Policy and Planning for Wheelchair Provision

 
Policy and Planning to Implement Sustainable Wheelchair Provision concludes our five part series on wheelchair provision in less resourced settings brought to you with permission from the World Health Organisation. In this article we cover the following policy and planning guidelines;

• present key activities for the planning and implementation of wheelchair provision
• suggest strategies for costing and financing wheelchair provision
• suggest links between wheelchair services and other sectors

Testimonial from a user in the Philippines

Michelle lives on the rural island of Masbate, a remote area of the Philippines. She is 20 years old, and was born without legs and with on one arm. Unable to propel a standard wheelchair, Michelle has lived without one for most of her life. For mobility she has had to “walk” with one arm and her torso. In 2005, Michelle was referred by community workers to a wheelchair service operated by an international nongovernmental organization.

The service team saw that for a wheelchair to be useful to Michelle, it would need to be operable by one arm, be suitable for rough surfaces, and be easily portable on public transport for travel into town. A local wheelchair factory that operates in partnership with the wheelchair service team was able to create a wheelchair to these specifications.

Michelle is now able to propel herself in her wheelchair, and no longer has to move herself along at ground level. She uses the wheelchair to attend church, make social visits and play basketball. Most importantly, Michelle, who has a keen entrepreneurial spirit, aims to improve the economic well-being of her family. With improved mobility, her opportunities for this are greater.

5.0 Purpose and Outputs

The purpose of the policy and planning guidelines is to develop and implement policies for cost effective and sustainable wheelchair provision. Implementation of these guidelines will lead to:

• develop a national wheelchair policy
• plan wheelchair provision programs at national level in collaboration with all stakeholders, based on identified needs
• integrate wheelchair services into existing health and rehabilitation services
• develop national standards for wheelchair provision
• calculate costs and establish sources of funding
• link wheelchair provision with existing sectors and institutions in society

Stakeholders and Resources

Stakeholders involved in policy and planning include policy-makers, planners and implementers, manufacturers and suppliers of wheelchairs, providers of wheelchair services, disabled people’s organizations and users.

5.2 Policy

Developing a Policy

A national policy on wheelchair provision can ensure that users receive wheelchairs that meet minimum requirements for safety, strength and durability and that are appropriate for their individual needs. A national policy can also ensure that wheelchairs are provided by trained personnel who know how to properly assess users’ needs and how to train users and caregivers on how to use and care for the wheelchairs.

When developing a national policy it is recommended that the following relevant areas are considered; 

• issues addressed by relevant international policies
• design, supply, service delivery, training and user involvement
• funding
• links with other sectors

To avoid a separate policy for wheelchair provision, wheelchairs can be included in a general policy for provision of assistive devices. However, specific issues related to wheelchair provision may need to be addressed in additional policy documents.

International Policies

The two main international policy instruments related to wheelchair provision are: 

• the Convention on the Rights of Persons with Disabilities; and
• the Standard Rules on the Equalization of Opportunities for Persons with Disabilities

The Convention

The Convention on the Rights of Persons with Disabilities consists of 50 articles. Articles 4, 20, 26 and 32 are particularly applicable to wheelchair provision as follows;

Article 4. General obligations

1. States Parties undertake to ensure and promote the full realization of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability. To this end, States Parties undertake:

(a) To adopt all appropriate legislative, administrative and other measures for the implementation of the rights recognized in the present Convention;

(g) To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost;

(h) To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities;

(i) To promote the training of professionals and personnel working with persons with disabilities in the rights recognized in this Convention so as to better provide the assistance and services guaranteed by those rights.

Article 20. Personal mobility

States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by:

(a) Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost;

(b) Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost;

(c) Providing training in mobility skills to persons with disabilities and to specialist personnel working with persons with disabilities;

(d) Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities.

Article 26. Habilitation and rehabilitation

3. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.

Article 32. International cooperation

1. States Parties recognize the importance of international cooperation and its promotion, in support of national efforts for the realization of the purpose and objectives of the present Convention, and will undertake appropriate and effective measures in this regard, between and among States and, as appropriate, in partnership with relevant international and regional organizations and civil society, in particular organizations of persons with disabilities. Such measures could include, inter alia:

(b) Facilitating and supporting capacity-building, including through the exchange and sharing of information, experiences, training programs and best practices;

(d) Providing, as appropriate, technical and economic assistance, including by facilitating access to and sharing of accessible and assistive technologies, and through the transfer of technologies.

The Standard Rules

The Standard Rules on the Equalization of Opportunities for Persons with Disabilities consists of 22 rules. With regard to preconditions for equal participation, Rules 3 and 4 apply to wheelchair provision. With regard to implementation measures, Rules 14, 19 and 20 are applicable.

Rule 3. Rehabilitation

“States should ensure the provision of rehabilitation services to people with disabilities in order for them to reach and sustain their optimum level of independence and functioning.”

Rule 4. Support services

“States should ensure the development and supply of support services, including assistive devices for people with disabilities, to assist them to increase their level of independence in their daily living and to exercise their rights.”

Rule 14. Policy-making and planning

“States will ensure that disability aspects are included in all relevant policy-making and national planning.”

Rule 19. Staff training

“States are responsible for ensuring the adequate training of personnel, at all levels, involved in the planning and provision of programs and services concerning people with disabilities.”

Rule 20. Monitoring and evaluation

“States are responsible for continuous monitoring and evaluation of the implementation of national programs and services concerning the equalization of opportunities for people with disabilities.”

Both the Convention and the Standard Rules clearly state that the government has the primary responsibility for wheelchair provision. It is therefore recommended that wheelchair provision be an integral part of national strategies.

Article 32. International cooperation

1. States Parties recognize the importance of international cooperation and its promotion, in support of national efforts for the realization of the purpose and objectives of the present Convention, and will undertake appropriate and effective measures in this regard, between and among States and, as appropriate, in partnership with relevant international and regional organizations and civil society, in particular organizations of persons with disabilities. Such measures could include, inter alia:

(b) Facilitating and supporting capacity-building, including through the exchange and sharing of information, experiences, training programs and best practices.

(d) Providing, as appropriate, technical and economic assistance, including by facilitating access to and sharing of accessible and assistive technologies, and through the transfer of technologies.

Specific wheelchair provision issues

There are five areas to be considered when developing a policy for basic wheelchair provision.

1. Design: Each person has a unique set of individual or environmental needs that dictate the wheelchair design that is best for him or her. Because user needs are so diverse, no single wheelchair design will be appropriate for all users under all conditions. It is recommended that policies:

• require that several types of wheelchair be made available to service providers to ensure that each user receives a wheelchair that meets his or her needs; and,
• specify minimum national requirements to ensure that wheelchairs will be safe, durable and locally maintainable.

2. Production and supply: Wheelchairs can be produced and acquired in a number of ways. They should be tested for strength, durability and suitability for the context in which they will be used. Decisions will need to be made on how wheelchairs will be produced and acquired. It is recommended that policies:

• approach the overall need for wheelchairs in relation to the funding available, the sustainability of supply over time, local economic development, and the impact on the local wheelchair provision infrastructure;
• encourage assessment of wheelchairs against minimum guidelines;
• encourage participation of users and service providers in the selection of wheelchairs; and,
•  take into account other national policies on related issues, such as support of local production and local employment.

3. Service delivery: Providers of wheelchair services play an important role in liaising between the users and the wheelchair manufacturers. They can ensure that individual users are provided with an appropriate wheelchair. They provide education and training about the user’s needs, as well as ongoing support and referral to other services. It is recommended that policies:

• promote user empowerment and choice;
• require that wheelchairs be provided through a proper wheelchair service delivery system;
• require that all wheelchair service providers follow recommended practices regarding of wheelchair availability, prescription, fitting, training of users and follow-up services; and,
• require wheelchair service providers to demonstrate transparency, fair pricing, and monitoring and evaluation of their services.

4. Training: Training of all personnel involved in wheelchair provision ensures that service delivery can be maintained at a nationally accepted level. It is recommended that policies:

• encourage that training be made available for all individuals directly associated with the development and implementation of wheelchair provision, including those involved in design, production, testing and service delivery.

5. Financing: Each of these four areas of basic wheelchair provision requires funding. Different funding strategies are described in Section 5.4. Typically, the costs of designing, producing and supplying a wheelchair, the delivery of wheelchair services and training of personnel are included in the price of the provided wheelchair, unless the costs are covered in other ways. It is recommended that policies:

• specify funding mechanisms;
• set eligibility criteria for funding;
• specify the categories and standards of wheelchairs and services that are funded under the scheme; and
• promote user empowerment and choice.

Other policy support mechanisim governments could consider

• waiving import duties on raw materials used to build wheelchairs;
• waiving import duties on wheelchairs if they are not available in the country;
• supporting local nongovernmental and disabled people’s organizations that provide wheelchairs and related services through direct grants, or by facilitating relationships between local and international nongovernmental organizations, business communities and other stakeholders;
• supporting private wheelchair manufacturing businesses through competitive tender offers, loans and training grants;
• promoting the participation of users at every level of service planning and implementation;
• removing architectural barriers to increased mobility, independence and participation, thus stimulating interest in, use of and demand for better wheelchairs; and
• including wheelchair provision and allied issues (such as accessible environments and accessible transport) in other national policies.

Example of a policy in India related to wheelchair provision

In India, the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act (2) was adopted in 1995 as a result of continual lobbying by disability activists and nongovernmental organizations. This lobbying involved extensive consultations with officials, protest marches and press conferences (3). Regarding wheelchairs, the Act states in Chapter VII: “The appropriate Governments shall by notification make schemes to provide aids and appliances to persons with disabilities.”

On the basis of this Act, the Indian Government introduced the Assistance to Disabled Persons of India scheme, under which people with a monthly income of less than US$ 160 can get a wheelchair free of charge. If the monthly income is between US$ 161 and US$ 250 the user has to pay 50% of the cost, and if the income is above US$ 250, the user has to pay the full cost of the wheelchair.

Example of a policy in Afghanistan related to wheelchair provision

In October 2003, the Ministry of Martyrs and Disabled in Afghanistan published a Comprehensive National Disability Policy. The policy was “developed in collaborative manner by all stakeholders including primarily disabled people organizations and self help groups; disability NGOs both national and international; major line ministries including Ministry of Education, Ministry of Public Health, Ministry of Labor and Social Affairs, Ministry of Women Affairs, and Ministry of Martyrs and Disabled (MMD); related UN agencies including UNOPS/CDAP, WHO, ILO, UNICEF, and UNHCR; National Constitution Commission; and President Office” (4). It is expected that the initial policy will lead to a more detailed and prioritized plan of action that needs to be developed in order to achieve the ultimate objectives of this policy. The policy goes on to state:

Provisions for people with physical disability for example, should include orthopedic rehabilitation centers; physiotherapy services; and orthopedic, assistive and mobility devices. These services should be close to a regional or provincial hospital with orthopedic surgical services so that the local population has easy access. They could be located ideally, in cities with medical teaching faculties such as in Kabul, Mazar, Herat, Kandahar and Jalalabad. Future services should provide for an expansion in orthotics as this is underserved.

All patients have the right to receive devices. Devices should be well-made, well-fitting, of local materials whenever possible and repairable locally. Appropriate technology should be standardized throughout the country. A mechanism for national standardization should be created with relevant experts in collaboration with MOPH [the Ministry of Public Health].

5.3 Planning

There are six key activities in planning and implementing wheelchair provision.

1. Identifying the need for wheelchairs and services

Identifying the need for wheelchairs is necessary to determine the numbers of services and personnel required and where to locate services. Such assessments also provide information on user satisfaction with wheelchairs that are in use and may have been distributed with or without service provision. Statistics should include the number of users, prevalence of different health conditions, impairments and restrictions in participation, and the geographical location of these individuals. Collection of data can often be facilitated by collaborating with community-based rehabilitation programs and disabled people’s organizations. Where collection of data is not possible, the conservative estimate that 1% of the population will require wheelchairs can be used.

2. Planning wheelchair provision at national level

It is recommended that governments be actively engaged in the planning, establishment and continuing development of wheelchair services. Governments are advised to consider funding wheelchair services along with other rehabilitation services. Where government funding is already allocated to wheelchair provision, it is recommended that the services be assessed to determine whether they are being provided in accordance with the recommendations made in these guidelines.

3. Encouraging collaboration between governmental and nongovernmental service providers

Wherever possible, national and international nongovernmental organizations involved in wheelchair provision are encouraged to collaborate closely with relevant ministries and departments to assist in developing and implementing the national plan for wheelchair provision. A coordinated plan can help to make maximum use of resources and ensure that the appropriate services are accessible to those who need them.

4. Integrating wheelchair services into existing rehabilitation services

Wheelchair services will be enhanced by integrating them into other rehabilitation and health care services where possible. Integration helps to coordinate efforts among key stakeholders, make the best use of resources such as health centres and personnel, and facilitate strong referral and consulting networks. A good example is that of the Kilimanjaro Christian Medical Centre, where a multidisciplinary group of medical professionals have established a wheelchair committee to address issues related to production, service delivery, distribution and maintenance (6).

Referral networks are critical to the sustainability of wheelchair services, and help to ensure that the services are accessible to those who need them. Consulting networks and access to health care professionals such as physicians, occupational therapists, physiotherapists, speech and language therapists and other specialists help to ensure that appropriate services and equipment are provided to users. This is particularly important for those with complex needs.

5. Adopting national standards of wheelchair provision

National authorities and providers of wheelchair services are urged to develop and adopt national standards. National standards need to address issues associated with the quality and testing of wheelchairs, personnel training and service delivery. These guidelines may serve as a starting point for developing standards. It is also recommended that monitoring and evaluation be carried out to ensure wheelchair services meet the established standards.

6. Empowering consumers

National governments and international development agencies can create and support an enabling environment. Users need to have the opportunity to choose the right product for themselves from among a variety of products. A good information package about these products, including possible sources of funding or subsidy, could be very useful for the user in making the right decision.

The best strategy for developing a national wheelchair provision programme will depend on the current state of wheelchair services in the country, the available resources and the needs the service has to meet. It is useful to consider the following questions when planning wheelchair provision.

• What are the characteristics and specific needs of the user population?
• Do stakeholder groups exist and, if so, what are their interests and opinions?
• Do wheelchair services already exist (through local workshops, community-based rehabilitation, disabled people’s organizations, other nongovernmental organizations, the private sector or government)?
• Is there any wheelchair provision outside the formal infrastructure, for example provision of mass imported wheelchairs?
• What can be done with existing resources?
• What are the current funding mechanisms?

Strategies for Developing a Wheelchair Provision Programme

1. The government wants to establish a national wheelchair service programme. The government may contact interested nongovernmental and disabled people’s organizations, users, training  programs for health professionals, international organizations such as WHO and the International Society for Prosthetics and Orthotics and relevant international nongovernmental organizations to help in developing an appropriate plan for a national wheelchair service. The government may look at its own prosthetic and orthotic services and use these as a basis for developing a wheelchair service. It may also contact government bodies in other countries to learn from their experience and seek advice.
    
2. Wheelchair provision exists but on a small scale through independent organizations; there is no collaboration. The government, local organizations or an international nongovernmental organization could assess the possibility of scaling up the operation. A resource centre can be set up to involve people from the different organizations in a collaborative effort. The resource centre can then evolve into either a coalition of organizations interested in wheelchair services or an independent nongovernmental organization in its own right.
    
3. There are organizations in the country but no wheelchair service delivery. An interested nongovernmental or disabled people’s organization can serve as the nucleus for a resource centre. The organization needs to identify an appropriate organization with wheelchair provision experience as a partner (e.g. a governmental or nongovernmental organization in a neighbouring country or an international nongovernmental organization) and should follow the other initial steps in scenario 4 below. Alternatively, this process may be started by an international nongovernmental organization, which then seeks out local nongovernmental and disabled people’s organizations as partners. Efforts should be made to identify and network with other countries or organizations that have had similar experience in initiating wheelchair services.
    
4. There are no organizations in the country and no regular wheelchair service delivery. An international nongovernmental organization, either on its own initiative or at the invitation of or in partnership with the government, could establish a resource centre in the capital or other major city. The resource centre could be an integral part of an already existing rehabilitation institute. The resource centre should begin by providing important information to users, their families or caregivers and health professionals about mobility needs and wider issues pertaining to mobility. The international nongovernmental organization should develop a stakeholder analysis and survey people who use or require wheelchairs, in order to identify gaps and determine the need for wheelchairs and services. Preliminary participatory research will present options for meeting the needs. Funding should be secured to begin wheelchair provision. Efforts should be made to establish a working relationship between the resource centre and relevant governmental bodies as a first step in establishing a national wheelchair service.
    

5.4 Funding Stratagies

An important part of setting up a wheelchair service comprises costing and establishing sources of funding in order to ensure the financial sustainability of the service.

Costing

 The first step towards financial sustainability is the accurate calculation of the direct and indirect costs of wheelchair services. It is important that the cost of service delivery and the cost of the product are accounted for. Initial costs of setting up a wheelchair service should also be provided for but do not need to be included in the calculation of running costs. When estimating funds needed to establish and sustain wheelchair services, planners are advised to consider the total cost of wheelchair provision. The total cost is the sum of all direct and indirect costs.

Direct Costs

Product

• Manufacturing cost or purchase price of wheelchair
• Shipping and transportation of wheelchair

Initial Service

• Personnel costs (clinical, technical, training) for assessing, ordering, fitting and training
• Personnel costs for ordering and inventory of wheelchairs
• Materials and equipment for assembly and modifications
• Supplies (assessment forms, record-keeping, etc.)

Follow-up service

• Personnel costs
• Maintenance and repair

Indirect  Costs

• Management
• Administration
• Overheads
• Capacity building – training of service personnel

Sources of Funding

Many individuals who need a wheelchair cannot afford to buy one. Nevertheless, everyone who needs a wheelchair is entitled to one, regardless of his or her ability to pay for it. Thus, funds will need to be made available to users needing financial assistance. Different funding mechanisms are described below.

Government Funding

Government funding is usually the most reliable funding source where the government is committed to wheelchair services. Where wheelchair services are being established or provided by nongovernmental groups, it is recommended that there be continued consultation with the relevant government departments. Consultation should include long-term planning to determine when, how and to what extent the government is able to assume overall responsibility for the service in the future, including financial contributions.

Donor Funding

In many contexts, the initiation of a wheelchair service may depend on funding from national and international donors. Owing to its usually short-term nature, donor funding should be complemented by advocacy for government and other more sustainable sources of funding.

Wheelchair Funds Managed by Committee

A local “wheelchair fund” may be established to subsidize the cost of wheelchairs for individual users. Wheelchair funds exist to source funding and equitably manage donations secured for wheelchair provision. Users apply to the fund committee for a full or partial subsidy of the cost of a wheelchair. It is recommended that such funds apply a means test to determine how much financial assistance should be given. Government funding may also be channelled through a wheelchair fund.

Committees should comprise a cross-section of individuals who have a vested interest in sustainable wheelchair provision, such as (though not limited to) users, representatives of disabled people’s organizations, clinicians and technicians, government representatives and local dignitaries.

Contributions From Users

Unless full government funding is provided for wheelchair purchase, it is recommended that any financing system incorporates an element of financial contribution from users themselves. Contribution  programs should be run in conjunction with individual means tests to ensure that users contribute no more and no less than they can realistically afford. Users’ contributions also stimulate demand for products and services of appropriate quality.

A credit scheme is an option that allows users to borrow funds to purchase a wheelchair and to repay it over a period of time. Another option is an employment scheme, linking wheelchair provision with the opportunity for the user to obtain a job or funds to start a business and to pay for the wheelchair over time.

Fees on Donated or Imported Wheelchairs

Even when a wheelchair is donated free of charge, there are costs associated with its responsible provision to the user, including follow-up with the user and maintenance of the wheelchair. Organizations that import wheelchairs on a large scale without ensuring the necessary services, as described in Chapter 3, could be required to pay a fee to support the services.

Income Generation

Wheelchair services can be subsidized through income from the sale of other products such as canes, crutches, walkers, and toilet and shower chairs.

Voucher System

A voucher system may enable users to make their own purchasing decisions. The user is assessed and receives a prescription for a wheelchair with certain features. The user is given a voucher to the value of the cheapest wheelchair that fits the user’s prescription and that also meets minimum standards for safety, strength and durability. Users who want a more expensive chair that meets the prescription have to find the additional funds themselves.
 

5.5 Links With Other Sectors

Wheelchair service stakeholders are encouraged to collaborate with other sectors and institutions. These linkages reduce the cost of establishing and operating a wheelchair service and allow the service to grow more rapidly. Professionals in these other sectors will learn about wheelchair services, while the services will benefit from the increased involvement of educated and trained professionals. Collaboration will also facilitate more enabling or barrier-free environments, and a higher level of inclusion and participation

Health services and community outreach campaigns

Existing health services provide an infrastructure into which wheelchair services can be integrated at the lowest possible cost. Information services can be expanded to include wheelchairs, thus facilitating the identification and follow-up of users. The advantages include a common location for all services, the use of existing referral networks, and greater awareness among health and rehabilitation workers. Visits by health services to outlying areas (for HIV/AIDS awareness, community-based rehabilitation  programs and vaccination campaigns, for example), as well as literacy, voter registration/political participation campaigns and any other outreach  programs, also provide an opportunity to provide wheelchair services.

Education

Linking wheelchair provision with the education sector can facilitate the development of training materials and implementation of training  programs. In some instances, core subjects may already exist within the academic institution. In these situations it may be possible to integrate training for wheelchair provision into existing courses.

Similarly, manufacturing and testing laboratories may exist, which can help facilitate the design, production and testing of wheelchairs. University students in a variety of technical and health disciplines can be recruited for careers in wheelchair provision. Service providers can engage students for field placements to obtain experience. Finally, academic institutions will be familiar with methods of accreditation, which may help in establishing nationally recognized, accredited training for wheelchair provision.

Wheelchair services can also work with the education sector to ensure education is accessible to people with disabilities, as stated in Article 9a of the United Nations Convention on the Rights of Persons with Disabilities. With a wheelchair and a barrier-free environment, a person with disability can access education in school or college. Schools and colleges need to have, as a minimum, easy access to classrooms, wide doorways and accessible toilets.

Livelihood

It is likely that new wheelchair users will need help in finding a job or acquiring the necessary skills to find a job or return to work. Article 27 of the United Nations Convention states: Parties recognize the right of persons with disabilities to work, on an equal basis with others; this includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities.

Policies that encourage employment training, job referral  programs and mainstream education for people with disabilities can help to increase the employment opportunities for users. There are benefits for both users and society when users are able to secure their own livelihood. Through employment, users and their families can better secure the necessities of life and improve their economic and social situation.

The Standard Rules on the “Equalization of Opportunities for Persons with Disabilities” notes that users have obligations as well as rights. With mobility, and a greater opportunity for work, users are in a better position to fulfil their obligations to society.

Social

Quality Of Life: With a wheelchair and a barrier-free environment, a person with disability can easily participate with dignity in social and community life. Active participation in the social, spiritual and cultural life of a community has a strong impact on the quality of users’ lives and their self-perception and self-esteem. Both participation in and appreciation of the arts, sports and recreational activities, can greatly contribute to a positive self-image and well-being.

Active Participation: Barriers to participation of users include negative attitudes held by the public, the users’ families and sometimes the users themselves. An effective way of overcoming attitudinal barriers is for users to become more visible, demonstrating to family, friends and the broader public that they can participate in social activities (see Fig. 5.3.). Through direct experience, users and those around them learn the full extent of a user’s abilities. Users have the same rights and opportunities as others to have a family. In fact, a wheelchair makes family life easier and less stressful for a person with disability and his or her family.

Governments are encouraged to assist users in accessing wheelchairs and services that allow them to function as independently as possible. Users and their families also need to receive the social benefits to which they are entitled.

Infrastructure: Barrier-free environments create opportunities for users to exercise their rights, opportunities and freedoms, to become productive members of the family and to fulfil their duties to their family and community. The success and optimization of wheelchair provision in any country largely depend on the environment: a barrier-free environment will benefit not only wheelchair users but also others, especially older people. Basic aspects of the infrastructure that need to be accessible include:

• buildings, i.e. housing and public buildings providing, for example, health services, education, employment, banking, government services and other public services;
• public transport, such as buses, trains and ferries;
• roads, streets and footpaths;
• food, water and sanitation facilities such as open-air restaurants and markets, water taps, tube wells and toilets; and
• facilities for culture and recreation, for example stadiums, cinemas, theatres, parks, public halls and community centres.

It is recommended that experts on wheelchair accessibility, for example users with adequate knowledge, be represented on local, regional and national committees that determine planning and construction. Universal design, including wheelchair access, could be included as a requirement in university  programs for civil engineering, architecture, urban planning and design.

Access for all in Sri Lanka

In Sri Lanka, a consortium of disability organizations was formed to support a campaign to promote the inclusion and participation of all people with disabilities in tsunami relief, reconstruction and development work. The Access for all campaign asks for the inclusion of people with disabilities when rebuilding the nation. This means rebuilding an accessible nation: making all public buildings, transport, places of employment, services and infrastructure accessible to all. It also means including people with disabilities in plans for the nation.
 

5.6 Inclusion and Participation

The ultimate aim of wheelchair provision is to facilitate inclusion and participation. Mobility is often a precondition for participation in society. Hence, provision of wheelchairs that enhance personal mobility is an essential element of interventions to ensure that all citizens of a country get equal opportunities to enjoy all human rights and fundamental freedoms.

Inclusion and participation of people using wheelchairs will require: 

• barrier-free environments and disabled-friendly products and services;
• general services and systems such as housing, health care, transportation, schools and income generating activities are made accessible; and
• specific services and systems such as medical treatment, rehabilitation, wheelchairs and other assistive devices and support services are made accessible and affordable

It is important that all stakeholders in wheelchair provision are aware of and understand the ultimate aim of providing wheelchairs, and translate this understanding into appropriate action to ensure sustainable inclusion and participation. When the wheelchair needs of people in less-resourced settings begin to be met, this will benefit not only the individuals and their families but also their countries.
 

Conclusions

• Countries have the primary responsibility for wheelchair provision, as stated in United Nations policy instruments.
• Areas to consider when developing a policy for wheelchair provision include design, production and supply, service delivery, training and financing.
• Key activities in planning and implementation wheelchair provision are:
  identification of need
  planning at national level
  collaboration among stakeholders
  integration of existing health care of rehabiliation services
  adoption of national standards
  emp0werment of users
• Linking wheelchair provision to other sectors of the society can be effective.
• Infrastructure and transport systems need to be accessible to all.
• The ultimate aim of wheelchair provision is to facilitate inclusion and participation.
   

Resources

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3. Wong-Hernandez l. Moving legislation into action: the examples of India & South Africa. Disability World, 2001, No. 6 (http://www.disabilityworld.org/01-02_01/gov/legislation.htm, accessed 11 March 2008).
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