilitation training schools. Training in wheelchair delivery is not provided at all within the country and none or few people in the country have skills related to wheelchair provision.
MEDIUM
Qualified rehabilitation professionals and CBR workers are present in some areas There are some people who have been trained in wheelchair delivery in some regions. Some training is provided to various cadres and there are a limited number of people able to train WSTP or equivalent packages. Limited wheelchair user training.
HIGH
There is a network of trained rehabilitation and CBR professionals covering all or most regions and a high number of those trained in wheelchair provision. Wheelchair specific personnel generally available and a certification in place. Regular courses in line with Wheelchair Guidelines are offered and integrated into curricula of rehabilitation professionals. Comprehensive wheelchair user training.
LOW
Lack of wheelchairs is generalized. Very few available, generally low quality and do not meet users need.
MEDIUM
A variety of wheelchairs available, possible that not all the types needed are available (e.g. All terrain wheelchairs). Quality and safety standards are not regulated (e.g. ISO 7176 or similar); may be subscribed to international standards and test methods for adverse environments available. Volume and level of reach is not generalized in the country.
HIGH
A variety of safe and good quality wheelchairs (complying with ISO 7176 or similar and tested for adverse environments when applicable) are available throughout the country. Country is subscribed to international standards and enforces them.