Picture a small workshop on the outskirts of Nairobi. A handful of skilled technicians build and repair wheelchairs, stock the right spare parts, and know their customers by name. Then a shipping container arrives. It is a donation, free, full of wheelchairs sourced from somewhere far away. For a year, no one buys a locally made wheelchairs. The workshop cannot pay rent or wages. It closes. The technicians scatter to other jobs. And when those donated wheelchairs break, as every chair eventually does, there is no longer anyone nearby who knows how to fix them.
This is not a hypothetical. It was described almost exactly this way by participants at the recent WHO–UNICEF regional workshop on assistive technology in Nairobi. One delegate put it plainly: a local producer can be put out of business for a year by a single donated container, and once they close, the whole community loses the repair capacity that came with them.
The container-load example captures a paradox at the heart of assistive technology (AT) provision across Kenya and much of Africa. Generosity, poorly designed, can entrench the very dependence it set out to relieve. From a rights-based perspective, this matters enormously: the Convention on the Rights of Persons with Disabilities frames AT as a right.
In this article we’ll use the wheelchair as an example to represent different ATs because wheelchairs are the best examples of ATs given out for free.
Why “free” is rarely free
A donated device feels like an unambiguous good. The problem is what surrounds it, or, more often, what doesn’t.
« The shift from generosity that creates dependence to investment that builds capacity. »
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It arrives without spare parts
1. Donated wheelchairs come from all over the world. New, used, second-hand, sometimes unusable. The range of parts needed to repair such a mixed fleet is so broad that no service centre can realistically stock it. People stop even looking for spares because they assume none exist.
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It arrives without a fitting
1. A wheelchair given to a person who needs a different size, or to a child who will outgrow it within a year, is a burden rather than a tool for participation. Adult chairs handed to children were singled out at the workshop as a recurring harm done with good intentions.
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It arrives without follow-up plan
When a political aspirant issues out 300 wheelchairs,” the users receiving them are rarely trained to fit, adjust, or maintain them. The maintenance burden falls back on the person using the device, who may have to travel hours to a city to find help that often isn’t there.
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It distorts the market
1. Each free shipment signals to local manufacturers that there is no reliable demand to invest in. Skilled workers are trained, then poached or laid off. The supply chain for materials never matures. The result is a permanent state of dependence on the next shipment.
None of this honours the rights of the person who uses the device. It treats them as a recipient of leftovers rather than a participant in a system built to serve them.
What a sustainable system looks like instead
The encouraging news from the workshop is that the alternative is not theoretical. Several countries are already building it, and the building blocks are clear.
• Government-coordinated procurement. Where a government tenders consistently for defined product types, a constant pool of matching spare parts becomes available. Repair becomes possible. Refurbishment and reuse replace disposal. The system, in one delegate’s words, “starts flowing.”
• Donor alignment, not donor direction. In Rwanda’s model, even a donor bringing funds must first agree with government on the best fit for those resources. The donor does not decide which devices arrive; the national system does, against real need.
• Local production and nearby suppliers. Custom-made devices such as prosthetics build in a return-for-repair relationship, the person comes back, and the device is adjusted or fixed. Locally made products keep that relationship alive and keep skilled jobs in the community.
• Financing that shares cost fairly. Free-for-all giveaways can be replaced by sliding-scale or insurance-embedded models. South Africa’s sliding scale charges according to income. Free or partly subsidised for those who earn least, with wealthier users paying above cost to cross-subsidise the poorest. Rwanda and other African countries are working to embed AT in community health insurance rather than give devices away. Both approaches make access predictable and dignified rather than a lottery.
A practical checklist before accepting a donation
If you work for an organisation of persons with disabilities (OPD), a county health office, a school, or an NGO in Kenya, these questions can turn a well-meaning offer into a genuinely useful one. Ask them before the container ships.
1. Did the people who will use these devices ask for them? If users and their organisations were not consulted, pause right there.
2. Are they the right specification? Sizes, types, and adjustability for the actual people on the waiting list, including children who grow. Users should always be assessed first.
3. Do they come with spare parts? Tyres, brakes, cushions, wheels, batteries. A device without a parts plan has a short life span.
4. Who will fit and maintain them, and where? Ideally at community level, not only in distant cities. Is there training included for the users themselves, the local health workers or technicians?
5. Will this undercut a local producer? If a Kenyan workshop already makes this product, a donation may do more harm than good. Consider funding that producer instead.
6. How does ownership and after-care transfer to the user? At what point does responsibility for handling and routine care pass to the person, and have they been shown how?
7. Is there a one-time-only understanding? A single, well-matched donation that strengthens a system differs from an open-ended dependence that weakens it.
What to do next
• Persons with disabilities and their families can claim AT as a right under the CRPD and Kenyan law, ask providers about repair and replacement before accepting a device, and report devices that don’t fit or work rather than struggling silently.
• OPDs can insist on a seat at procurement and design tables, track whether AT budget allocations are utilized each year, and use the consultation checklist above when approached by donors.
• County health teams can favour consistent tendering of defined products over ad-hoc giveaways, and build a basic spare-parts and repair pathway alongside new devices.
• Donors and NGOs can fund local producers and repair capacity rather than shipping finished goods, align spending with national plans, and measure success by devices still working in two years and not devices distributed on day one.
The bottom line
The shift that the Access to AT workshop called for is from generosity that creates dependence to investment that builds capacity. A person who uses a wheelchair has the right not just to receive one, but to keep it working, to have it fit their body and their life, and to have a say in how the whole system is run.
A free chair that breaks in six months with no parts and no technician is a hidden cost passed quietly to the person who can least afford it. A locally made chair, fitted properly, repaired nearby, and paid for through a fair shared system, is something else entirely. It is a right and it’s built to last.
Article by: Maryanne Emomeri