Insights into the demand landscape and supply-cost components for digital assistive technology, hearing aids, prostheses, spectacles and wheelchairs in low- and middle- income countries, alongside China’s supplier landscape
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A blue cover page for a report, featuring white line drawings of assistive devices such as eyeglasses, a smartphone, a hearing aid, a prosthetic limb, and a wheelchair. In the upper left, there is a white text box that reads:
"Insights into the demand landscape and supply-cost components for digital assistive technology, hearing aids, prostheses, spectacles and wheelchairs in low- and middle-income countries, alongside China’s supplier landscape."
At the bottom, a bright blue banner contains the title in white capital letters: "ASSISTIVE PRODUCTS MARKET REPORT 2025".
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© ATscale, The Global Partnership for Assistive Technology (2025)
Suggested citation. Assistive Products Market Report 2025. Geneva: ATscale, The Global Partnership for Assistive Technology and Clinton Health Access Initiative (CHAI); 2025.
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| Foreword | 1 |
| Acknowledgements | 2 |
| List of Tables and Figures | 4 |
| Acronyms | 6 |
| Executive summary | 8 |
| 1. Introduction | 12 |
| 2. Demand landscape | 16 |
| 2.1 Hearing aids | 22 |
| 2.2 Prostheses | 28 |
| 2.3 Smartphones (digital assistive technology) | 36 |
| 2.4 Spectacles | 41 |
| 2.5 Wheelchairs | 51 |
| 2.6 Recommendations to address demand challenges for assistive products | 62 |
| 3. Assistive products supply cost drivers | 63 |
| 4. Conclusion | 75 |
| References | 76 |
| Annex 1: China Assistive Product Supplier Landscape | 79 |
| Annex 2: NGOs, social enterprises and corporate foundations included in the report | 82 |
| Annex 3: Country Summaries: Demand Landscape | 83 |
The demand for assistive technology (AT) is growing rapidly, particularly in low- and middle-income countries (LMICs). This is driven by factors such as ageing populations, the rising rates of non-communicable disease and a growing understanding of the importance of AT in promoting inclusion and improving quality of life.
The Assistive Products Market Report 2025 builds upon the success of its predecessor, the Assistive Products Market Report 2024, which provided a comprehensive guide to assistive products, prices, specifications and suppliers. This new edition takes a crucial step forward by focusing on the demand side of AT market dynamics. It delves into the significant unmet need for AT in LMICs, analyses the complexities of supply chain costs and examines the role of China’s supplier landscape.
This report is a valuable resource for policymakers and suppliers seeking to gain a deeper understanding of the AT market needs in LMICs. It offers actionable strategies to improve AT access and encourages collaboration to strengthen the AT ecosystem.
By highlighting the scale of the unmet needs, the report underscores the urgent requirement for a more robust and equitable market for assistive products. It provides a road map for policymakers to develop and implement effective strategies and policies that promote access to affordable and appropriate AT for underserved populations.
We believe that this report will serve as a catalyst for change, fostering greater collaboration between policymakers, suppliers and other stakeholders to ensure that everyone, regardless of their location or income, has access to the AT they need to live healthier, more dignified and productive lives.
Pascal Bijleveld
CEO, ATscale
2This report was developed by ATscale, the Global Partnership for Assistive Technology, under the guidance of Satish Mishra and Ranjavati Banerji. The contributing authors were Ritubhan Gautam, Yolanda Liang, Fernando Gracia Albero and Frederic Seghers, Clinton Health Access Initiative (CHAI).
ATscale and CHAI are grateful to the contributors and peer reviewers who provided their valuable input in a generous voluntary capacity in drafting, providing content input, reviewing and revising this guidance:
We would also like to express our gratitude to our public and private sector partners across low- and middle-income countries. Thanks to the dedicated efforts of all involved, we are collectively working to increase the accessibility of assistive technology for more people in need.
4Table 1: Global need and current provision by NGOs, corporate foundations and social enterprises
Table 2: NGOs providing hearing aids to LMICs
Table 3: Corporate foundations providing hearing aids in LMICs
Table 4: Global procurement services providing hearing aids in LMICs
Table 5: NGOs providing prostheses in LMICs
Table 6: Smartphone inclusion efforts and volume within public AT procurement programmes (within survey reporting period)
Table 7: List of countries with priority assistive product lists (APLs) that include smartphones
Table 8: Illustrative NGOs providing spectacles in LMICs
Table 9: NGOs providing wheelchairs in LMICs
Table 10: Social enterprises providing wheelchairs in LMICs
Table 11: Global procurement services providing wheelchairs in LMICs
Table 12: Cost component for spectacles supply
Table 13: Key tax components for spectacles import in Ghana
Table 14: Cost component for hearing aids supply
Table 15: Cost component for prostheses component supply
Table 16: Cost component for wheelchair supply
Figure 1: Global Hearing Aid Unit Sales and annual growth (2018-2023)
Figure 2: Units of prostheses provided by ICRC by region (2021-2023)
Figure 3: HI headquarters’ procurement value for prostheses (2021-2024)
Figure 4: Total units of prostheses delivered by ROMP (2020-2025)
Figure 5: Mobile ownership (per cent of the population)
5Figure 6: Mobile ownership year-over-year growth rate (per cent; 2022-2023, ranked by growth rate)
Figure 7: Aggregated NGO procurement volume for spectacles (2021-2024)
Figure 8: Volume trends for the three NGOs with the highest spectacles dispensing volume (2021-2024)
Figure 9: Example of cost component for spectacles shipment to Bangladesh
6| AAC | Augmentative and Alternative Communication |
| ADIP | Assistance to Disabled Persons |
| AFES | African Federation for Emergency Services |
| AFWC | African Federation of Wheelchair Communities |
| AI | Artificial Intelligence |
| AK | Above Knee |
| ALTSO | A Leg to Stand On |
| ASEAN | The Association of Southeast Asian Nations |
| AT | Assistive Technology |
| BK | Below Knee |
| BRI | Belt and Road Initiative |
| BTE | Behind the Ear |
| CADTC | China Assistive Devices and Technology Center for Persons with Disabilities |
| CBM | Christian Blind Mission |
| CDPF | China Disabled Persons’ Federation |
| CE | Conformité Européenne (European Conformity) |
| CHAI | Clinton Health Access Initiative |
| COVID | Coronavirus Disease |
| CR | Crown Resin (lens material) |
| CSR | Corporate Social Responsibility |
| CURE | CURE International |
| FDA | Food and Drug Administration |
| FWM | Free Wheelchair Mission |
| GSMA | Global System for Mobile Communications Association |
| HI | Humanity and Inclusion |
| HKI | Helen Keller International |
| HTWF | Hear the World Foundation |
| IAPB | International Agency for the Prevention of Blindness |
| ICRC | International Committee of the Red Cross |
| IEC | International Electrotechnical Commission |
| ISO | International Organization for Standardization |
| JKN | Jaminan Kesehatan Nasional (Indonesia health insurance scheme) |
| KEBS | Kenya Bureau of Standards |
| LDS | Latter-day Saints |
| LMIC | Low- and Middle-income Countries |
| NGN | Nigerian Naira |
| NGO | Non-governmental Organization |
| NMPA | National Medical Products Administration |
| NPO | Non-profit Organization |
| NVG | New Vision Generation |
| ODM | Original Design Manufacturer |
| OEM | Original Equipment Manufacturer |
| P&O | Prosthetic & Orthotic |
| PAC | Product Advisory Council |
| PRP | Physical Rehabilitation Programme |
| QA | Quality Assurance |
| QC | Quality Control |
| R&D | Research & Development |
| RMB | Renminbi (Chinese Yuan) |
| ROMP | Range of Motion Project |
| SAMR | State Administration for Market Regulation |
| SGS | Société Générale de Surveillance |
| TR | Trade Regulation |
| UN | United Nations |
| UNICEF | United Nations International Children’s Emergency Fund |
| US | United States |
| USAID | United States Agency for International Development |
| UV | Ultraviolet |
| VAT | Value Added Tax |
| WHO | World Health Organization |
The Assistive Products Market Report 2024 edition was focused on presenting a one- stop guide to assistive products, prices, specifications and suppliers and on providing a brief overview of the market landscape for hearing aids, spectacles, prostheses, wheelchairs and digital AT. Launched on World Day for Assistive Technology, 4 June 2024, the report provided a road map to countries for procuring assistive products. While this report focused on enhancing information transparency on the supply-side, significant gaps in knowledge remained on the demand side including on the scale of unmet need for assistive products, particularly in low- and middle-income countries.
Therefore, the Assistive Products Market Report 2025 report complements the previous edition by focusing on the demand side of AT market dynamics, such as the unmet need for AT, supply chain costs and China’s supplier landscape, and offers actionable strategies to improve AT access in low- and middle-income countries. The report is aimed at policymakers and suppliers to gain a deeper understanding of the AT market needs in LMICs and encourages them to adopt suitable strategies and policies to collaborate and strengthen access to AT to underserved populations.
The estimated value of the global assistive products market in 2024 is between US$26 billion and US$31 billion, with a projected annual growth rate of 7 to 10 per cent through to 2030. LMICs remain underrepresented in the market, with an unmet need potentially tenfold larger than current demand. Though LMICs account for about 84 per cent, or 6.6 billion, of the world’s population. Moreover, the assistive products market in LMICs is expected to grow significantly, driven by factors such as an ageing population and a rise in non-communicable diseases (NCDs). For instance, the World Health Organization (WHO) projects that by 2050, two thirds of the global population aged 60 and above will reside in LMICs.
The unmet need for assistive technology is significant in LMICs and can be illustrated through the following examples.
On average, two in three users in LMICs purchase their AT through the private sector, which goes up to four in five for spectacles. Therefore, people in LMICs heavily rely on out-of-pocket expenditures to access AT. Provision through NGOs, corporate foundations and government initiatives remains limited in reach, with only a small portion of the need for hearing aids being met, and with slightly more, though still limited, provision for prostheses and wheelchairs.
Given the heavy reliance on out-of-pocket expenditure in LMICs, the high cost of assistive products remains a major barrier to access. Cumulatively, additional costs such as duties, shipping, logistics, distributor and retailer margins can push the price as high as 500 per cent of the ex-factory cost. These costs are driven by the following factors:
Several structural challenges hinder the effective provision of assistive products and deepen the unmet need in LMICs:
To address these challenges, key recommendations include the following:
(1) enhancing transparency in supply chains to improve efficiency and accountability;(2) strengthening government policies to integrate at into health or social insurance schemes; (3) consolidating funding sources to encourage multi-stakeholder partnerships; and (4) promoting market efficiency with supportive policies, such as tax exemptions, increased private sector engagement and encouraging local and regional manufacturing, where feasible.
12Globally, 1 billion people are unable to access assistive technology that they need [1]. Market failures are a key reason for this, impacting low- and middle-income countries in particular. Information asymmetries are one of the most important market failures: policymakers often have limited visibility of demand in LMICs, the available supply of AT and the complete magnitude of the associated supply costs. These failures disproportionately affect vulnerable populations, underscoring the need for systemic reforms and robust market development to enhance access to priority assistive products, including digital assistive technologies, spectacles, hearing aids, prostheses and wheelchairs.
The Assistive Products Market Report 2025 is a continued effort to mitigate market information gaps and complements the Assistive Products Market Report 2024, which was published by ATscale and CHAI on World Day for Assistive Technology on 4 June 2024 [2]. The 2024 report aimed to address some of these failures by offering a one- stop product guide for buyers, donors and policymakers. This edition complements that report and focuses on the demand landscape for AT, including analysis of procurement by governments, NGOs and corporate foundations. It also presents an in-depth analysis of the price components that affect the cost of supplying assistive products, which in turn influences its demand.
The report focuses on five assistive products: wheelchairs, prostheses, spectacles, hearing aids and digital AT (including augmentative and alternative communication, screen readers and smartphones), selected for their high demand in LMICs.
The report is organized into sections:
In addition, it includes three annexes:
The methodology of this report includes a combination of primary and secondary data collection. Primary data were obtained through structured interviews and surveys with global AT providers such as UNICEF, NGOs, corporate foundations, implementing partners and ministries in various countries. These included over 50 key informant interviews with stakeholders across various LMICs to understand procurement practices, demand trends and price components of supply. A survey was conducted in the selected 12 countries, targeting government representatives, to gather official information on procurement, cost and financing of assistive products.
Where exact data were unavailable, proxy values were used based on similar products or regions and validated through consultation with suppliers and practitioners. All cost estimates were standardized to a percentage of the ex-factory price of the product. This approach enables a comparative view of where costs are concentrated within the supply chain and highlights opportunities for efficiency gains or price reductions through pooled procurement, local production or policy reforms.
We are committed to continually enhancing these reports. Your contributions, in the form of sharing feedback and information, will be invaluable for their inclusion in future editions, thus enriching this resource for all stakeholders.
Email us at atmarketreport@clintonhealthaccess.org
16WHO estimates the value of the global AT market at between US$26 to US$31 billion, a figure that doubled over last 9 years [3]. According to various market research firms, the market for assistive products is expected to grow significantly over the coming years, with projections indicating year-on-year growth of about 7 to 10 per cent from 2024 to 2030 [4]. However, this figure underrepresents the demand in LMICs, where unmet needs are estimated to be tenfold larger than current demand.
LMICs are expected to drive significant growth in the AT market, propelled by an ageing population, the rising prevalence of non-communicable diseases and a growing awareness among governments, donors and consumers about the benefits of AT. For instance, the WHO projects that by 2050, two thirds of the global population aged 60 and above will reside in LMICs [5]. Furthermore, non-communicable diseases disproportionately affect people in LMICs, where more than three quarters of the 31.4 million global deaths occur [6].
There exists a large gap between the global need for assistive products, the demand in LMICs and the current level of procurement in LMICs by governments, NGOs and social enterprises. Table 1 summarizes the estimates across the five product categories and highlights the significant gap between the need and nationally funded procurement of AT. NGOs, faith-based organizations and social enterprises aim to bridge this gap by providing assistive products to those in need.
Their efforts remain pivotal, but demand is highly influenced by funding constraints, the shifting priorities of global donors and alignment with national policy frameworks. This fragmented but growing demand underscores the need for strategic coordination and investment to address gaps in LMIC markets effectively.
17Table 1: Global need and current provision by NGOs, corporate foundations and social enterprises
Hearing aids
| Global need | 1.6 billion have hearing loss, with 430 million having moderate to severe loss |
| Unmet need | More than 80% lack access |
| LMIC procurement landscape | 45,000 units from major NGOs, corporate foundations, global procurement services, and surveyed governments |
| NGO procurement/ donation | Less than 5,000 units provided by NGOs (2023) |
| Corporate foundations procurement/donation | Over 4,000 units (2023) |
| Social enterprises procurement | NA |
| Global procurement service procurement | 15,000-20,000 units since 2022 |
| Government procurement (illustrative) |
|
Prostheses
| Global need | 65 million people live with amputations |
| Unmet need | More than 80% lack access |
| LMIC procurement landscape | High reliance on NGOs, around 25,000-30,000 units in total from major NGOs, social enterprises, and surveyed governments per year |
| NGO procurement/ donation | 22,376 units (2023) provided by ICRC |
| Corporate foundations procurement/donation | NA |
| Social enterprises procurement | NA |
Prostheses
| Global procurement service procurement | NA |
| Government procurement (illustrative) |
|
Wheelchairs
| Global need | 80 million people need wheelchairs |
| Unmet need | 65% to 95% lack access |
| LMIC procurement landscape | Over 150,000 units from major NGOs, social enterprises, global procurement services, and surveyed governments |
| NGO procurement/ donation | Over 100,000 units provided by large NGOs (2023) |
| Corporate foundations procurement/donation | NA |
| Social enterprises procurement | Over 15,000 units (2023) |
| Global procurement service procurement | Over 10,000 units since 2022 |
| Government procurement (illustrative) |
|
Smartphones (Digital AT)
| Global need | 1.3 billion persons with disabilities would benefit from digital AT |
| Unmet need | Smartphone ownership gap can range from 16% to up to 76% |
Smartphones (Digital AT)
| LMIC procurement landscape | 7 in 10 countries showing year-over-year growth above 2% in smartphone demand |
| NGO procurement/ donation | NA |
| Corporate foundations procurement/donation | NA |
| Social enterprises procurement | NA |
| Global procurement service procurement | NA |
| Government procurement (illustrative) | Georgia: 50 units (2021) |
Spectacles
| Global need | 2.6 billion people with myopia, 1.8 billion with presbyopia |
| Unmet need | 64% lack access |
| LMIC procurement landscape | 80% procurement through private sector, with 10-15 million served by NGOs and social enterprises |
| NGO procurement/ donation | 7 million units in 2023 provided by large NGOs; 11.5 million units expected in 2024 |
| Corporate foundations procurement/donation | 14 million units (2023) [7] |
| Social enterprises procurement | 2 million units (2023) |
| Global procurement service procurement | NA |
| Government procurement (illustrative) | Indonesia: 1.3 million units (2018) |
Despite the fast-growing needs in LMICs, several challenges continue to impede the effective provision of assistive products:
Hearing aid helps individuals with hearing loss to listen, communicate and participate more fully in daily activities. Latest estimates reveal that hearing loss affects 1.6 billion people worldwide, of whom 430 million have moderate or higher severity hearing loss [8]. By 2050, the number of people with hearing loss is projected to reach nearly 2.5 billion, of whom 700 million will have moderate or higher severity of hearing loss [8]. Prevalence of hearing loss varies across regions, with 80 per cent living in LMICs [8]. The need is significantly under-tapped despite this growth, with fewer than 20 per cent of people who need hearing solutions currently have access to one [9].
Access to hearing aids is just one component of rehabilitation for people with hearing loss. Counselling, speech and language therapy, hearing aid fittings, follow-ups, provision of repair and spare parts such as batteries are critical for the success of hearing aid rehabilitation programmes. It is important to note that this section focuses solely on the number of hearing aids being provided in LMICs as a measure of demand. 1
The global market for hearing aids has demonstrated consistent growth in recent years, driven by demographic shifts, technological advancements and increasing awareness of hearing health [2]. In 2024, the European Hearing Instrument Manufacturers Association reported a 7.7 per cent increase in global hearing aid sales by the world’s largest hearing instrument manufacturers, bringing the total to 21.8 million units in 2023. This follows a pattern of overall growth in global unit sales (Figure 1) [10]. One should note that the 2020 decline in sales was predominantly linked to the COVID-19 pandemic.
1.It does not assess the provision of the hearing aid fittings and services being provided, nor does it consider essential factors such as access to repair, maintenance and spare parts, all vital for ensuring successful outcomes from hearing aids fittings. Readers must reference this report along with WHO’s guidance on hearing aid service delivery approaches for low- and middle-income settings. Additionally, the report does not further segment demand into adult and paediatric hearing aids. ↩︎
Figure 1: Global Hearing Aid Unit Sales and annual growth (2018-2023)
Image Description
Line graph showing units sold (in millions) from 2018 to 2023. The vertical axis ranges from 12 to 24 million units. The horizontal axis lists the years: 2018, 2019, 2020, 2021, 2022, and 2023.
- In 2018, about 16 million units were sold, with a +6.6% increase from the previous year.
- In 2019, sales rose to around 17 million units, a +6.4% increase.
- In 2020, sales dropped sharply to about 14 million units, a -17.2% decrease.
- In 2021, sales rebounded to about 19 million units, a +37.0% increase.
- In 2022, sales increased to about 20 million units, a +4.7% rise.
- In 2023, sales reached about 22 million units, a +7.7% increase.
The graph shows a dip in 2020, followed by a strong recovery and steady growth through 2023.
Despite global growth, demand for hearing aids remains low in LMICs. The WHO estimates that coverage in these regions is less than 3 per cent [11]. This low coverage is in part attributed to the lack of government provision or insurance coverage. Relatively few non-profit organizations are active in this space. Corporate foundations aim to bridge this gap. Mayflower Medical Outreach’s International Humanitarian Hearing Aid Purchasing Programme (IHHAPP) and UNICEF have negotiated more affordable prices and offer procurement services to countries and development organizations respectively.
The hearing aid market in LMICs is driven by a small number of NGOs and corporate foundations and supported by global procurement services such as UNICEF and the IHHAPP. Overall, hearing aid market demand in LMICs is significantly insufficient compared to need. For approximately 400 million people in LMICs who could benefit from hearing aids, major NGOs, corporate foundations, global procurement services and surveyed governments provide fewer than 50,000 units annually.
Only one third of surveyed governments, such as South Africa, procure and provide hearing aids (≈18,000 annually). NGOs account for around 10 per cent of the served demand, while corporate foundations contribute 15 per cent and global procurement services around 60 per cent. The remainder is met through scattered, small-scale government procurement or donations.
Few NGOs are active in hearing health and NGO procurement for hearing aids is low, estimated at approximately 5,000 units per year and declining due to reduced funding. CBM is the largest NGO buyer. NGOs have adopted WHO guidelines and procure digital Behind the Ear (BTE) hearing aids. Product selection is informed by WHO’s
24recommendations for hearing aids specifications and quality [12], [13], [14]. Optimal quality at an affordable price, and prior experience with the supplier’s procurement capabilities and reliability are critical factors in supplier and product selection by NGOs.
Table 2: NGOs providing hearing aids to LMICs
| Organization | Christian Blind Mission |
|---|---|
| About | International Christian Development Organization active in 40 countries |
| Volumes (units) |
|
| Specifications |
|
| Suppliers |
|
| Pricing |
|
| Organization | World Wide Hearing |
|---|---|
| About | Non-profit active in Guatemala, the Philippines, Peru and Zimbabwe. |
| Volumes (units) |
|
| Specifications |
|
| Suppliers |
|
| Pricing | NA - varies by region |
Corporate foundations are important providers in LMICs. Based on available info, Hear the World Foundation and Starkey Foundation are the two largest donors of hearing aids. Hear the World Foundation donated more than 4,000 units in 2023. 2
Table 3: Corporate foundations providing hearing aids in LMICs
| Organization | Hear the World Foundation |
|---|---|
| About | Non-profit foundation founded by Sonova Group, dedicated to improving access to hearing care for children in LMICs; currently active across 13 countries in LATAM, EMEA and APAC |
| Volumes (units) |
|
| Specifications | • Digital BTE programmable hearing aids |
| Suppliers | • Sonova Group’s Products- Phonak, Hanston, Unitron |
| Pricing | NA |
| Organization | Starkey Hearing Foundation |
|---|---|
| About | Corporate Foundation linked to Starkey Hearing; active in over 100 countries |
| Volumes (units) | NA |
| Specifications | • Digital BTE hearing aids tailored to local care professionals |
| Suppliers | • Starkey |
| Pricing | NA |
UNICEF and IHHAPP offer procurement services for hearing aids for governments/UN agencies and NGOs respectively. Based on available information, between 15,000 – 20,000 hearing aids have been purchased through UNICEF procurement services since 2022. Demand for hearing aids through IHHAPP is low and has dropped since COVID.
2.Data from the Starkey Foundation were unavailable when the report was published. ↩︎
Table 4: Global procurement services providing hearing aids in LMICs
| Organization | IHHAPP |
|---|---|
| About | Hearing Aids Purchasing programme managed by Mayflower Medical Outreach |
| Volumes (units) |
|
| Specifications | • Digital BTE hearing aids, adjustable via screw set potentiometers or software-based |
| Suppliers |
|
| Pricing | • US$85 to US$135 |
| Organization | UNICEF Supply Division |
|---|---|
| About | UNICEF’s procurement services can be accessed by governments and UN agencies |
| Volumes (units) | • Since 2022: 15,000-20,000 |
| Specifications | • Digital BTE pre-programmed and programmed hearing aids |
| Suppliers |
|
| Pricing | • US$56 to US$162 |
Based on limited data collection, only 4 out of 12 countries (33 per cent) procure hearing aids, primarily upper-middle-income countries.
27Examples of governments procuring hearing aids:
| China | The procurement of hearing aids is not yet fully centralized through national bulk purchasing programmes, but are largely procured or subsidized through various channels, including local Disabled Persons' Federations of each province or cities, or the Audiology Development Foundation of China under the National Health Commission. |
| Georgia | Hearing aids are procured by the government through open tenders. The most recent national tender on supply and distribution of hearing aids was released in March 2022. Based on WHO’s ATA-C report, 1,060 hearing aids for adults and 100 hearing aids for children were procured through the government tender and supplied to beneficiaries. |
| South Africa | The most recent transversal tender was released in October 2023 for supply and delivery of hearing aids and implantable hearing devices. This tender covers a period of 36 months. South Africa provided on average 18,000 hearing aids annually between 2017 and 2020. |
Governments subsidizing hearing aids:
| Indonesia | The government supports hearing aids through the national insurance scheme. It covers one hearing aid up to IDR1.1 million (approximately US$71) via certified sellers upon prescription for 5 years. Based on WHO’s ATA-C report, the national health insurance subsidized 7,690 hearing aids in 2018. |
The global hearing aids market has shown significant growth in recent years. Despite this progress, access to hearing aids remains uneven, particularly in LMICs, where coverage is critically low. While NGOs and corporate foundations are attempting to provide essential hearing care services where no formal provisions exist, the scale remains far below the level of need. To address the large unmet demand, it is essential for donors and LMIC governments to allocate dedicated budgets for the provision of hearing aids.
28Globally, it is estimated that 65 million people live with limb amputations, with 60 per cent being lower limb amputations. But fewer than 20 per cent of the people who could benefit from prostheses have access to them [2]. The WHO estimates that the demand for prostheses will continue to grow and double by 2050, particularly in LMICs [15], driven by population growth, rising trauma incidence and an increase in non- communicable diseases such as diabetes.
International NGOs, such as Humanity & Inclusion (HI) and the International Committee of the Red Cross (ICRC), are key providers of prosthetic care in LMICs, particularly countries affected by conflict or natural disaster. Demand for prostheses in LMICs is influenced by the following factors: 1) lack of comprehensive and reliable market information; 2) limited product offerings; 3) high markups in supply chains (see Section Price Component of Assistive Products); and 4) lack of qualified service providers and trained clinicians.
For millions of people in LMICs who need prostheses, major NGOs, social enterprises and surveyed governments provide approximately 25,000–30,000 units annually. The ICRC, the largest NGO in this field, supports prosthetic services across 28 countries, supplying around 23,000 units each year. Half of the surveyed governments also procure prostheses annually – for example, Cambodia purchases 4,000 units, while Georgia and Indonesia each procure 300 units.
NGOs play an important role in LMICs. Often, NGOs set up prosthetic care in the context of humanitarian response and have continued to offer services thereafter. These NGOs generally operate under two primary models, either fully subsidised (e.g. ALTSO) or partially subsidized (e.g. ROMP).
We do not have a full picture of the aggregated volume as some NGOs like HI also buy through a decentralized system. The available data also show a steady or growing demand for prostheses.
The ICRC Physical Rehabilitation Programme appears to be the largest NGO buyer with 22,376 units in 2023 [16]. The largest markets for ICRC are South Asia, the Near and Middle East and East Africa.
29Figure 2: Units of prostheses provided by ICRC by region (2021-2023)
Image Description
Bar chart comparing the number of people (in thousands) across different regions for the years 2021, 2022, and 2023. Each region has three vertical bars, colored in shades of blue for each year. The regions listed from left to right are: Europe and Central Asia, Americas, West Africa, North and Central Africa, Southeast Asia, Near and Middle East, East Africa, and South Asia.
The values for each region and year are as follows:
Europe and Central Asia: 373 (2021), 308 (2022), 108 (2023)
Americas: 785 (2021), 522 (2022), 332 (2023)
West Africa: 1,215 (2021), 1,427 (2022), 1,399 (2023)
North and Central Africa: 1,663 (2021), 1,733 (2022), 1,409 (2023)
Southeast Asia: 2,305 (2021), 3,461 (2022), 3,491 (2023)
Near and Middle East: 4,870 (2021), 4,796 (2022), 4,356 (2023)
East Africa: 4,173 (2021), 4,539 (2022), 4,817 (2023)
South Asia: 6,847 (2021), 8,031 (2022), 6,468 (2023)
ICRC predicts that the total volume of prostheses delivered in 2024 and 2025 will remain at a similar level. Due to a rise in global conflicts and the corresponding rise in humanitarian needs, ICRC is experiencing funding constraints for its global physical rehabilitation programmes. Consequently, the number of prostheses delivered is not expected to grow. In response to the funding constraints, ICRC began exploring new financing models and ended physical rehabilitation projects in 11 countries: Algeria, Democratic People's Republic of Korea, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Niger, the Philippines, Tanzania and Viet Nam [17]. 3
HI provides rehabilitation services across 42 countries [18]. Its prostheses procurement is mainly decentralized via countries with partial procurement from the headquarters. The data from headquarters procurement show an increase from 2021 to 2024.
Figure 3: HI headquarters’ procurement value for prostheses (2021-2024) 4
3.Further edition from ICRC team. ↩︎
4.The data is provided by Humanity & Inclusion. Please note that the 2024 data is only up to the beginning of the year, and more should be expected for the full year. ↩︎
NGOs, such as CURE International, ALTSO and ROMP, each deliver an average of around 500 prostheses per year. These NGOs fully or partially subsidise costs for patients. NGOs indicated that demand has been either steady or increasing over the last five years (see Figure 4). The primary products procured by these NGOs are lower-limb above-knee (AK) and below-knee (BK) sets, with ROMP reporting that over 90 per cent of its procurement is for lower limbs [19]. ALTSO and CURE focus on lower-limb products for children.
Figure 4: Total units of prostheses delivered by ROMP (2020-2025)
The price across all NGOs interviewed ranges from US$67 to US$450 for a BK set and from US$222 to US$700 for an AK set. NGOs report that users in LMICs are seeking higher-functionality prostheses than those currently available in LMICs. NGOs therefore expect to increasingly source higher-functionality products such as dynamic feet and higher-mobility-level knees.
The key selection criteria across NGOs are as follows: 1. price; 2. quality; and 3. logistics. The NGOs stated that they are trying to seek more affordable options from emerging countries. However, accessing product information, assessing quality and managing logistics is challenging. As a result, they often rely on global providers with a stronger local presence and reputation.
31Table 5: NGOs providing prostheses in LMICs
| Organization | A Leg to Stand On (ALTSO): |
|---|---|
| About | NGO providing prosthetic limbs, orthotic braces and wheelchairs to children; active in 10+ countries |
| Volumes (units) |
|
| Type | • Joshi: a modular lower limb system from lightweight aluminium materials |
| Suppliers | • Designed by ALTSO and produced by a contract manufacturer in India. |
| Reference pricing | • US$350 to donate a Joshi |
| Organization | CURE International |
|---|---|
| About | Christian NGO that operates 8 children’s hospitals around the world. |
| Volumes (units) | • 2023: 459 |
| Type | • Mainly BK set and AK set for children |
| Suppliers |
Mainly two channels: Regal Prostheses (Hong Kong SAR) OADCPH, a distributor from Togo |
| Reference pricing |
|
| Organization | Humanity & Inclusion (HI) |
|---|---|
| About | NGO providing rehabilitation services across 42 countries |
| Volumes (units) |
No volume data available but HI shared the procurement funding for their headquarters. 2021: €9,500 2022: €69,000 2023: €158,000 2024: €477,2005 This does not include local programme purchases. |
| Type | • Various components, such as knee joints, ankle joints, connectors, etc. |
| Suppliers |
|
| Reference pricing |
|
| Organization | ICRC - Physical Rehabilitation Programme |
|---|---|
| About | An ICRC programme established in 1979 to support physical rehabilitation services globally. |
| Volumes (units) |
2021: 22,231 2022: 24,817 2023: 22,376 The volume for 2024 and 2025 is predicted to remain stable. |
| Type |
|
| Suppliers |
|
5.The data were retrieved from September 2024 and therefore does not include the full year funding. ↩︎
| Organization | ICRC - Physical Rehabilitation Programme |
|---|---|
| Reference pricing |
|
| Organization | The Range of Motion Project (ROMP) |
|---|---|
| About | NGO dedicated to ensuring access to high-quality prosthetic care, active in Guatemala and Ecuador. |
| Volumes (units) |
|
| Type | • Copoly Socket Fabrication |
| Suppliers |
|
| Reference pricing |
|
Note: The list is not exhaustive, but shows the product types, volumes, manufacturer and prices in NGO procurement. The NGOs were strategically selected to cover different geographies and age groups.
Based on limited data, government demand for prostheses in LMICs is limited to a few more developed countries, with many countries still relying on NGOs for provision. Out of 12 countries surveyed, 6 (50 per cent) procure or subsidize prostheses.
Examples of governments procuring prostheses:
34| Cambodia | The government procures prostheses through the Ministry of Social Affairs, Veteran, and Youth Rehabilitation. According to primary survey data, in 2023 the government procured 4,257 units of prosthetics and orthotics at prices ranging from US$120 to US$585 per unit. |
| China | Regional disabled persons' federations, public hospitals and rehabilitation centres announce tenders through local government websites and national platforms like the China Assistive Device and Technology Centre and the China Disabled Persons’ Federation. The government does not disclose the annual procurement volume of prostheses. |
| South Africa | South Africa issued its most recent national transversal tender for rehabilitation equipment, including prostheses, in 2019 under bid number RT55. The tender covers the period from March 2020 to February 2023. |
| Zambia | The government procures prostheses through public tenders and Requests for Proposals issued by the Zambia Public Procurement Authority. The latest tender for prostheses and orthoses closed in October 2024, but the value remains undisclosed [20]. |
Examples of governments subsidizing prostheses:
| Georgia | The government allocated GEL2.7 million (≈US$984,000) in 2020 and GEL 2.1 million (≈US$769,000) in 2021 for prostheses. It subsidised up to GEL 5,135 (≈US$1,885 dollars) for lower-limb prostheses and up to GEL 7,410 (≈ US$2,720 dollars) for upper- limb prostheses. In total, 379 state-subsidized prostheses were provided in 2020 and 262 in the first half of 2021 [21]. |
| Indonesia | The government procures prostheses through its national medical equipment procurement platform, “E-catalogue” [22]. It subsidizes up to IDR 2.8 million (≈US$177 dollars) for prostheses6. In 2018, the Indonesian national health insurance subsidized 401 prostheses, with a total reimbursement of IDR964.7 million (≈US$62,000 dollars), accounting for around 0.03 per cent of total government expenditure on assistive products that year [23]. The coverage remains limited due to a lack of national planning and funding. |
6.Data collected by CHAI country team. ↩︎
The need for prostheses in LMICs significantly exceeds current procurement volumes. The high costs and limited product availability restrict access for those in need. Government procurement for prostheses in LMICs is limited to a few more developed countries, while NGOs serve as the primary purchasers across LMICs, supplying prostheses to underserved populations. ICRC and HI are the leading buyers, while regional NGOs fill the demand gaps across different continents.
In the short term, given the increasing global conflicts and growing humanitarian needs, the main demand generator, ICRC, faces funding constraints and does not anticipate a substantial rise in procurement. However, in the long term, demand for high-quality, affordable and logistically efficient prosthetic solutions is expected to grow. Key drivers include population growth, rising trauma cases and the increasing prevalence of non- communicable diseases.
36The 2024 edition offered a comprehensive overview of screen readers, augmentative and alternative communication tools and smartphones, collectively categorized as digital assistive technology. This 2025 edition focuses more narrowly on smartphones, reflecting recent findings that highlight their consistent presence in the demand landscape across LMICs compared to the standalone technologies covered in the previous editions.
Smartphones have emerged as an assistive product that may effectively and potentially more affordably meet the needs of persons with disabilities. They offer features that support a wide range of disabilities, including cognitive and sensory impairments, by consolidating functions traditionally handled by separate, more specialised devices. For example, they can integrate screen reading, text-to-speed applications and navigational aids, all on one device [1].
Smartphones are becoming one of the most cost-effective and widely used assistive products [24], [25], [26]. In Kenya, for instance, 69 per cent of smartphone owners with visual impairment use mobile internet daily, compared to 56 per cent of owners without a disability [27]. A study by GDI Hub, ATscale and Google is underway to assess the impact of smartphones in these contexts. The study’s preliminary findings across Brazil, India and Kenya indicate that smartphones are “both an enabler in people’s lives and a piece of assistive technology with the potential to replace older forms of stand-alone assistive technology” [28]. This highlights the smartphone’s potential as an enabler of independence for persons with disabilities.
Few comprehensive data exist on smartphone demand in LMICs specifically for persons with disabilities. However, experts consulted suggest their demand is unlikely to be lower than that of the general population, as smartphones would generally be used for similar tasks in most cases; it is only the features and functions to deliver those tasks that vary. Therefore population-level smartphone demand data are used as a proxy to estimate demand among persons with disabilities.
GSMA’s Mobile Internet Connectivity Index estimates the smartphone demand trends in LMICs (see Figure 5) [29]. All countries in scope are seeing notable growth in demand, as evidenced by 10 of the 14 illustrated countries having a year-over-year growth rate of over 2 per cent. However, the trend resembles an inverted bell shape, with slower growth at the extremes of smartphone penetration and higher year-over-year growth in the mid-range. For example, China has a high mobile ownership rate but displays the smallest year-over-year growth. Low-income countries like Ethiopia and Liberia also show relatively small year-over-year growth, under 2 percentage points. Comparatively,
37countries like Cambodia and Kenya, in the mid-range of the overall ownership figures, display relatively high ownership growth rates of over 3 percentage points.
Figure 5: Mobile ownership (per cent of the population, ranked by ownership rate)
Image Description
Horizontal bar chart comparing percentages for the years 2022 and 2023 across various countries. Each country is listed on the left, with two bars extending to the right for each year: a lighter blue for 2022 and a darker blue for 2023. The percentages increase from left to right, starting at 0% and going up to 100%.
From top to bottom, the countries listed are: China, Georgia, South Africa, Egypt, India, Cambodia, Indonesia, Kenya, Nigeria, Rwanda, Zambia, Pakistan, Liberia, and Ethiopia.
China has the highest percentages for both years, with the 2023 bar slightly longer than 2022, reaching close to 90%. Georgia follows closely, also with high percentages for both years. The percentages decrease as you move down the list, with Ethiopia at the bottom, having the lowest percentages for both years, just above 30%.
In general, most countries show an increase from 2022 to 2023, as the darker blue bars (2023) are longer than the lighter blue bars (2022) for each country.
Figure 6: Mobile ownership year-over-year growth rate (per cent; 2022-2023, ranked by growth rate)
Image Description
Horizontal bar chart showing the percentage values for different countries. The countries are listed on the left, with bars extending to the right to indicate their respective percentages. The percentages range from 0.0% to 4.5%.
Egypt has the longest bar, just over 4.0%, followed closely by Cambodia and South Africa. Kenya and India follow, with bars slightly shorter, around 3.5%. Indonesia, Georgia, and Nigeria have bars between 2.5% and 3.0%. Rwanda, Zambia, and Liberia are just under 2.5%. Pakistan, Ethiopia, and China have the shortest bars, with China being the lowest at just above 1.0%.
The chart uses a light blue background and dark blue bars.
While smartphone adoption is growing, disparities exist in access for persons with disabilities. For example, in the United States, 72 per cent of persons with disabilities own a smartphone, compared to 88 per cent of persons without a disability [30]. Among LMICs, the gap can be significant. In countries like Algeria, only about 15 per cent of persons with disabilities own a smartphone, compared to 63 per cent of persons without disabilities. This represents an absolute gap of 48 percentage points, meaning that persons with disabilities have a 76 per cent lower smartphone ownership rate relative to those without disabilities [31].
In addition to smartphone access, there is a lack of understanding on accessibility features. Many persons with disabilities are unaware of the built-in accessibility features of their devices beyond the more widely known tools like video conferencing, or may struggle to use multiple accessibility features simultaneously, highlighting digital literacy as a challenge to adopting smartphones as AT [32]. For example, in Ghana, less than 20 per cent of persons with disabilities are aware of the accessibility features built into their mobile devices [33]. As highlighted in the previous report, product selection also matters, as lower-cost devices are often produced by smaller manufacturers that may not have the capacity to test all accessibility features thoroughly. Experts note that, in such cases, software updates can inadvertently alter or disrupt these features.
CHAI analysis found that governments in LMICs often perceive smartphones as luxury items rather than potential assistive products. This perception limits policy interest and procurement programmes, leading to funding schemes that prioritise specialised equipment, even when smartphone features align with AT requirements. While recent regulatory developments like the European Accessibility Act suggest a shift toward recognizing mainstream consumer technologies like smartphones as assistive tools, this trend has yet to take hold in LMICs [34].
Some LMIC governments have begun recognizing smartphones as assistive products, but few have established direct procurement or subsidy programmes. Based on a survey across 10 LMICs, CHAI found that only three countries procure smartphones for public programmes, as shown in Table 6, but volumes are small. As experts indicated, the limited procurement indicates the nascent stage of LMIC government involvement in this market. Globally, some exceptions exist. Israel and Australia have integrated smartphones in their public funding schemes through technology-agnostic mechanisms that do not prescribe specific devices for different user needs. 7 However, no similar approaches were identified in LMICs.
7.Assistive technology (equipment, technology and devices). National Disability Insurance Scheme, d. ↩︎
Table 6: Smartphone inclusion efforts and volume within public AT procurement programmes (within survey reporting period)
| Country | Government efforts | # of smartphones distributed |
|---|---|---|
| Georgia | The State Programme for Social Rehabilitation and Childcare contains specific provisions for the financing of smartphones with videocall capabilities. 100% of device cost covered. | 50 |
| India | The Digital India initiative incorporates smartphones under certain programmes (e.g. Assistance to Disabled Persons scheme), with a focus on increasing access for young people seeking education. | Information not available |
| South Africa | Digital AT, under which smartphones may be included, can be provided directly through by the government, potentially subsidized, or accessible through an insurance scheme. | Information not available |
A growing number of LMICs have developed priority assistive product lists, and while some include mobile phones, only two include smartphones. (see Table 7).
Table 7: List of countries with priority assistive product lists (APLs) that include smartphones
| Country | Smartphone included in APL? |
|---|---|
| Cambodia | NA* |
| China | No |
| Egypt | NA* |
| Ethiopia | No |
| Georgia | NA* |
| Kenya | No (only simple phones included) |
| Liberia | Yes (categorized as a Personal Digital Assistant) |
| India | Yes |
| Indonesia | Not applicable* |
| Pakistan | No |
| Country | Smartphone included in APL? |
|---|---|
| Nigeria | No (only simple phones included) |
| Rwanda | Not applicable* |
| South Africa | Not applicable* |
| Zambia | Not applicable* |
*Priority assistive product list does not exist or is in development.
Note: some countries may have a list of priority assistive products, but this may not be officially categorized as an APL.
Very few NGOs operate in this sector, and none have international reach, resulting in sparse market data. Experts highlighted that local NGOs, often in collaboration with Organizations of Persons with Disabilities (OPDs) provide smartphones including training, and maintenance. For example, Vision Aid has distributed smartphones for people with visual impairments in India [35]. However, the small number of NGOs engaged in smartphone distribution, and likely the smaller volume of smartphones distributed by each, makes it difficult to capture these data.
Collaboration between mobile network operators (MNOs), governments and NGOs can lower costs and improve distribution. Experts have pointed at MNOs, because of their unique position, as important stakeholders in driving increased accessibility of smartphones. This is echoed by GSMA, which specifically highlights multiple interventions by MNOs, including offering discounted mobile packages to customers with disabilities, and promoting products and services in accessible formats, following the guidelines laid out by the Global Accessibility Reporting Initiative [36]. Experts suggest that strengthening the collaboration efforts between MNOs, OPDs and government can result in more accessible products and services, which will further increase demand for them.
Smartphones consolidate multiple assistive functions. Demand for smartphones across LMICs is increasing, primarily driven by increasing smartphone affordability and mobile internet penetration, but access is lagging for persons with disabilities. In absence of government programmes, persons with disabilities rely on NGOs or private channels for access. Experts point at multiple opportunities to overcome these challenges, primarily through a stronger focus on policy reform, public-private partnerships and targeted digital literacy programmes to enhance smartphone access as an AT.
41Spectacles compensate for refractive errors, such as myopia (near-sightedness) and presbyopia (age related far-sightedness), hypermetropia and astigmatism. According to WHO’s 2019 World Vision Report, two of the most common refractive errors – myopia and presbyopia – affected 2.6 billion and 1.8 billion people respectively [37]. However, more than 64 per cent of the global population do not have access to appropriate spectacles, with 90 per cent of them living in LMICs [38], [39]. In addition, there exists gender inequality in access, with the effective coverage of refractive error services (eREC) being 10.4 per cent higher in men than in women [40]. It is recognized that this limited accessibility of spectacles in these regions is often due to the lack of public awareness, the high cost of corrective eyewear and a lack of optometric services [41].
No robust estimates exist on the procurement of spectacles in LMICs, but purchasing is highly fragmented with a significant number of spectacles being paid for out-of- pocket by users. According to EYElliance, in LMICs spectacles provision in 2019 was 80 per cent from the private sector, 19 per cent from the public sector and 1 per cent from NGOs. The private sector in LMICs primarily serves higher-income customer segments. According to an EYElliance analysis in five African countries, the price of spectacles is typically 30-50 per cent higher than what consumers are willing to pay, leaving an access gap for low-income groups. 8 This gap is being filled by NGOs, corporate foundations and social enterprises across LMICs.
The demand for spectacles is rapidly growing due to the following factors: 1) an ageing population and the corresponding increase in presbyopia; 2) lifestyle changes, such as increased screen time leading to a rise in myopia; and 3) a growing policy focus. Global initiatives such as WHO’s launched SPECS 2030 Initiative, which aims to support member States in achieving the 2030 target of a 40 per cent increase in effective refractive error coverage further raise awareness about the importance of spectacles in LMICs [42], [43].
For millions of people in LMICs who need spectacles, an estimated 80 per cent of procurement occurs through the private sector, while the remaining 20 per cent comes from the public sector, including NGOs, social enterprises and governments. NGOs account for around 25 per cent of the served demand, while corporate foundations— particularly OSELF—cover 50 per cent. Social enterprises contribute to less than 10 per cent of the demand. Among the governments that provide services, half offer subsidies or procure spectacles for their citizens. For example, the Indonesian Government procures 1.3 million spectacles annually.
8.EYElliance analysis. ↩︎
Based on limited available data, the procurement and provision of spectacles in LMICs appear to have grown in recent years. For example, VisionSpring, a global eyewear social enterprise, estimated 15 to 20 per cent annual increase in procurement over the last five years, with many other stakeholders reporting similar or even higher growth trends across their programmes.
The market coverage remains uneven and tied to economic development. In more developed economies like Indonesia, Nigeria and Kenya, governments are increasing the provision of spectacles, which boosts the overall demand. However, in lower- income countries such as Cambodia, Ethiopia and Liberia, governments are still highly dependent on NGOs to address the market gap, and unmet need remains very high.
Based on available data, the global aggregated NGO procurement volume for spectacles appears to be growing. In 2023, it is estimated that NGOs dispensed at least 9 million spectacles, 9 more than double the volume in 2021. According to estimates from the NGOs interviewed, the volume is expected to exceed 14 million units in 2024.
Figure 7: Aggregated NGO procurement volume for spectacles (2021–2024)
Note: 2024E is the estimated NGO procurement of spectacles in 2024
NGOs with the highest volumes in 2023 include RestoringVision (≈5 million), Sightsavers (≈ 1 million), and CBM (≈0.7 million), accounting for 74 per cent of the total aggregated volume within the NGO market. The combined volume of these three organizations in 2023 increased by 120 per cent over a two-year period. The upward trend is mainly driven by a growing focus on near-vision spectacles. RestoringVision donated 2.5 times more spectacles in 2023 than in 2021. The organization stated that the ready- made nature of near-vision spectacles allows them to quickly scale up distribution when donor funding increases. In 2022, RestoringVision raised US$3.1 million for their programmes which is a 60 per cent increase from 2021 [44].
9.Note: the volume includes NGO self-outreach programmes, procurement on behalf of governments and contributions as part of global initiatives and interventions. ↩︎
Figure 8: Volume trends for the three NGOs with the highest spectacles dispensing volume (2021–2024)
Note: Data for 2024 is not available for CBM at the time of report publication
Table 8 summarizes the procurement activities of 10 global eye health NGOs between 2021 and 2023. It provides detailed information on procurement volume, product types, suppliers and pricing. Some key procurement patterns across the NGOs are as follows:
Table 8: Illustrative NGOs providing spectacles in LMICs
| Organization | Brien Holden Foundation |
|---|---|
| About | Australian eyecare NGO; active in Australia and 5 LMICs. |
| Pairs of spectacles dispensed | |
| Type |
|
| Suppliers |
|
| Pricing |
|
| Organization | CharityVision |
|---|---|
| About | US NGO focused on restoring curable sight impairment worldwide. Active in 30 countries. |
| Pairs of spectacles dispensed |
|
| Type | NA |
| Suppliers | NA |
| Pricing | NA |
10.For 2024, an estimated total of 150,000 spectacles will be dispensed across Brien Holden’s key eye health programmes in Pakistan, Papua New Guinea and Viet Nam. Pakistan accounts for 90 per cent of the total, with Papua New Guinea and Viet Nam each contributing around 5 per cent. ↩︎
11.Note: 2021-2023 volume data are retrieved from the organization’s annual reports. The volume data include eye devices, but the details of which devices and their respective percentages are not specified. ↩︎
| Organization | Christian Blind Mission (CBM) |
|---|---|
| About | International Christian NGO active in 40 countries |
| Pairs of spectacles dispensed |
|
| Type |
|
| Suppliers |
|
| Pricing | • US$3 - US$5512 |
| Organization | Fred Hollows Foundation |
|---|---|
| About | Australian NGO focused on treating and preventing vision problems across 25 countries. |
| Pairs of spectacles dispensed |
|
| Type |
|
| Suppliers |
|
| Pricing | NA |
12.Note: CBM does not handle procurement directly; their programme implementation partners manage it. Additionally, some of the spectacles they dispense are donated and provided free of charge. ↩︎
| Organization | Helen Keller International |
|---|---|
| About | NGO providing vision screenings, eye exams, and prescription spectacles for vulnerable populations. Active in Cameroon, Bangladesh and the USA. |
| Pairs of spectacles dispensed |
|
| Type |
|
| Suppliers | |
| Pricing |
|
| Organization | Light for the World |
|---|---|
| About | NGO committed to disability inclusion and eye health across 9 countries, primarily LMICs |
| Pairs of spectacles dispensed |
|
13.Plan to procure 1,500 frames and 8,000 lenses in Cameroon. ↩︎
14.Note: some spectacles are purchased from suppliers, others are directly donated by suppliers. ↩︎
15.A non-profit organization collaborating with Helen Keller to provide affordable spectacles to garment workers in Bangladesh. ↩︎
| Organization | Light for the World |
|---|---|
| Type |
|
| Suppliers |
|
| Pricing | • Prescription: US$12 - US$16 |
| Organization | Seva Foundation |
|---|---|
| About | Eye care NGO active in 20 countries |
| Pairs of spectacles dispensed |
|
| Type |
|
| Suppliers | • Some source locally and some hospital partners have existing contracts with companies like EssilorLuxottica. |
| Pricing | • Prices vary depending on the country and frame style |
| Organization | Sightsavers |
|---|---|
| About | NGO that prevents sight loss, avoidable blindness and treats eye diseases in 30 countries across Africa and Asia. |
| Pairs of spectacles dispensed |
|
| Type |
|
16.Note: the products do not include rimless single vision (SV) or sphero-cylindrical lenses. ↩︎
| Organization | Sightsavers |
|---|---|
| Suppliers |
|
| Pricing |
|
| Organization | RestoringVision |
|---|---|
| About | NGO that runs vision care and spectacles delivery programmes in more than 150 countries. It serves as a supplier to many other NGOs that integrate vision services into their programmes |
| Pairs of spectacles dispensed |
|
| Type |
|
| Suppliers | • The supplier is FGX (a company under EssilorLuxottica) who manufactures in China |
| Pricing | • Near-vision spectacles: US$0.50 |
| Organization | VisionSpring |
|---|---|
| About | Social enterprise provides spectacles, vision screening and training across 8 countries. |
| Pairs of spectacles dispensed |
|
17.Note: the numbers for 2024 and 2025 are target numbers. ↩︎
18. VisionSpring has stated the number is lower because of COVID-19. ↩︎
| Organization | VisionSpring |
|---|---|
| Type |
|
| Suppliers | • Long term contract manufacturer in Bangladesh, China, India, and Vietnam |
| Pricing |
|
Based on limited data collection, government provision for spectacles is small and many LMICs still rely on NGOs to provide spectacles. Out of 12 countries surveyed, half procure or subsidize spectacles through public sector delivery channels, with examples given below:
| South Africa | The Department of Health or provincial health departments typically manage spectacles procurement. The national and provincial tender process consists of several stages: planning, procurement initiation, selection and award, contract and implementation. When the value of the goods or services being procured is below the monetary threshold of ZAR 500,000 (US$2,860), a procuring entity may ask suppliers to directly provide quotations, instead of going through the full tender process. |
| Zambia | The government procures spectacles through public tenders or requests for proposals issued by Zambia’s Public Procurement Authority (ZPPA). The latest tender for optical frames and lenses closed in November 2024, with a total bid value of ZMW555,050 (≈US$20,900) [20]. |
Governments subsidizing spectacles include Indonesia, Kenya, Nigeria and Rwanda.
50| Indonesia | The government subsidizes spectacles through its national insurance scheme. Subsidies range from IDR165,000 (≈US$11 dollars) to IDR330,000 (≈US$21 dollars). In 2018, the scheme subsidized 1,313,941 spectacles. |
| Kenya | Kenya officially launched its new national insurance scheme in October 2024, which has included spectacles as part of its social health insurance scheme benefit package [46]. A KES1,000 (≈US$8 dollars) subsidy per household is provided under the newly introduced benefit package, limited to beneficiaries below 18 years old [47]. |
| Nigeria | The National Health Insurance Scheme subsidised spectacles up to a limit of NGN10,000 (≈US$27 dollars). The Ministry of Health of Ekiti State allocated a total federal budget of NGN20 million (≈US$54,000 dollars) for eye check-up and provision of spectacles. |
| Rwanda | The national health system includes eye care services and products, including spectacles. The country’s National Plan of Action on Eye Health aimed to allocate a budget of US$20 million to national eye health services and provided 330,388 low-cost near-vision spectacles in health centres from 2018 to 2024 [48]. |
The current procurement volume in LMICs is still far below the level of needs. The lack of access is often due to low public awareness, the high cost of spectacles and insufficient optometric services. The private sector dominates the market but focuses more on the high-income segments in LMICs, while governments, NGOs, social enterprises and corporate foundations are filling the demand gap.
Government coverage remains uneven and tied to economic development. In more developed economies, governments are increasing spectacles advocacy and provision, which boosts overall demand. However, lower-income countries governments are still highly dependent on NGOs to address the market gap, and unmet need remains high. NGO procurement has seen an increasing trend in recent years, with locally available, low-price, high-quality and diverse designs being key purchasing criteria across NGOs.
51Wheelchairs enhance personal mobility. They are designed for people who cannot walk or have difficulty walking, enabling them to move around and participate in everyday activities [49]. According to the WHO, approximately 1 per cent of the global population, or 80 million people, require a wheelchair [50]. A significant proportion, around 65 million individuals, is concentrated in LMICs. According to the WHO and UNICEF Global Report on Assistive Technology, between 65 and 95 per cent of those who need a wheelchair do not have access to one [1]. Appropriate wheelchairs prevent the development of secondary complications that may occur from incorrect device provision, incorrect fitting and poor positioning, such as pressure injuries, fixed postural deformities and loss of function. 19
It is important to note that this report focuses solely on the number of wheelchairs being provided in LMICs as a measure of demand. It does not assess the appropriateness of the wheelchairs being provided, nor does it consider essential factors such as access to repair, maintenance, fitting, training and other critical aspects of service delivery, all of which are vital for ensuring the provision of an appropriate wheelchair. 20
19. An “appropriate wheelchair” as defined by WHO is a wheelchair that meets the following factors:
WHO emphasizes that inappropriate wheelchairs can lead to poor outcomes for wheelchair users, including decreased health and mobility, development of secondary complications – which in cases of people with spinal cord injuries and similar conditions can cause premature death – participation barriers, and/or wheelchair breakdown resulting in disruption in use and the growing prevalence of wheelchair graveyards. Wheelchair provision can only enhance a wheelchair user’s quality of life if all parts of the process are working well. This includes ensuring users have access to:
Personnel involved in each area of wheelchair provision, including funders, procurement and clinical teams, need to have the correct skills and knowledge, underscoring the importance of training for those involved in wheelchair provision. The International Society of Wheelchair Professionals provides a comprehensive wheelchair provider certification programme which provides wheelchair providers with the minimum set of knowledge to assess and prescribe appropriate wheelchairs. Consulting wheelchair users in the region to ascertain appropriateness of services and products being used is critical. ↩︎
20.Readers must reference this report along with WHO’s guidance on provision of manual wheelchairs in less resourced settings. Additionally, the report does not further segment demand into adult and paediatric wheelchairs. The report also does not differentiate between manual and powered wheelchairs, nor does it report on wheelchair accessories such as cushions or postural supports. ↩︎
Wheelchairs are classified into manual and powered variants. Within these, products can provide varying levels of postural support, dependent on the user’s needs. Wheelchair users can be classified as having basic, intermediate or complex needs, depending on their medical condition which may be fast progressing, with different requirements for postural support, customization and time between clinical reviews. Wheelchair requirements vary based on the needs from childhood to young adult and even to old age. Accurate data on the global wheelchair market size remain limited. According to published market reports, manual wheelchairs accounted for over 60 per cent of the revenue share in 2022 [51].
While reliable statistics on the overall LMIC market segmentation are limited, this report applies a consistent methodology to generate indicative estimates. Although these are not comprehensive, they offer a useful approximation of market dynamics and scale of provision. However, donor aid remains an important source of wheelchair procurement. According to WHO, humanitarian crises have steadily increased the demand for assistive products suited for emergencies such as active wheelchairs [52]. However, the funding for wheelchair procurement has shifted. There is now less financial support from bilateral and multilateral donors for direct product procurement, except for emergency humanitarian needs. Instead, funding is increasingly directed toward building national systems for sustainable AT provision. While this shift aims to create long-term solutions, it does not necessarily translate into immediate product procurement, leaving a gap in the availability of assistive products. The effectiveness of system provision work depends upon product availability, and investment in system development needs to be accompanied by ensuring availability and accessibility of assistive products.
The wheelchair market in LMICs is driven by NGOs and social enterprises and supported by global procurement services like UNICEF and Consolidating Logistics for Assistive Products (CLASP). Overall, wheelchair market demand in LMICs is insufficient compared to need. For 65 million people who need a wheelchair in low- and middle-income countries, major NGOs, social enterprises, global procurement services and surveyed governments provide approximately 150,000 units annually, with few governments, such as South Africa, procuring and providing wheelchairs (≈23,000 annually). NGOs account for two thirds of the served demand, while social enterprises contribute 10 per cent and global procurement services 7 per cent.
53NGO demand for appropriate wheelchairs in LMICs is significant, with an estimated 94,000 units21 in 2023. The Free Wheelchair Mission stands as the largest global buyer with 63,696 units. The two largest NGO buyers, Free Wheelchair Mission and the Church of Jesus Christ of Latter-day Saints (Latter-day Saint) Charities have developed custom wheelchairs specifically tailored to the needs of LMICs based on their assessment of an appropriate wheelchair.
These organizations have partnered with contract manufacturers in China and other LMICs. Key design considerations for these wheelchairs include adjustability to minimize the number of Stock Keeping Units, ease of assembly, durability in rugged environments, availability of locally sourced materials for repairs and cost-effectiveness – all critical factors driving NGO decision-making in wheelchair design.
Table 9: NGOs providing wheelchairs in LMICs
| Organization | Christian Blind Mission (CBM) |
|---|---|
| About | International Christian Development Organization active in 40 countries |
| Volumes (units) |
|
| Type | • Not available |
| Suppliers |
|
| Pricing | • US$250 - US$600 |
| Organization | Free Wheelchair Mission (FWM) |
|---|---|
| About | Nonprofit organization with distribution in 33 countries |
| Volumes (units) |
|
21.Excluding CBM and ICRC volumes to avoid double counting with demand from FWM, LDS Charities, Motivation, ShonaquipSE and CLASP. ↩︎
| Organization | Free Wheelchair Mission (FWM) |
|---|---|
| Type | • Manual: 2 models for rugged conditions |
| Suppliers | • Own-design - contract manufacturing in India and China |
| Pricing | • US$96 including freight |
| Organization | International Committee of the Red Cross |
|---|---|
| About | Nonprofit organization with physical rehabilitation projects in 31 countries |
| Volumes (units) |
|
| Type |
Manual: 3-wheel fixed frame 4-wheel folding 3-wheel folding Postural support Sports |
| Suppliers |
|
| Pricing | Not specified |
| Organization | The Church of Jesus Christ of Latter-day Saints– LDS charities |
|---|---|
| About | Faith-based organization active in 60 countries |
| Volumes (units) | • 2021 – 2023: 18,750 annually on average (based on orders from manufacturing partner in China) |
| Type |
Manual: Urban - 15 per cent Rough Terrain - 12 per cent Dual Terrain - 18 per cent Standard - 53 per cent |
| Suppliers |
|
| Pricing | • US$100 – 275 |
| Organization | Walkabout Foundation |
|---|---|
| About | UK and US charity operating primarily in Kenya, Uganda and Haiti |
| Volumes (units) |
|
| Type |
Manual: Urban – 37-43 per cent Rough Terrain – 37-54 per cent Dual Terrain – 6-25 per cent |
| Suppliers |
|
| Pricing | • US$70 - US$350 |
Social enterprises play an important role by producing and delivering affordable wheelchairs for LMIC environments. CLASP, a Momentum Wheels for Humanity social enterprise, Motivation and ShonaquipSE are three prominent social enterprises. Together these are serving approximately 17,000 units. Out of these, 45 per cent are for urban/semi urban settings with the remainder being either rough terrain or dual terrain wheelchairs.
Table 10: Social enterprises providing wheelchairs in LMICs
| Organization | CLASP, a Momentum Wheels for Humanity (MWH) social enterprise |
|---|---|
| About | MWH works to promote inclusion for people with disabilities through strengthening rehabilitation and AT services, assistive product supply and provision, and inclusive disaster response. MWH operates the CLASP22 supply chain mechanism. |
22.CLASP was launched with USAID funding. ↩︎
| Organization | CLASP, a Momentum Wheels for Humanity (MWH) social enterprise |
|---|---|
| Volumes (units) |
|
| Type |
Manual Postural Support Wheelchair Included in CLASP: Urban/Semi-Urban All Terrain Postural Support Transport Sports |
| Suppliers |
|
| Pricing | • US$90-US$85023 |
| Organization | Motivation |
|---|---|
| About | Designing and supplying adult and paediatric everyday wheelchairs, sports wheelchairs, and postural support devices globally, along with training and services in East Africa and South Asia. Supplies to over 25 countries globally. |
| Volumes (units) |
|
23.The lowest cost is for a transport wheelchair and highest for a sports wheelchair. ↩︎
| Organization | Motivation |
|---|---|
| Type |
Manual: Active dual terrain - 38% Active rough terrain - 20% Manual & postural support -16% |
| Suppliers | • Contract manufactured in China |
| Pricing | • US$233 – 408 |
| Organization | ShonaquipSE |
|---|---|
| About | Providing paediatric wheelchairs and 24-hour posture support products, training and services in South Africa, Botswana, Namibia, Mozambique, Zimbabwe, Lesotho, Eswatini, Kenya, Uganda, Iraq and Georgia. Focus on addressing the needs of children and youth. |
| Volumes (units) |
|
| Type |
|
| Suppliers | • Products locally designed and manufactured in South Africa with 90 per cent local sourced components. Designed to be fitted and maintained in under-resourced settings. |
| Pricing | • US$295 - US$920 |
UNICEF and CLASP, a global marketplace for buyers in LMICs, provide quality affordable wheelchairs at their negotiated terms. Together, these two organizations are responsible for an estimated 10,000 products in 2023.
Table 11: Global procurement services providing wheelchairs in LMICs
| Organization | CLASP (MWH) |
|---|---|
| About | CLASP serves buyers, NGOs, and governments in LMICs. It has shipped to over 60 countries. |
| Volumes (units) |
|
| Type |
|
| Organization | CLASP (MWH) |
|---|---|
| Suppliers |
|
| Pricing | • US$250 – US$600 |
| Organization | UNICEF Supply Division |
|---|---|
| About | UNICEF’s procurement services can be accessed by governments and development partners across 190 countries. |
| Volumes (units) | • To date: 6,000-7,000 units (since 2022) |
| Type |
|
| Suppliers |
|
| Pricing | • US$250 to US$500 |
Based on limited data, only 6 out of 12 countries (50 per cent) procure wheelchairs. Examples of governments procuring wheelchairs:
60| Cambodia | The government procures wheelchairs through the Persons with Disabilities Foundation under the Ministry of Social Affairs, Veterans and Youth Rehabilitation. In 2023, based on pilot survey data, the government procured 1,540 wheelchairs at a price of US$195 to US$320. |
| China | The government procures wheelchairs through established procedures. Government tenders for medical supplies, including wheelchairs, are posted on the national official procurement platform, China Government Procurement Network, or their own provincial and municipal’s Disabled Persons’ Federation website. These announcements in general detail the technical specifications, quantity, delivery timelines and quality standards required for the wheelchairs. |
| Ethiopia | Based on a 2020 report, the government procured a few manual transport wheelchairs as one-off procurement for health centres. |
| South Africa | South Africa released its most recent transversal tender on the supply and delivery of wheelchair and sitting systems in January 2023 (bid number RT233). This tender covers a period of 60 months. According to a published report, South Africa has provided 23,000 wheelchairs on average annually between 2017- 2020. |
| Zambia | The government is involved in the procurement of wheelchairs, through public tenders or requests for proposals, primarily issued by ZPPA. The latest tender for the supply and delivery of wheelchairs. The latest enquiry for supply and delivery was closed in May 2024, with 1 specialized wheelchair and 4 electric wheelchairs procured at a total cost of ZMW74.1 million (US$2.8 million). |
Example of government subsidising wheelchairs:
| Georgia | The budget allocated by the Georgian Government to wheelchairs was GEL 990,000 (approximately US$363,970) in 2021, according to WHO’s ATA-C report in 2023. The government subsidized through the State Programme for up to GEL760 (approximately US$280) for manual wheelchairs and up to GEL5,053 (approximately US$1,858) for electric wheelchairs. A total of 416 state-subsidized wheelchairs were provided in 2020. |
Free Wheelchair Mission remains the largest single provider. NGOs like the Church of Jesus Christ of Latter-day Saints- LDS charities and CBM contribute significantly to the
61provision of assistive products in LMICs. Social enterprises offer tailored, affordable wheelchair solutions designed specifically for the challenging environments found in LMICs. The role of CLASP and UNICEF as a procurement service has been instrumental in facilitating the procurement process for buyers, NGOs and governments by providing quality-assured products and by creating a streamlined purchasing mechanism.
Alternative models for wheelchair provision in LMICs also exist and may be equally effective. For instance, supply chains that integrate providers from the private and social enterprise sectors have the potential to support local production. Ensuring continuity of access to a consistent range of products over time is important for clinical management, regular upgrades and replacements. Additionally, maintaining stable access to wheelchairs can influence affordability and accessibility of repair and maintenance services.
62Given the heavy reliance on out-of-pocket expenditure in LMICs, the high final cost of assistive products remains a major barrier to access to and demand for AT. Affordability of assistive products is heavily affected by added costs from the manufacturer to the end-user. These include shipping and insurance fees, import duties and in- country taxes. Once the product arrives in the destination country, storage costs, in-land transportation fees and distributor margins further increase the final price. Understanding the breakdown of these costs is critical for addressing the affordability challenges faced by consumers in LMICs. This section provides visibility into these cost components to help buyers understand the drivers of the final landing price of assistive products.
The cost estimate analysis in this report is based on secondary research and primary data collection from social enterprises, corporate foundations and NGOs, reflecting actual costs across various markets, adjusted for geographical and economic differences. The provided cost ranges account for regional pricing variability influenced by factors such as import duties and taxes, fluctuating shipping costs due to geopolitical conditions and seasonal demand, varying distributor and retailer margins depending on market competitiveness and regulatory frameworks, economies of scale from bulk purchasing, and additional expenses arising from regulatory and administrative barriers like customs procedures and certification requirements.
By presenting both lower and higher estimates, the report aims to give stakeholders a realistic understanding of the cost implications in different procurement scenarios. It is important to note that this report focuses solely on supply cost associated with products and does not consider other essential costs such as diagnostics, fitting, repair, and maintenance, training and other critical aspects of service delivery. All of these are vital for ensuring the provision of an assistive product. It also does not consider non- financial costs such as lead times, among other factors.
64Across the assistive products analysed, the cumulative mark-ups from ex-factory to end-user prices are substantial – ranging from 25 per cent to over 500 per cent depending on the product type and country context. High base prices, particularly for products like hearing aids (typically US$100 to US$500), combined with layered costs such as international shipping, warehousing, distributor and retailer margins and import duties, result in prohibitively high prices for consumers in LMICs.
In some cases, such as spectacles, retailer margins alone can exceed 200 per cent, while in others, like wheelchairs, international shipping accounts for a major share of the final cost due to bulk and logistics constraints. These inflated cost structures not only disincentivise investment and scale but also exclude many individuals from accessing essential assistive products.
65The final cost of spectacles for end users in LMICs are estimated between 63 per cent to greater than 510 per cent of the ex-factory costs, depending on import tariffs, inventory and shipment costs, distributor and retailer margins and other associated costs. All these components significantly influence the final price to the consumer, with import duties and retailer margins contributing the most. Within this import taxes and duties significantly contribute to the higher costs and can contribute from 0-100 per cent of the increase in costs. Across the assistive products analysed, the cost mark-ups are the highest for spectacles, especially since they are often considered luxury goods and do not benefit from exemption of other assistive products.
66Table 12: Cost component for spectacles supply
| Cost Component | Lower estimate | Higher estimate |
|---|---|---|
| Total shipment cost | 23 per cent | 55 per cent |
| • Warehouse cost | 10 per cent | 25 per cent |
| • International shipping | 10 per cent | 15 per cent |
| • In-country shipment | 3 per cent | 15 per cent |
| Taxes and duties: import duty/custom tax/VAT | 0 per cent | >100 per cent |
| Other associated cost 24 | 25 per cent | 50 per cent |
| Distributor margin | 15 per cent | >95 per cent |
| Retailer margin | 0 per cent | >210 per cent |
| Additional cost | 63 per cent | >510 per cent |
24.Other Associated Costs include the rest associated costs on operations such as quality inspection costs, management costs, clearing + forwarding agent fees, among others. ↩︎
25.Note: Regarding import tax and duties, the cost incurred before in-country, such as freight cost, among others, are also taxable value in any calculation. ↩︎
Table 13: Key tax components for spectacles import in Ghana
| # | Tax item | Additional cost |
|---|---|---|
| 1 | Import VAT | 17 per cent |
| 2 | Import Duty | 9 per cent |
| 3 | Import National Health Insurance Levy | 3 per cent |
| 4 | Ghana Education Trust (GET) Fund Import Levy | 3 per cent |
| 5 | Special Import Levy | 2 per cent |
| 6 | COVID-19 Health Recovery Levy | 1 per cent |
| 7 | Ghana Export-Import Bank Levy | 1 per cent |
| 8 | ECOWAS Levy | 1 per cent |
| 9 | Network Charge | 0.5 per cent |
| 10 | African Union Levy | 0.5 per cent |
| Total | 38 per cent |
The final cost of hearing aids for end users in LMICs are estimated between 25 per cent to greater than 100 per cent of the ex-factory cost, depending on import tariffs,
68inventory and shipment cost and distributor margins. Note that the base price of hearing aids is already high – typically ranging from US$100 to US$500 – and additional markup on that further renders them entirely prohibitive for LMICs. Four major cost components significantly influence the final price to the consumer and distributor margins account for the largest proportion. While import duties and taxes may be a significant contributor to the cost, many countries may apply some exemptions.
Table 14: Cost component for hearing aids supply
| Cost Component | Lower estimate | Higher estimate |
|---|---|---|
| Taxes and duties: import duty/custom tax/VAT | 0 per cent | 41 per cent |
| Shipment, inventory, and in-country transport cost | 20 per cent | 40 per cent |
| Quality inspection cost | 0 per cent | 10 per cent |
| Distributor margin | 5 per cent | >15 per cent |
| Additional cost | 25 per cent | >106 per cent |
26.VAT and import duties can be waived if the organization obtains a waiver and the pre-export verification of conformity (PVOC) to standards in advance. It is also waived for individual with disability importing for personal use. ↩︎
The final cost of prostheses for end users in LMICs are estimated between 30 per cent to greater than 115 per cent of ex-factory costs, primarily driven by transportation costs and import taxes. In addition to these mark-ups during product procurement, the service fees associated with prostheses fittings are another key factor influencing the final price paid by the customer.
The ICRC estimates that the service cost is the largest component of the entire process and could further increase the product cost by an additional 100 per cent. In terms
of the service cost, one prosthetic care company indicated that the labour cost of the certified prosthetist is one of the most significant components. The limited availability of certified prosthetists is a major cause of restricted access to prosthetic care worldwide.
Table 15: Cost component for prostheses component supply27
| Cost Component | Lower estimate | Higher estimate |
|---|---|---|
| Taxes and duties: import duty/custom tax/VAT | 0 per cent | 45 per cent |
| Shipment, inventory and in-country transport cost | 25 per cent | 40 per cent |
| Distributor and retailer margin | 5 per cent | >30 per cent |
| Additional cost | 30 per cent | >115 per cent |
27.The data were collected and consolidated from multiple international NGOs that import prostheses. ↩︎
The final cost of wheelchairs for end users in LMICs are estimated at between 28 per cent - 255 per cent, depending on the shipment route, import tariffs and distributor margins. Four major cost components significantly influence the final price to the consumer with distributor margins accounting for the largest proportion. Shipment costs are the major cost drivers due to the bulky nature of the products. While import costs can vary and many countries may have exemptions that are variably applied.
Table 16: Cost component for wheelchair supply
| Cost Component | Lower estimate | Higher estimate |
|---|---|---|
| Taxes and duties: import duty, custom tax, VAT | 0 per cent | 20 per cent |
| Shipment cost | 15 per cent | 20 per cent |
| Quality inspection cost | 5 per cent | 15 per cent |
| Distributor margin | 8 per cent | 200 per cent |
| Additional cost | 28 per cent | 255 per cent |
The following key recommendations can help reduce costs and improve access:
The Assistive Products Market Report 2025 reaffirms the critical need to address systemic barriers, especially in LMICs, where access to AT remains severely limited. Building on the insights from the 2024 report, this edition highlights persistent challenges such as inadequate funding, fragmented procurement systems and supply chain inefficiencies leading to higher costs. Despite the efforts of NGOs, corporate foundations and select government initiatives, the provision of assistive products remains insufficient to meet the current and growing global demand, particularly among vulnerable populations.
Lack of reliable data on demand and procurement volumes complicates suppliers’ efforts to plan production and distribution effectively. Suppliers face an unpredictable business environment due to fragmented funding models and inconsistent policy frameworks across LMICs, limiting their ability to scale operations and optimize supply chains. This report applies a consistent methodology to generate indicative estimates, offering a useful approximation of market dynamics and scale of provision.
Additionally, the report underscores the need for coordinated action by governments, international donors and private sector actors. Recommendations include streamlining procurement processes, reducing supply chain costs related to shipping, import duties and in-country logistics, and fostering public-private partnerships that can enhance product availability. Governments must prioritize the inclusion of assistive technologies in national health and social welfare programmes, which would create more stable, long-term demand for suppliers and ensure access to and uptake of assistive products by their people.
Ultimately, the pathway to achieving equitable access to assistive products will require a multi-stakeholder approach, focusing on building resilient supply chains, promoting innovation in product design and distribution and mobilizing increased financial resources. By addressing these critical gaps, the assistive products market can move closer to ensuring that all individuals, regardless of geography or economic status, have access to the essential technologies they need to live healthy, empowered lives.
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The annex provides insights on assistive product manufacturing in China for five priority assistive products: digital AT, hearing aids, prostheses, spectacles and wheelchairs. It examines the manufacturing landscape and identifies suppliers capable of and interested in doing business in LMIC markets. Additionally, it explores growth trends, challenges and opportunities for China’s exports to LMICs and provides recommendations for global stakeholders to better leverage China’s AT manufacturing capability worldwide.
The annex is documented in a separate PDF and is available via the link here.
China is the world’s largest domestic market and a key global manufacturing hub with over 25,000 companies manufacturing assistive products also serving LMIC markets.
The limited availability of reliable publicly accessible information makes it challenging for buyers to identify suitable suppliers offering affordable, high-quality products. To address this, ATscale and CHAI have partnered with the China Assistive Devices and Technology Center for Persons with Disabilities (CADTC) to provide updated market intelligence to improve access to assistive technology in LMICs.
This annex is based on a survey to gather information on suppliers interested in expanding into LMIC markets. A total of 90 suppliers responded, over 20 were further interviewed and 10 site visits were conducted.
28.Note: the market size calculated here includes assistive products for both rehabilitation and disability use. ↩︎
The annex documents all organizations mentioned in the report, detailing their following characteristics:
The annex is documented in a separate PDF and is available via the link here.
83The annex 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 annex examines each country’s regulatory framework, including policies, regulations and financing mechanisms, while also exploring its recent procurement activities related to the priority products. One should note that some information, such as procurement data, is only illustrative, as detailed volume figures are publicly available for just a few countries.
The annex is documented in a separate PDF and is available via the link here.