PROBLEM STATEMENT

3 million people in Kenya lack access to appropriate assistive technology (AT) and rehabilitative services, which they much need to per take in activities of daily living and enhance their independence.

In addition, use of inappropriate AT (which is rampant in Kenya) leads to poor health outcomes. For example, a person who uses inappropriate wheelchair is likely to suffer from pressure sores and contractures; a person who uses inappropriate prostheses or orthoses is predisposed to skin breakdowns, muscular pain and osteoporosis.

AT and rehabilitative services are usually grouped per respective disability domains, and there are 6 key domains namely: physical, vision, hearing, communication, mental health and neurodevelopmental disabilities. The AT Program in Kenya will kick-start interventions on the most prevalent disabilities before scaling to all (see prevalence summary per the KDHS 2022).

Figure 1: Prevalence of Disabilities in Kenya (KDHS 2022)

The Program will focus to scale up AT and rehabilitative services in these 4 domains by increasing access to respective AT as summarized below:

1.     Physical/ mobility: wheelchair and prostheses

2.     Vision : spectacles, low vision devices, braille, orbit readers and note takers

3.     Hearing: hearing aids

4.     Communication : communication boards and smart eye-gazes

 WHY INTERVENTION IS NECESSARY

Pathway to accessing AT in Kenya (regardless of domain) is convoluted owing to challenges in service delivery, supply chain and financing of AT and rehabilitative services. Service delivery is a challenge due to limited availability of services in public health facilities, gaps in HRH skills and lack of diagnostics/ equipment at facilities. Supply chain is a challenge due to AT not being part of national supply chain owing to policy gaps and, lack of sufficient, quality products in the country. Financing is a challenge due to AT and rehabilitative services not being a priority in national financing schemes and county development plans, thus leaving persons who require AT to finance for AT and related services out of pocket.

These are challenges that the AT program aims to fix by streamlining access to AT and rehabilitative services hence greatly reducing the burden of consequential health conditions which could else have been averted and empowering persons with disabilities in Kenya.

 TRANFORMATIONAL IMPACT

Sustainable provision of AT in Kenya can be achieved through concerted efforts geared towards incorporating AT and rehabilitative services into the public sector. CHAI is working with MOH, the State Department of Social Protection, counties and key state agencies such as KEMSA and NCPWD, to drive the desired changes in the disability landscape in Kenya.

The AT Program aims to increase access by over 300,000 units of AT and, enable millions of people to access rehabilitative services over the next 3 years.

 Domain specific impact is summarized below:

Physical/ mobility domain: Over 30,000 additional users to be reached with wheelchairs and prostheses, support the government to develop and implement investment case for local production of wheelchairs and, to have upgraded infrastructure for production of prostheses and orthoses across 5 regional facilities.

Vision domain: School-based screening to be scaled-up and provide access to 210,000 eyeglasses and 30,000 low-vision devices, to establish 10 optical labs across the country and, 38 inclusive and special schools for blind children to be capacitated with Braille/Orbit Readers.

Hearing domain: 5 regional hospitals to be upgraded with advanced diagnostic equipment (BERA machines), hearing diagnostic services to be expanded to 15 hospitals by installing audiometers, to scale up community-based hearing screening and referrals, and provision of 100 screening devices and 3,000 hearing aids.

Speech and language domain: Introduce speech and language therapy in 7 regional facilities, rehab staff to be trained on providing care to children with cognitive challenges and avail communication assistive devices across 15 specialized facilities.

To achieve the forementioned impact, the Program will utilize a phased approach to scale up access, with clear annual targets. The targets will be achieved through concerted efforts by all actors in the disability ecosystem in Kenya, and through being deliberate on access at all levels of care, right from early identification and diagnosis to post-provision of assistive technology.

 Specific interventions across the thematic areas

Service delivery:

1.     Establish rehabilitative services in health facilities across the country; with clarity on services to be offered by different levels of care.

2.     Introduce play therapy in the care for children requiring rehabilitative services due to neurodevelopmental challenges, facing critical medical procedures and chronic illnesses.

3.     Build capacity of healthcare workers to provide rehabilitative services and appropriate AT through both long-term trainings and on-the-job trainings.

4.     Invest in ideal diagnostics and infrastructure to assist with early diagnosis of disability and identification to enable timely interventions.

5.     Develop policies and guidelines to anchor interventions.

 Supply chain:

1.     Develop AT Essential list and product specifications.

2.     Integrate AT into the national supply chain infrastructure and support counties with forecasting and quantification.

3.     Support counties to develop and implement last mile distribution for AT.

4.     Introduction of AT products into the country.

5.     Support the government to develop investment case for local production of wheelchairs.

 Data and data use:

1.     Establish rehabilitative services reporting framework and develop tools to be used in capturing essential indicators.

2.     Work with stakeholders to disseminate analyses based off the developed tools - to decision makers at both national and county levels.

3.     Advocate for integration of AT into health programming.

 Health financing:

1.     Advocate for inclusion of AT in NHIF benefits packages.

2.     Advocate for scaling up the national development fund at NCPWD.

3.     Advocate for inclusion of rehabilitative services and AT in country’s development plans.

4.     Work with stakeholders on demand generation for rehabilitative services and AT.