Global Report on Assistive Technology Consultation

Resolution WHA71.8 – Improving access to assistive technology calls upon WHO to prepare a global report on access to assistive technology by 2021. This Global Report is intended to highlight the current status of AT, as well as good practices for innovation and recommendations to improve access.

Motivation Australia has joined with colleagues from the Pacific Region to contribute to the Global Report. We have combined experience and learning from our shared AT journey to draft a paper (see below) that looks at the successes and gains in access to AT in our region. Most importantly, the paper draws out what we think has most contributed to this change, as through focusing on positive lessons we better equip ourselves to keep moving in the right direction.

Representatives from our author group will be attending the 2019 GReAT Consultation in Geneva, where academics, practitioners, policy makers, and AT users will come together to help guide content for the Global Report. We look forward to working with global AT stakeholders, sharing and learning on behalf of the Blue Pacific


Building sustainable and effective assistive technology provision in partnership: lessons from the Pacific

Lead Author: Kylie Mines, Chief Executive Officer, Motivation Australia

Co Authors: Lee Brentnall, Prosthetist Orthotist, Motivation Australia; Almah Kuambu, Technical Lead, National Orthotics and Prosthetics Service, Papua New Guinea; Ambrose Kwaramb, Manager Health Services and Standards, Papua New Guinea; Dr Natasha Layton, Motivation Australia Clinical Technical Reference Group, Senior Lecturer in Occupational Therapy, Swinburne University of Technology, President, ARATA; Seta Macanawai, Chief Executive Officer, Pacific Disability Forum; Christina Parasyn, Occupational Therapist, Independent Consultant; Elsie Taloafiri, Director, Rehabilitation/Physiotherapy Division, Solomon Islands; Faatino Masunu Utamapu, Manager, Nuanua o le Alofa, Samoa

Keywords: Pacific, Partnership, Collaboration, Assistive Technology, Stakeholders, Sustainability, Local Service System, People who use AT (user), Workforce, Procurement


The Blue Pacific is home to multiple small island nations, a number of which are the most isolated states in the world, making access to assistive technology (AT) a challenge. The Blue Pacific values regionalism and embraces its diverse geography, demography, cultures and economic development through collective action and sharing of institutions, resources and markets. Through the lens of Pacific AT stakeholders, this paper draws on existing data and Pacific perspectives to share the region’s story about how and for whom access to AT has improved in the period from 2008 to 2019, as well as the factor’s that influenced the change.

We show that sustainable, local and reliable access to AT is reliant upon the right mix of ingredients. Our findings highlight the benefit of: strong advocacy, genuine partnership and growing informed demand from the People who need and provide AT; a Product range suited to each context and funders willing to support procurement; Provision opportunities to integrate AT services into existing government and non-government services; effective and consistent local training for Personnel through the availability of an appropriate training package, training provider and funding support; as well as the global, regional and national Policy frameworks that support increased actions to make AT more readily available. The Blue Pacific journey offers the global AT community unique practices and innovations for meeting AT demand and supply and strengthening sustainable local sector capacity in less resourced settings.

1. Introduction

1.1 The Pacific

A view of Samoa from the top of a hill. The land is lush and green, the sky and ocean are clear are bright.

The Pacific is home to multiple small island nations, many of which are considered Small Island Developing States. With the notable exception of Papua New Guinea, which has a population of 8.2 million, populations range from 1,499 (Tokelau) [1] to 885,000 (Fiji) [2]. Together these nations, which are home to over 11 million people, comprise a land area of only half a million square kilometres scattered in the world’s largest ocean. Distance is a key feature of Pacific life, with a number of Pacific Island Countries (PICs) being recognised as the most isolated states in the World [3].

PICs are diverse in their geography, demography, cultures and economic development. PICs also share similarities including small populations and geographical size; remoteness from each other and to global markets; limited scope to exploit economies of scale; and exposure to global environmental and economical challenges [3]. Regardless of this acknowledged diversity, a key defining characteristic of the region is a common sense of identify and purpose. Pacific Island Forum Leaders and its people embrace Pacific regionalism and the ‘Blue Pacific’ identity as the core driver of collective action to advance the Pacific vision. Within this vision is the progressive sharing of “institutions, resources, and markets, with the purpose of complementing national efforts, overcoming common constraints, and enhancing sustainable and inclusive development within Pacific countries and territories and for the Pacific region as a whole” [4].

The Pacific Island Countries and Areas World Health Organisation (WHO) Cooperation Strategy 2018–2022 highlights the achievements by PICs in the development of health services in recent years. At the same time, WHO and Pacific leaders recognise the continued triple burden on health service delivery created by the unfinished communicable disease agenda; a rapidly rising noncommunicable disease epidemic; and climate change [5]. This context has particular relevance to assistive technology (AT), as the need becomes increasingly relevant to an increasing section of the population.

1.2 Objectives and method

The authors of this paper represent stakeholders in AT across the Pacific including service providers, government, disabled persons organisations (DPOs), people using AT and development partners. We have tasked ourselves with reviewing work towards building more sustainable, consistent and effective AT services in the Pacific in the past decade, choosing as a base-line the year 2008. This was the year of the first Motivation Australia mobility device feasibility studies, the second Pacific Disability Forum Conference, the first Pacific ratification of the Convention on the Rights of Persons with Disabilities (CRPD) [6] and the year the Australian Government led consultations in the region to inform its first ever disability inclusive development strategy Development for All 2009-2014 [7]. We have each been directly involved in the Pacific AT journey in different ways, and believe that in working together in drafting this paper, we bring a richer, better informed and more nuanced response to our task.

Our objective is to reflect on our shared AT journey, to draw and share conclusions of value for both the Pacific and global GATE community in increasing access to AT. Using the framework of People, Provision, Personnel, Policy and Products as well as the precursors to and ingredients of sustainable development, we specifically seek to identify from our shared perspective:

  • How and for whom access to AT has improved in the Pacific since 2008
  • What may have influenced this change

Our approach included:

  • Mapping of data including published and unpublished reports, papers, project documentation and statistical data sets from Motivation Australia; other grey literature and publications; national and regional disability, health and legislative documents; and formally published work (see reference list).
  • Mapped data from 2007 – 2012 was grouped to inform our baseline and documents later than 2017 used to present the picture of access to AT in the Pacific today.
  • Review and analysis of data to identify characteristics of the status of access to AT approximately ten years ago, the situation today, and evidence of change facilitators.
  • Concurrently with the above actions, authors completed a set of reflective questions (see Appendix A) to contrast and deepen understandings of the data and illuminate and synthesise change factors.

Authors acknowledge many other individuals and organisations who have driven change in the AT space in our region, which may not be captured in this paper due to limitations in time, availability of published AT literature relevant to the region, access to written documentation, opportunity to consult and word limit. We also note that although our collective experience encompasses a range of different AT, much of the literature available for this paper focuses on mobility devices. An important step in progressing this work would be to engage with other stakeholders who may also have chronicled their journey through internal documents, around increasing access to (for example) hearing, vision and Information and Communication Technology (ICT) AT. This would deepen the overall understanding of the development of access to AT in the Pacific and to ensure important lessons are not missed.

2. A journey in accessing AT

2.1 AT provision in the Pacific today

A group of people gathered together in a circle sharing in a discussion.The CRPD has been well socialised across PICs, and as of August 2019, 15 countries in the region have signed and 13 have ratified this international treaty. PICs Governments have also prioritized empowering persons with disabilities as one of the issues requiring collective attention in the Pacific Roadmap for Sustainable Development [8] and through the Pacific Framework for the Rights of Persons with Disabilities [9].

In 2018 the Pacific Disability Forum (PDF) highlighted in their SDG-CRPD Monitoring Report the importance of AT as a pre-condition for inclusion [10]. The same report also recognises that while there exist pockets of success in increased access to AT, there remain significant gaps “with regards to availability, accessibility, affordability and quality”.

Successful AT provision in a number of PICs is driven by collaborative and individual efforts of governments, non-government organisations (NGOs), disabled persons organisations, development partners and an emerging private sector. An increasing number of physiotherapy personnel are trained in basic level wheelchair service delivery and provide basic mobility devices such as walking aids and wheelchairs through their departments when stock is available. A number of ophthalmology departments in the region support provision of prescription glasses when stock is available, private opticians offer services in a few locations, and there are some small scale initiatives supporting the use of low vision and blind AT [11]. Hearing aids are provided in a few PICs through visiting missionary programmes and in one country there has been some exposure to cochlear implants. Government health services in Fiji, Kiribati, Papua New Guinea, Samoa and Tonga offer integrated prosthetics, orthotics and wheelchair services; and the Solomon Islands will soon add prosthetics and orthotics to existing wheelchair services. Also of note, is the development in Papua New Guinea of National Guidelines for the Provision of AT [12] addressing training, personnel and priority products for people with mobility, hearing or vision impairment. These are the first AT specific guidelines developed in the Pacific region.

While progress has been made, a 2019 Pacific AT Procurement Study [13] led by Motivation Australia in partnership with the Pacific Disability Forum and Nossal Institute for Global Health, drew together a snapshot from ten PICs, identifying consistent patterns of AT access, including:

  • Low levels of awareness of AT amongst people using services, service personnel and policy makers. This was less marked in mobility AT compared to AT for self-care, communication and cognition.
  • Minimal representation from those who need and use AT in the planning, service delivery and evaluation of AT initiatives. One study informant noted “Honestly, people with disability don’t have any choice, they get what they are given.” This is particularly an issue for people with deafblindness, as well as intellectual and psychosocial disabilities who may benefit from AT use.
  • Significant variance in the availability of AT depending on the type of device. Mobility devices were found to be most readily available, followed by glasses and hearing aids. AT for people with low vision or blindness was limited, while devices for self-care, communication and cognition are largely unavailable.
  • Significant inequity in access to AT. Informants and data highlights that children, older people, those living furthest from services and with less resources are less likely to access AT than others. Additional Pacific research indicates that girls and women also face access barriers [14, 15].
  • Where people have accessed AT, they are unlikely to have all the AT they need.

The study highlighted issues impacting on the availability of appropriate AT in PICs as being: limited rehabilitation and AT capacity, human resource constraints, lack of required facilities, competing priorities for health financing, supply and procurement challenges associated with the context of PICs, and donations of poor quality and in-appropriate devices.

2.2 What was the situation like a decade ago?

Between 2008 – 2012 Motivation Australia carried out mobility device feasibility studies in five PICs, in partnership with national agencies the Community Based Rehabilitation Unit (Solomon Islands); Te Toa Matoa and the Tungaru Rehabilitation Service (Kiribati); the Vanuatu Society for People with Disabilities (Vanuatu); Nuanua O Le Alofa, Disability Advocacy Organisation (Samoa); and the Naunau ‘o e ‘Alamaite Tonga Association (Tonga).

A review of these five reports [16 – 17, 18, 19 – 20] and a report of disability service and human resource mapping by the CBM Australia Nossal Institute Partnership in 2011 [21] provides some perspective on the status of AT provision in the Pacific at that time.

Amidst a background of active processes underway in the region and at national level to raise awareness of the CRPD, rehabilitation and AT services were limited. Despite a long history in most PICs of government or non-government physiotherapy and/or community based rehabilitation services, these services were largely under-funded, under-staffed and reliant upon ad-hoc second hand donations of AT. Furthermore, there were very few personnel in the region with formal training in AT provision.

Focused on mobility device services, the studies noted above explored access to wheelchairs, walking aids and prostheses. In each country there was no formal service delivery for wheelchairs and walking aids. In the region, prosthetics and orthotics services were available only in Kiribati and Papua New Guinea. The mapping report [21] highlights mobility devices (mainly wheelchairs and walking aids) as the most commonly available, although “informants raised concerns about the suitability of the devices provided for the Pacific context. For example, the Vanuatu Society for Disabled People received a donation of wheelchairs that were not suitable for the island terrain.

The mapping report further notes services and assistive devices for people with hearing impairments as rare, with a notable exception of a cochlear implant project initiated in Samoa by a local non-government organisation and the support of the Australian Government. Other AT mentioned in the report includes some vision aids such as white canes, all donated, with no systematic service provision. There is no mention of AT to assist with communication, cognition, and self care [21].

2.3 What has changed?

Sarah sits in her wheelchair the centre of the image, she smiles down at a young boy who is running towards the camera.The Pacific AT study [13] completed in 2019 highlights considerable current gaps in access to AT across the Pacific. However, comparison between the findings of this study and that of a decade ago illuminates specific areas of improvement. This data, as well as authors’ responses to a series of reflective questions (see Appendix A) and a similar question answered by managers of nine mobility device services from five PICs during an evaluation workshop in April 2019 [22], reflect change in three areas.

Awareness and demand

There is strong evidence of growth in awareness of the need for an appropriate and diverse range of AT, with a corresponding increase in informed demand for appropriate AT services with trained personnel. DPO representatives, service providers and other stakeholders are increasingly specific in their advocacy and direct requests for appropriate AT inclusive of service delivery, training for people using devices and follow up. This is evidenced by the highlighting of AT as one of three pre-conditions for inclusion in the PDF SDG-CRPD Monitoring Report accompanied by a list of recommendations for increasing access to AT in the region [10]. There is also more known about who needs AT, for example through growing census data [23, 6, 24]; who is accessing AT; and who is likely to be missing out, which is also key in understanding and expressing demand. This is also critical information to identify and ensure the voice of those missing out inform and increase demand in future.

Services, personnel and products

The number of AT services and personnel with formal AT training has increased. This increase is most marked in the area of mobility device products and services. Where ten years ago there were no systematic wheelchair services in the Pacific, and prosthetic and orthotic services only in three countries, there are now mobility device services in seven PICs, five of which offer integrated services inclusive of walking aids, wheelchairs, prosthetic and orthotic devices. There are personnel trained in the clinical and technical aspects of wheelchair service delivery, and this is recognised as a requirement for the safe and effective provision of wheelchairs. All physiotherapists trained in Fiji and employed across the region in the past six years have had training in basic level wheelchair service delivery as well as all of the community based rehabilitation workers who have graduated in the Solomon Islands since 2012. The number of trained prosthetist orthotist clinical personnel has increased from five in the region with some formal training in 2008 to 15 trained to an internationally recognised standard as of August 2019.

Furthermore, the range of devices has increased. From almost universally orthopaedic style (often second hand) wheelchairs, there are now a range of different adult and paediatric products being consistently provided through the established wheelchair services [25]. Likewise, the range of prostheses has increased, through the introduction of polypropylene technology.

Findings indicate there has also been growth in access to vision and hearing AT. However, evidence suggests this is less marked, has occurred in fewer locations, and is less comprehensive in terms of addressing the need for local services, personnel and product solutions [13].

Policy environment

The policy environment is increasingly supportive of a systematic approach to the provision of AT as an integral component of health services, and as a precondition for inclusion for many. A review of a sample of disability policies, national and health action plans current between 2008 – 2012 [26, 27, 28] compared to those current in 2019 [29 – 30, 31, 32, 33, 34, 35 – 36] reveals increased content and specificity of goals and actions supporting rehabilitation and AT. Many of these goals and actions align with and have reciprocally informed WHO commitments focused on rehabilitation and access to AT.

3. What helped create change?

3.1 People

A young man crouches beside another man using a wheelchair. They are looking at another wheelchair.Advocacy: The past decade has seen rapid growth in formation of DPOs and strengthening of the disability movement in the Pacific. This has been facilitated by the leadership of PDF as the peak body for the region, the CRPD and advocacy training of DPO leaders, as well as national government, development partner and donor support. A stronger DPO network has driven increasingly effective and informed advocacy for progressive realisation of the CRPD, inclusive of enablers such as access to AT. DPOs have been active in diversifying representation within their movement and advocating for programmes to implement a variety of AT services. For example, Nuanua o le Alofa (NOLA) in Samoa were particularly influential in lobbying for Government and donor investment in mobility device and hearing services [37] as well as greater investment in accessible ICT [11].

Service providers have also been strong advocates for strengthening rehabilitation and AT services. For example, the Tongan DPO Naunau ‘o e ‘Alamaite Tonga Association Incorporated (NATA) and the national physiotherapy department were both active in advocating for existing services to be expanded to include provision of mobility devices [38].

Multi-stakeholder collaboration: Alongside the growth of the DPO network has been a deliberate strategy in the Pacific to encourage multi-stakeholder dialogue in all issues related to realising the rights of people with disabilities. There are multiple examples of national and regional workshops and meetings that have been inclusive of all key stakeholders including DPOs, service providers, government representatives, donors and development partners attending and working together to address and solve issues. Such collaboration saw the establishment of the Pacific Community Based Inclusive Development Network in 2012. A strength in the region, “unique and fruitful regional and multi-stakeholder collaboration” was recognised in the PDF CRPD-SDG monitoring report [10] as a key factor in overall progress.

Full and effective participation in society by a person using AT is dependent on many factors. AT stakeholders recognise that increasing their engagement across sectors is a critical advocacy strategy for influencing improvements in accessible infrastructure and transport as well as access to the same opportunities as others such as education, employment, justice and political participation.

Information about the people who need AT, and those who are accessing it: Establishment of practical service data systems, enabling tracking of services provided and to whom, has been a consistent component of the establishment of mobility device services in the region [39, 40]. To date there are over 4,000 people registered across seven service databases [25]. The use of qualitative surveys has further strengthened available information about people who use AT, their experiences of accessing services and the impact on their lives [41, 42].

This growing body of information is an important contributor to change. Active analysis of service data and qualitative surveys for example has led to more information about the demographics and perspectives of people using services, helping to identify and respond to issues such as service quality, suitability of products and equity of access.

Additionally, the region is set to benefit from increased information about who may need AT, through the inclusion of, for example, the Washington Groups Questions in the national census, which have been used in six PICs [10] in recent years.

3.2 Products

A young girl uses a dome magnifier to read letters on a paper on a table in front of her.Availability of products appropriate to the context: Improvement in access for more people to a greater range of wheelchairs has been one of the most significant AT developments in the Pacific. A critical success factor is the availability of a range of affordable wheelchairs suitable for the Pacific context coupled with training for service personnel in the provision of this range [43].

When systematic wheelchair service delivery began in the Pacific, the region benefitted from over a decade of innovation in wheelchair design for settings with comparable conditions elsewhere. In addition, large scale production of these designs was underway, making it feasible to procure bulk orders of ‘flat packed’ wheelchairs that could be locally assembled. This availability of appropriate designs and/or technology has also been an advantage in the introduction of prostheses, with the Pacific being able to utilise polypropolene technology developed elsewhere, however well suited to the capabilities of PIC services and the needs of people accessing them. There are no notable similar examples in other product domains, and identification and procurement of appropriate products was a common challenge identified by informants to the Pacific AT Procurement Study for other types of AT [13].

Product trials: Trials of new products are important in order to confirm whether products and their specifications are appropriate to a given context [44]. Trials are also important to socialise new technology, and build local confidence in both prescription and use. As new wheelchairs were introduced into the Pacific, trials were carried out with the support of national service providers, initially in Papua New Guinea [45] and then the Solomon Islands [46]. Critically, these trials and others [42] were active in securing feedback from both service personnel and service users to fully understand how well different products performed. Further product evaluation activities in the region have capitalised on the expertise of DPOs and their members, engaging them as data collectors to gather feedback from service users [41]. There is good evidence to suggest these local trial opportunities have assisted in the successful introduction of these new technologies. In contrast, the Pacific AT Procurement Study highlighted a lack of trials of hearing aids introduced in the Pacific and reported high levels of abandonment [13]. These issues could be better understood and results improved with context specific trials and systematic gathering of service user feedback.

Consistent supply of products: To enable reliable access to AT, a constant supply of stock is required, which requires consistent funding. At 2019, no PICs have national, consistent annual recurrent budgets for AT [13]. Again, wheelchair services have had an advantage not seen in other areas, through steady support from the Latter-day Saints Charities (LDSC). A major donor of appropriate wheelchairs into the region, LDSC support has grown from 666 wheelchairs donated into one country in 2009 to 2,746 wheelchairs and walking aids donated into six countries in 2018. This has supported recipient service providers to offer a more consistent wheelchair service. LDSC has also been responsive to increasing their range from one wheelchair design to a range as personnel were trained and the capacity of services to absorb and work with a broader range of products increased. Other donors and a few PICs have also supported procurement of wheelchairs, utilising a now established supply chain for wheelchairs.

3.3 Provision

Funding: The establishment of new services, or increasing the scope of a service, requires an initial investment to provide training for personnel as well as to equip services with facilities, tools, equipment and service systems. It also requires absorption by government and ongoing recurrent government budget to ensure the service continues. Availability of development programme funding has been a driver of change in the Pacific, with some notable examples of support from the Australian Government in accordance with the Development for All Strategy 2008-2012 [7] and 2015-2020 [47] addressing mobility device services specifically. This has included the first mobility device service pilot in the Solomon Islands [48], establishment of the new mobility device service in Samoa, [39] the re-building of the Tungaru Rehabilitation Service (after a fire) in Kiribati, expansion of rehabilitation services in Tonga [38] to include mobility device services, and similar expansion of services to encompass mobility device provision in Vanuatu. Without these investments, delivered through a development partner with relevant technical experience alongside national service partners, the gains recognised in mobility device services would not have been possible. Continued advocacy for recurring government budgets for AT and associated services is a priority moving forward.

Sustainable, local solutions: Given the constraints under which health services operate in PICs, the ongoing success of AT provision relies on services being locally owned, valued and affordable. Mobility device services in the region have been driven by local demand. Implementation has focused on building local ownership and capacity and systematic use of service data has helped demonstrate the value of the services. Technology introduced has been suited to the context, appropriate to the skills of local providers and relatively affordable. These are all viewed as factors contributing to success, in contrast to initiatives relying on visiting teams with less local involvement. Additionally, effective coordination between stakeholders can increase service efficiencies. Vanuatu offers an example of effective coordination between government health and non-government service providers that has helped drive improvements in the reach of walking aid and wheelchair services [49].

Integrated services: Integrating the provision of different mobility devices within one service has been a cost-efficient strategy in the Pacific. These integrated services share physical and human resources, service systems and referral networks to provide a ‘one stop shop’ for mobility device users, providing a more holistic service that can address the overall mobility needs of individual clients [39].

3.4 Personnel

Two men smile and laugh with each other. The man on the left is using a wheelchair, the man on the right in seated with a document in front of him. They are on the porch of a home.Viable and practical training: The increase in personnel trained in wheelchair service delivery in the Pacific was facilitated by the WHO Wheelchair Service Training Package (WSTP), a resource that enabled local delivery of a standardised and relevant training for health and other personnel. WSTP was introduced into the region as a pilot in 2010 by Motivation Australia in partnership with WHO and the Solomon Islands Rehabilitation Division [48]. There have since been over 340 participants of WSTP basic, intermediate, management and refresher training across the Region [50] (noting that some individuals have been counted more than once as they progressed through training). In 2012, a collaboration between Motivation Australia, the Solomon Islands National University and Fiji National University, saw the integration of WSTP into the curricula for community based rehabilitation workers (Solomon Islands) and physiotherapists (Fiji) [51]. Through this project and other initiatives, there are now national trainers of the WSTP in Fiji, Papua New Guinea and Kiribati.

Training of existing workforce: A success factor in increasing the number of personnel trained in provision of AT and in a position to use their skills has been a focus on training an existing workforce, coupled with effective service delivery support [43]. In the Pacific this has largely involved up-skilling community based rehabilitation workers, physiotherapists and nurses. It should be noted this has been accompanied with a slow increase in staffing numbers overall and in some instances new Government positions (for example more prosthetist-orthotist positions).

3.5 Policy

Regional policies and frameworks: After the completion of the Asian and Pacific Decade of Disabled Persons, 1993-2002, the Biwako Millenium Framework for Action (2003 – 2012) was the first key regional policy document supporting fundamental change for people with disabilities, including increasing access to information, communications and assistive technologies as one of seven priorities. The CRPD reinforced impetus gained by the Biwako Millenium Framework. It has had significant impact in the Pacific, providing a foundational human rights platform that has supported all efforts since in realising the rights of persons with disabilities. In 2012 the Incheon Strategy [52] was embraced by Pacific leaders, inclusive of a target specific to increasing access to AT. The Sustainable Development Goals have also played an important role, reinforcing AT as a precondition to ensure that no-one is left behind in the global development agenda. This has been further reinforced by the WHO AT Resolution [53] and other WHO rehabilitation and disability frameworks [54].

Together, these high-level documents, supported at implementation level by the Pacific Regional Strategy on Disability (2010-2015) [55] and the Pacific Framework on the Rights of Persons with Disabilities (2016-2025) [9] have supported PIC Governments to promote, protect and fulfil the rights of persons with disabilities. They have also driven and informed national policy documents such as disability policies and health strategies; and provided powerful advocacy and bench-mark tools that have been used effectively by the DPO network and others. At a national level, the increased acknowledgement of the need for AT and specificity regarding how this should be provided seen in current national policies and planning documents is both change in itself and also a driver for further change. Overall, the policy environment is considered by Pacific stakeholders as a key factor in increasing awareness, demand and support for disability specific services such as provision of AT [22]. Pacific stakeholders want to see greater resourcing of these policies to ensure sustainability of AT provision.

4. Conclusions

A woman wearing a prosthesis and using crutches walks supervised by two women in bright dresses. All are smiling and focused on the activity.Our findings suggest a range of factors, systems and development approaches underpin pathways to increasing access to AT, in particular in less resourced settings. These include (and are not limited to):

  • A supportive policy framework and political commitment.
  • Genuine multi-stakeholder partnership and quality collaboration between DPOs, people who use AT and their families, service providers, government, development partners and donors.
  • Building of awareness, knowledge and capacity within local agencies including DPOs, service providers and government, as well as people using AT, to plan, prioritise, advocate for, implement and evaluate AT local solutions.
  • Availability and opportunity to access, evaluate locally and utilise context appropriate and affordable AT, training approaches, service and data systems.
  • Embedding AT services within the existing health system, including training existing groups of personnel and integrating services for groups of AT (such as mobility devices) to maximise the workforce and resources, and streamline referral pathways.

Most importantly, sustainable and reliable access to AT is reliant upon the right mix of ingredients across the domains of People, Products, Provision, Personnel and Policy. Our findings highlighted the most significant improvement in access to AT over the past ten years has been the increase in access to mobility devices, and most notably wheelchairs. Wheelchairs have had the benefit of strong advocacy and growing informed demand from the People who need and provide such devices, the availability of a Product range suited to the Pacific and funding mechanisms to support procurement. Provision opportunities have been facilitated by the integration of wheelchair service delivery into existing government and non-government services, as well as the ability to provide effective local training for Personnel through the availability of an appropriate training package, training provider and financial support. At the same time, global, regional and national Policy frameworks have increasingly supported increased actions to make AT more readily available.

Pacific stakeholders remain positive about future progress with plans to ensure existing services continue to strengthen, that a diversity of voices inform the demand and availability of an increasing range of appropriate AT provision, and that governments fulfil their policy commitments by ongoing resourcing of AT.

5. Reference list

Appendix A: Author’s reflection questions

1. Compared to ten years ago, has there been an increase in the capacity of Pacific service providers to provide more and better AT services?

2. If AT service capacity has increased, in what areas has capacity increased? A useful framework is to consider capacity in these areas:

  • Human resources
  • Technical resources
  • Service systems (which includes data, service forms, referral pathways etc.)
  • Policy

Also consider if there are differences in capacity across different areas of AT (e.g. mobility, vision, hearing, communication, cognition, communication).

3. Compared to ten years ago, is it easier for Pacific Island people to access AT? Does the answer vary depending on:

  • The type of AT a person needs? Are some types of AT more readily available than others?
  • The country in which a person lives?
  • The part of a country in which a person lives?
  • A person’s age (child, adult, older person)?
  • A person’s gender?
  • A person’s level of education?
  • A person’s socio-economic situation?

4. What key events (e.g. project, activity, meeting, policy, global commitment or other) have occurred in the past ten years that had a positive influence on increasing access to AT in the Pacific? For each event, how did that event help increase access to AT?

5. How important (if at all) have the following been in helping to increase access to AT:

  • Partnership and collaboration (if yes, what partnerships and collaboration)
  • Access to AT that is appropriate for the Pacific (if yes, what AT specifically)
  • Activities that increase awareness of AT
  • Activities that support users of AT and their representatives (e.g. DPOs) to advocate for AT
  • Activities that support training of national personnel
  • Activities that support system development for AT provision (e.g. data tools, service forms etc.)
  • Activities that support improvements in infrastructure (facilities, tools, equipment)
  • Activities that strengthen policies, national and regional planning and/or frameworks that support AT provision