The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone

Lay Summary Assistive technology (AT) (e.g. wheelchairs, hearing aids, or products for people with visual impairments) are crucial for the wellbeing of users, but there is huge and growing unmet need for AT globally. In low-income settings many users access AT from the informal (unregulated) economy, which tends to provide AT in under-served communities, and at lower cost, helping to address this gap. However, AT from informal providers often fails to meet minimum product standards and/or lacks associated services such as assessment, fitting, user training, maintenance and repairs. On the other hand, many users of AT from informal sources value, in addition to low cost, some other features, such as their ability to customize assistive products and innovate in product development. This study therefore proposes exploring ways in which formal and informal providers of AT could work together to improve access at the same time as ensuring the safety and quality of AT for low-income users. Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.