Introduction
The limited success of free market
mechanisms in wheelchair provision in low income countries requires a
comprehensive, coordinated, and sustained intervention by governments,
charities, and development agencies working in close collaboration with the
organized movement of people with disabilities. To be effective, this effort
must be designed to stimulate market mechanisms. Up to now, funders have
usually subsidized supply, that is, they have purchased wheelchairs that are
then given to users. This system must be
turned on its head. Funders must instead
subsidize demand, that is, provide funds for wheelchair users to choose for
themselves what wheelchairs they want and need.
A healthy market economy tends to correct
imbalances in price, quality, and availability of goods and services through
competition among producers and feedback from consumer purchasing
decisions. The introduction of new
products creates new needs and demand and thus provides opportunities for
further economic development via a continually evolving array of products and
services. A healthy market economy tends
toward efficient use of investment resources as each product and service in the
web of related products and services develops apace, usually getting neither too
far ahead of nor too far behind the demand.
A Distorted market
The market economy, however, is skewed when
it comes to wheelchairs in low income countries. End users have little money and are most
often not the purchasers of the wheelchairs they use. Instead, governments, charities and
international development organizations purchase the wheelchairs and give them
away. Initial cost is the predominant consideration for these distributors; the
wheelchairs provided are rarely built for the environments in which they will
be used. There is little consumer input to make manufacturers and distributors deal
with other considerations, such as quality, fitness for use, proper fit, and
safety. Furthermore, a flood of cheap or free imports has the effect of
lessening competition by driving out the small, local manufacturers who depend
on local governments and charitable organizations, the users, and the users’
families to pay for their chairs.
A stunted Rehabilitation Infrastructure
The influx of very large numbers of
wheelchairs into a region also outpaces the development of secondary
facilities, goods, and services, what we will call “the rehabilitation
infrastructure” required for users to get the most out of their
wheelchairs. The result is that millions
of dollars are wasted each year because there are few spare parts to repair the
wheelchairs when they break, few repairers trained in wheelchair repair, and few
trained personnel to measure and assess users for a proper chair-to-user fit.
The Solution
The most efficient use of capital resources
for wheelchair purchases requires that the number of wheelchairs introduced
into any given area not greatly exceed the capacity of the rehabilitation
infrastructure to support them. That is,
in order for the chairs to be properly fitted, maintained, and repaired, it is
better to apportion resources between wheelchairs and these necessary services.
A wise intervention will regularly evaluate the capacity of the extant
rehabilitation infrastructure, support a commensurate level of wheelchair
production, and build up and extend the capacity of the infrastructure to be
able to increase the number of wheelchairs that can be provided effectively.
Demand Subsidies
In order for a system of user choice to
work, donors would place their money in a managed fund. There should be a variety of wheelchairs,
readily accessible consumer information, standards for safety, strength and
durability, and trained persons who can advise the users in choosing an
appropriate wheelchair. With these elements in place, a user could receive a
voucher to purchase the least expensive of the approved wheelchairs that meet
the user’s needs. If the user wanted a
more expensive chair, the user would have to pay the difference. An adequate pot of money would be attractive
to manufacturers who would produce chairs to meet the users’ requirements. The type and variety of available wheelchairs
would grow, along with related services, giving users greater and greater
choice and improving a user’s chances to obtain the most appropriate wheelchair
for his or her individual needs
Conclusion
Governments, donors and development
agencies can learn how best to allocate resources between wheelchairs and
wheelchair services/training by participating in a collaborative effort with
disabled people’s organizations to provide wheelchair users with the
opportunity to choose their own wheelchairs.
The resulting feedback will directly benefit wheelchair users and help
donors to get the best results in the most cost-effective way.
