Consensus Conference on Wheelchairs for Developing Countries Held in Bangalore
By Bruce Curtis
International Projects Manager
World Institute on Disability
The International Society of Prosthetic and Orthotics, in collaboration with the Leahy War Victims Fund of USAID and the World Health Organization, held a Consensus Conference on Wheelchairs for Developing Countries, hosted by Mobility India, 6-11 November 2006, in Bangalore, India. (For background information on the technical and controversial issues of distributing, fabricating and repairing wheelchairs in developing countries, please read the Disability World article published online in Issue no. 27 December 2005 - January 2006 or visit the Whirlwind Wheelchair International website at: http://www.whirlwindwheelchair.org)
The 86 invited participants of the conference included; international charity wheelchair distributors, governmental and non-governmental development organizations, organizations of disabled persons, local wheelchair businesses, large wheelchair factory exporters, universities, rehabilitation centers, orthotic and prosthetic experts and wheelchair users. According to Dr. Federico Montero of WHO, around 1 of 5 participants were wheelchair-users.
The conference participants explored various issues related to the provision of wheelchairs in developing countries with a focus on the following topics:
- Poverty and Inclusion
- Service Provision
- Product Standards
- Production and Distribution
- Training of Personnel
All recommendations for definitions, policy and implementation guidelines were developed in small discussion groups and were reported back to the full conference where proposed language modifications could be exchanged until a full consensus was reached. Ultimately it was hoped by the organizers that the consensus recommendations of the conference would be finalized into a guidance document to help improve wheelchair provision and services in the developing world. It was also the desire of the participants that the final document would be adopted by the ISPO, WHO, the UN, USAID, other international development agencies, international NGOs and all governments and be utilized in their wheelchair provision activities.
The general atmosphere of the conference was very polite even though there were strong feelings of disagreement often expressed between the charity wheelchair distributors and the wheelchair users, many of whom were from Asia and Africa. There was a great deal of discussion on the more contentious issues such as: what is the definition of an appropriate wheelchair for the environment of developing countries; should the distributors of free wheelchairs also provide assessment, fitting, and follow-up to each wheelchair recipient; should a seat cushion be included in the definition of an appropriate wheelchair; how can we best respond to the millions of wheelchairs needed today by the elderly and disabled persons of the world; and what is the impact to local wheelchair businesses when a mass distribution of free wheelchairs occurs?
Examples of differing approaches
As examples of problematic issues, the plastic wheelchairs that are being mass distributed to many countries by the Free Wheelchair Mission, a Christian NGO, was often the target of criticism and controversy over the safety of their wheelchair design. They use a molded plastic patio chair for seating, a single piece steel conduit frame which follows the contours of the molded plastic chair and attach mountain bike wheels. The Free Wheelchair Mission has distributed over 150,000 free wheelchairs in over 61 countries since its beginning in 2001. (For more information about the work of this organization and a photo of their wheelchair design, see http://www.freewheelchairmission.org ) The Wheelchair Foundation is another large distributor of free wheelchairs and uses a Chinese factory to manufacture a wheelchair based on a 1960 American wheelchair design. Their wheelchair is painted red, comes in three sizes and 560,000 have been delivered free to 147 countries. (For more information about the work of this organization and a photo of their wheelchair design, see http://www.wheelchairfoundation.org) Representatives from the Wheelchair Foundation and the Free Wheelchair Mission participated in the conference and were available to answer many of the questions and criticisms raised by other participants.
The general question of, "Is any kind of wheelchair better than no wheelchair at all?" was often raised in the conference discussion and in private conversations. This question would often occur during criticisms of the free and mass distributed wheelchair designs. Representatives of organizations providing free wheelchairs defended their criticized designs by pointing out that most of the recipients of their wheelchairs were the poorest of the poor, often crawling in the dirt or confined to beds in their homes. They asserted that the very low cost of their wheelchair production or design is necessary in order to maximize the numbers of free wheelchairs provided. They confidently stated that that with their free wheelchairs, these persons' lives and opportunities for social inclusion were greatly improved. While they both acknowledged the limitations of their wheelchair design and their mass distribution model, they also challenged the conference participants to propose a better way of quickly meeting the need for a wheelchair by millions of elderly and disabled persons. By the end of the conference, both of these organizations indicated that they would try to incorporate some of the recommendations of the conference into their ongoing distribution of free wheelchairs. In addition, some of the small locally-based wheelchair businesses have decided to explore new partnerships with charity wheelchair distributors in order to increase the numbers of wheelchairs purchased from local businesses, improve the delivery of individual assessment and fitting to the most appropriate wheelchair and to provide follow up repair services.
Examples of draft conclusions
The list of consensus recommendations created by the conference participants will be further refined by the organizing committee and the final document will be submitted to various international organizations for their adoption in the next few months. A few examples of the important draft conclusions reached by the participants include:
Definition of an appropriate wheelchair:A wheelchair is appropriate when it meets the individual’s needs and environmental conditions; provides proper fit and postural support based on sound biomechanical principles; is safe and durable; is available and can be accessed, maintained and sustained in the country at the most economical and affordable price.
User involvement: “It is about the user, not just about the wheelchair”. Wheelchair users should be involved in all aspects of wheelchair provision
Services: The aim of wheelchair services is to ensure that the person in need of a wheelchair receives it together with the necessary information and support. The wheelchair should meet the individual’s needs in terms of mobility, comfort and ability to carry out activities of daily living and to exercise basic human rights.
Production Standards and guidelines: All wheelchairs, whether locally produced or imported, and whether made in small, medium or large scale enterprises should meet or exceed ISO standards.
Acquiring wheelchairs:When determining whether to acquire wheelchairs via import or local production, decision makers are advised to balance a variety of factors. These include needs of the local population, quality and variety of wheelchair models, purchase price, cost of repair and replacement, effect on local employment and wheelchair production, and national policies and strategies including long-term sustainability.
Distribution: Wheelchairs are to be provided following a provision process that meets or exceeds internationally agreed minimum requirements for service provision, including requirements for assessment, fitting, user training and follow-up; and that wheelchairs are repairable in the region of the country where they are provided.
In summation, the organizers of this important Consensus Conference on Wheelchairs for Developing Countries are to be commended for advancing new international standards for the provision of wheelchairs and wheelchair services to the millions of elderly and disabled persons in the world. The Leahy War Victims Fund of USAID should be especially congratulated for paying for the costs of the conference and the participation of a large number of wheelchair users from developing countries. Everyone at the conference worked extremely hard throughout the week in order to develop the best possible recommendations and guidelines for improving the state of the art in wheelchair provision, and to improve the numbers and quality of service of wheelchairs being provided to disabled persons worldwide.