Annex 3: Country Summaries: Demand Landscape

ATscale
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Annex 3: Country Summaries: Demand Landscape

Logo of CLINTON HEALTH ACCESS INITIATIVE Logo with icons of eyeglasses, hearing aid, prosthetic limb, and smartphone. Text reads: ATscale GLOBAL PARTNERSHIP FOR ASSISTIVE TECHNOLOGY Hosted by UNOPS.
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The section documents the public sector demand landscape for the five priority assistive products (hearing aids, prostheses, spectacles, wheelchairs and digital assistive technologies) across 12 strategically selected countries. These countries were chosen to represent diverse geographies, varying levels of maturity in AT programmes, differing degrees of government involvement and distinct regulatory environments.

The analysis covers each country’s regulatory framework, including relevant policies, regulations and financing mechanisms, alongside a review of recent public procurement activities related to the priority products. Data were gathered through a combination of desk-based research and a primary survey conducted in selected countries. The survey targeted government representatives and implementing partners to capture information on procurement practices, cost structures and financing mechanisms for assistive products. It is important to note that some data, such as procurement volumes, are illustrative only, as comprehensive figures are publicly available for only a limited number of countries.

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1. Cambodia

1.1. Policy

1.2. Regulation

1.3. Financing

Wheelchairs and prostheses are provided free of charge at Physical Rehabilitation Centres. They are offered independently of insurance schemes. Spectacles are available only through NGOs or donor funding.

1.4. Procurement

2. China

2.1. Policy

2.2. Regulation

2.3. Financing

The 14th Five-Year Plan for the Protection and Development of Persons with Disabilities (State Issue [2021] No.10) states that, if budget permits, regional governments should provide subsidies for basic AT to persons with disabilities who face financial difficulties or have severe disability conditions [12]. Under the policy guidance, all provinces across China provide a certain level of AT subsidies. Subsidies mainly focus on low-income and severely disabled individuals, with some regions prioritizing students or elderly.

The subsidy standards are normally based on the type of assistive product, family income, severity of disability and the financial capability of the local government. Each region can formulate its own subsidy policy and mechanism for providing the subsidy, e.g. a percentage of the out-of-pocket payment, a fixed amount subsidy, or even free donation of selected basic assistive products. The subsidy coverage for assistive products reaches over 190 device types in some regions.

In addition, for certain groups like disabled servicemen, China’s “Regulations on Subsidies and Benefits for Military Serviceman [2024] No.788” stated that if AT such as hearing aids, wheelchairs and prostheses are needed for them, the government should provide financial support [13]. The Ministry of Veterans Affairs further developed the “Measures for the Provision of Rehabilitation Assistive Devices for Disabled Servicemen [2025] No.4" and “Catalogue of Rehabilitation Assistive Devices for Disabled Servicemen" [14] [15]. This policy clearly states that the provincial government should cover the cost for all the 128 products listed in the catalogue for disabled servicemen.

2.4. Insurance scheme

In general, most AT are not covered by national health insurance schemes. Regional governments' subsidies are the main methods to reduce the financial burden on those in need. Recently a few regional governments have started including some AT in their regional insurance schemes. For example, Anhui, Jiangsu and Inner Mongolia have all started to cover some AT partially in their health insurance, including hearing aids and prostheses, and the reimbursement rate is around 30 per cent to 50 per cent.

And if the disability is caused by work-related injury, according to the State Council's Regulations on Work-Related Injury Insurance, the Work-related Injury Insurance Fund should pay for these people’s needed assistive products.

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2.5. Procurement

3. Ethiopia

3.1. Policy

3.2. Regulation

3.3. Financing

There is no relevant public financing or importing mechanism provided by the government. AT provision is primarily funded by NGOs, with most devices supplied by international donors. Mobility aids such as wheelchairs are also provided by private suppliers and pharmaceutical companies through imports.

3.4. Procurement

Procurement and pricing model

AT are included in the country’s national essential medical equipment lists. The Ethiopian Pharmaceutical Supply Agency procures some transport wheelchairs upon request from hospitals or medical rehabilitation centres, but this is minimal compared to NGOs efforts. The procurement is mainly conducted by NGOs.

For government procurement, the process begins with a bid, followed by selecting manufacturers, establishing contracts, and preparing shipping documents. Simultaneously, the importer secures permits from the FDA, arranges multi-modal shipping, and facilitates clearance, storage and the final distribution through pharmaceutical supply services.

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Table 4: Ethiopia procurement of assistive products by NGOs

Type Illustrative procurement
Wheelchairs

1,223 manual wheelchairs were provided by NGOs in 2018 alone.

According to Addis Guzo Centre for people with disabilities, from 2017- 2023, it also distributed 15,000 wheelchairs.

Prostheses

4,824 were provided by NGOs in 2018 alone.

Additionally, Cheshire Services Ethiopia receives international donations in raw materials form for production of P&Os and other mobility aids. ICRC aims to provide 4,000 mobility aids each year through direct procurement.

Spectacles NGOs use various approaches to import spectacles. This includes national optical work, which comprises separate networks supported by optical NGOs with local distribution agencies, and local production, where raw materials are imported but spectacles are produced domestically.
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4. Georgia

4.1. Policy

4.2. Regulation

4.3. Financing

There is state-funded provision for assistive products through social services programmes. AT is financed in accordance with the budget specified in the State Programme for Social Rehabilitation and Childcare. Regional funding is also available. NGOs also play a role in specialized device provision.

4.4. Procurement

5. India

5.1. Policy

5.2. Regulation

5.3. Financing

Wheelchairs, prostheses and hearing aids are provided for free by the government, under the ADIP Scheme. 2 Spectacles are also provided for free by the government under the NPCBVI Scheme. Some digital AT, such as accessible software, can be provided through government initiatives. Several NGOs also play an important role in providing assistive products for free through donation or specialized programmes.

5.4. Procurement

6. Indonesia

6.1. Policy

6.2. Regulation

6.3. Financing

Funding for assistive products comes through national health insurance schemes, such as Jaminan Kesehatan Nasional (JKN) offered by Badan Penyelenggara Jaminan Sosial. Local governments and NGOs also support the financing of specialized Assistive Technologies.

6.4. Procurement

7. Kenya

7.1. Policy

7.2. Regulation

7.3. Financing

Most AT provision is primarily funded by NGOs, with most products supplied by donors. Wheelchairs are sometimes provided by the Ministry of Health and National Council for Persons with Disabilities through donations.

7.4. Procurement

8. Liberia

8.1. Policy

8.2. Regulation

8.3. Financing

Financing for AT primarily comes from NGOs, as the public sector has limited resources. International NGOs and faith-based organizations are the largest funders.

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8.4. Procurement

Procurement and pricing model

The Supply Chain Management Unit and Procurement Unit of the Ministry of Health is in charge of coordinating procurement of assistive products. However, its involvement is limited due to difficulties in technical capacity and in budgetary matters.

Procurement of AT is now managed primarily through NGOs or donor-funded public service delivery points, for example, JFK Medical Center ’s Monrovia Rehabilitation Center and Liberia Eye Center, and most assistive products are distributed through international donations, as entailed below. There is also a growing group of private sector service delivery points for spectacles.

Table 8: Liberia governmental and NGO programmes related to financing and provision of AT (Updated to 2019)

Organization Product(s) Total beneficiaries Total budget (most recent financial year)
Governmental
JFKMC – Monrovia Rehabilitation Center Wheelchairs, prostheses, crutches 5,000 (2008-2016) Unknown
JFKMC – Liberia Eye Center Spectacles, magnifiers 8,263 (2018-2019) Unknown
Non-governmental
SightSavers Spectacles, magnifiers 15,000 (cumulatively) US$100,000
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Organization Product(s) Total beneficiaries Total budget (most recent financial year)
EYElliance Spectacles 34,516 4 (cumulatively) US$42,550
Ganta United Methodist Hospital Orthopedic Center Prostheses 3,500 (cumulatively) Unknown
Ganta United Methodist Hospital Optical Center Spectacles Unknown Unknown
Ganta Leprosy Rehabilitation Center Wheelchairs, prostheses walking frames, crutches 2,500 (cumulatively) Unknown
LV Prasad Eye Institute Spectacles 5,263 (cumulatively) Unknown
Phebe Hospital Optical Center Spectacles 4,617 (cumulatively) Unknown
New Sight Eye Center Spectacles Unknown Unknown

Source: CHAI, WHO AT Assessment on Capacity (ATA-C, 2020)

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9. Nigeria

9.1. Policy

9.2. Regulation

9.3. Financing

The National Commission for Persons with Disabilities and few other MDAs supports the financing and conducts annual procurement of AT in limited quantities, constrained by insufficient funding and a lack of coordinated procurement and distribution systems. Most AT provision comes through the private sector and NGOs. Annual AT budget for five

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NGOs totalled NGN216 million (US$600,000) in 2021. Out-of-pocket expenses are common, with minimal subsidies from the government.

9.4. Procurement

10. Rwanda

10.1. Policy

10.2. Regulation

10.3. Financing

The public sector has limited resources and mainly focuses on providing support for mobility impairment through distribution of wheelchairs through National Council of Persons with Disabilities. Financing for AT primarily comes from NGOs and private sectors.

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10.4. Procurement

11. South Africa

11.1. Policy

11.2. Regulation

11.3. Financing

State funding is available through various departments, with specific policies for different types of AT, including wheelchairs, prostheses, prostheses, hearing aids, and digital AT. AT provision is the responsibility of the government, however patients are liable to an out-of-pocket fee depending on their socioeconomic classification i.e. full paying (H4), partially subsidized (H1-H3), and fully subsidized (H0) patients.

11.4. Procurement

12. Zambia

12.1. Policy

12.2. Regulation

12.3. Financing

AT are funded through the National Health Insurance Scheme started in 2018. The total budget for AT and related services in 2021 is ZMW 61,451,789 (US$3,595,799).

12.4. Procurement

References

[1] China Association of Assistive Products (2021). Blue Book on the Development of China's Rehabilitation and Assistive Device Industry. China Association of Assistive Products. ↩︎

[2] Ministry of Civil Affairs (2020). Notice on Issuing the List of Policy Measures to Support the National Comprehensive Innovation Pilot Program for the Rehabilitation Assistive Devices Industry. Ministry of Civil Affairs. https://www.gov.cn/zhengce/zhengceku/2021- 01/18/content_5580778.htm ↩︎

[3] State Council (2016). Several Opinions of the State Council on Accelerating the Development of the Rehabilitation Assistive Devices Industry, State Issue [2016] No. 60. State Council. https://www.gov.cn/zhengce/content/2016-10/27/content_5125001.htm ↩︎

[4] Ministry of Civil Affairs of the People's Republic of China (2023). China Catalogue of Rehabilitation Assistive Products (2023 Edition). Ministry of Civil Affairs of the People's Republic of China. https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.quannan.gov.c n%2Fqnxxxgk%2Fqn8515%2F202312%2Ff793fb50128b491d84772a58cf09b1d6%2Ffiles%2F35 763148012f4a1ca60069d11342aa2f.doc&wdOrigin=BROWSELINK ↩︎

[5] State Council (2019). Opinions of the General Office of the State Council on Promoting the Development of Elderly Care Services, State Issue [2019] No.5. State Council. https://www.gov.cn/zhengce/zhengceku/2019-04/16/content_5383270.htm ↩︎

[6] The National Development and Reform Commission (2019). Action Outline for Promoting High-Quality Development of the Health Industry [2019-2022]. The National Development and Reform Commission. https://www.gov.cn/xinwen/2019- 09/30/content_5435160.htm ↩︎

[7] State Council (2024). Opinions of the General Office of the State Council on Developing the Silver Economy and Enhancing the Well-being of the Elderly, State Issue [2024] No.1. State Council. https://www.gov.cn/zhengce/zhengceku/202401/content_6926088.htm. ↩︎

[8] Xinhua News Agency (2024). Value-Added Tax Law of the People's Republic of China. Xinhua News Agency. https://www.gov.cn/yaowen/liebiao/202412/content_6994557.htm ↩︎

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[9] General Administration of Customs of the People’s Republic of China (1997). Interim Provisions on the Exemption of Import Duties for Special Articles for Persons with Disabilities. General Administration of Customs of the People’s Republic of China. http://www.customs.gov.cn/customs/302249/302266/302267/356587/index.html ↩︎

[10] Economic Daily (2020). Provisional import tax rates lower than the Most-Favored- Nation (MFN) rates will be implemented for 883 items. Economic Daily. https://www.gov.cn/xinwen/2020-12/24/content_5572889.htm ↩︎

[11] General Administration of Customs. https://online.customs.gov.cn/ociswebserver/pages/jckspsl/index.html ↩︎

[12] State Council (2021). 14th Five-Year Plan for the Protection and Development of Persons with Disabilities (State Issue [2021] No.10). State Council. https://www.gov.cn/zhengce/content/2021-07/21/content_5626391.htm ↩︎

[13] State Council and Central Military Commission (2024). Regulations on Pensions and Preferential Treatment for Servicemen. State Council and Central Military Commission. https://www.gov.cn/zhengce/zhengceku/202408/content_6968087.htm ↩︎

[14] Ministry of Veteran Affairs (2025). Notice by the Ministry of Veterans Affairs, the Ministry of Civil Affairs, the Ministry of Finance, and the China Disabled Persons’ Federation on Issuing the Measures for the Provision of Rehabilitation Assistive Devices for Disabled Servicemen. Ministry of Veteran Affairs. https://www.mva.gov.cn/gongkai/zfxxgkpt/zhengce/gfxwj/202502/t20250206_465569.ht ml ↩︎

[15] Ministry of Veteran Affairs (2025). Catalogue of Rehabilitation Assistive Devices for Disabled Servicemen. https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.mva.gov.cn%2 Fgongkai%2Fzfxxgkpt%2Fzhengce%2Fgfxwj%2F202502%2FP020250206372440371699.docx& wdOrigin=BROWSELINK ↩︎

[16] Ministry of Finance, Government of India (2017). GST exemption for products used by differently abled people. Government of India. https://pib.gov.in/newsite/PrintRelease.aspx?relid=168575 ↩︎

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[17] Health Professions Council of South Africa. https://www.hpcsa.co.za/?contentId=0&menuSubId=54&actionName=Professional%20Bo ards ↩︎