The Importance of User Choice for Cost-Effective Wheelchair Provision in Low Income Countries

by Marc Krizack, J.D., Executive Director
Whirlwind Wheelchair International at San Francisco State University

The limited success of free market mechanisms in wheelchair provision in low income countries requires a comprehensive, coordinated, and sustained intervention by governments, charities, and development agencies working in close collaboration with the organized movement of people with disabilities. To be effective, this effort must be designed to stimulate market mechanisms. Up to now, funders have usually subsidized supply, that is, they have purchased wheelchairs that are then given to users. This system must
be turned on its head. Funders must instead subsidize demand, that is, provide funds for wheelchair users to choose for themselves what wheelchairs they want and need.
A healthy market economy tends to correct imbalances in price, quality, and availability of goods and services through competition among producers and feedback from consumer purchasing decisions. The introduction of new products creates new needs and demand and thus provides opportunities for further economic development via a continually evolving array of products and services. A healthy market economy tends toward efficient use of investment resources as each product and service in the web of related products and services develops apace, usually getting neither too far ahead of nor too far behind the demand.

The market economy, however, is skewed when it comes to wheelchairs in low income countries. End users have little money and are most often not the purchasers of the wheelchairs they use. Instead, governments, charities and international development organizations purchase the wheelchairs and give them away. Initial cost is the predominant consideration for these distributors; the wheelchairs provided are rarely built for the
environments in which they will be used. There is little consumer input to make manufacturers and distributors deal with other considerations, such as quality, fitness for use, proper fit, and safety.
Furthermore, a flood of cheap or free imports has the effect of lessening competition by driving out the small, local manufacturers who depend on local governments and charitable organizations, the users, and the users’ families to pay for their chairs.

The influx of very large numbers of wheelchairs into a region also outpaces the development of secondary facilities, goods, and services, what we will call “the rehabilitation infrastructure” required for users to get the most out of their wheelchairs. The result is that millions of dollars are wasted each year because there are few spare parts to repair the wheelchairs when they break, few repairers trained in wheelchair repair, and few trained personnel to measure and assess users for a proper chair-to-user fit.

The most efficient use of capital resources for wheelchair purchases requires that the number of wheelchairs introduced into any given area not greatly exceed the capacity of the rehabilitation infrastructure to support them. That is, in order for the chairs to be properly fitted, maintained, and repaired, it is better to apportion resources between wheelchairs and these necessary services. A wise intervention will regularly evaluate the capacity of the extant rehabilitation infrastructure, support a commensurate level of wheelchair production,
and build up and extend the capacity of the infrastructure to be able to increase the number of wheelchairs that can be provided effectively.

In order for a system of user choice to work, donors would place their money in a managed fund. There should be a variety of wheelchairs, readily accessible consumer information, standards for safety, strength and durability, and trained persons who can advise the users in choosing an appropriate wheelchair. With these elements in place, a user could receive a voucher to purchase the least expensive of the approved wheelchairs that meet the user’s needs. If the user wanted a more expensive chair, the user would have to pay the difference. An adequate pot of money would be attractive to manufacturers who would produce
chairs to meet the users’ requirements. The type and variety of available wheelchairs would grow, along with related services, giving users greater and greater choice and improving a user’s chances to obtain the most appropriate wheelchair for his or her individual needs.

Governments, donors and development agencies can learn how best to allocate resources between wheelchairs and wheelchair services/training by participating in a collaborative effort with disabled people’s organizations to provide wheelchair users with the opportunity to choose their own wheelchairs. The resulting feedback will directly benefit wheelchair users and help donors to get the best results in the most cost-effective way.

12th World Congress of the International Society for Prosthetics and Orthotics
Vancouver, Canada, July 29 –August 3, 2007

Customizing and Ordering My Roughrider

Seat Width

To find the distance between your hips, first position yourself seated with pelvis upright on a firm surface. Then, measure the distance between the widest points of the hips and thighs without compressing any tissue. Finally, record your measurements. It is important not to have a chair that is wider than necessary as it will be harder to push and may prevent you from passing through narrow doorways.

Seat Depth

Position yourself seated upright on a firm surface. Measure the length of your upper leg, the distance from behind the knee to the back of the pelvis (back of your lower leg). Subtract 1/2” to find the maximum seat depth, to allow for space between the back of the knee/upper leg and seat fabric. Record the final measurement.

Backrest Height

Your preferred backrest height is determined by your personal comfort level and physical ability. Whirlwind recommends, generally, that the top of the back support should fall just beneath the bottom of the shoulder blade. For less active riders who require more torso support, the back support should be higher, falling just beneath the armpit. Position yourself seated upright on a firm surface. Hold your hands flat against the surface you are sitting on. Measure the distance from the seated surface to the desired, most comfortable point for support on your back. To this number add the height of your cushion when you are sitting on it. Record the measurement.

Preferred Backrest Angle

Backrest angles are determined by the torso control of the rider. Whirlwind recommends that those with less torso control, such as quadriplegics, sit with a backrest angled further backwards to avoid falling forward in a wheelchair. Those with more torso control, such as amputees, can sit with the backrest more upright. Proper backrest angle is best determined by an occupational therapist or healthcare professional. Although there is only one option – 8 degrees – in the drop-down list below, you can adjust the backrest angle by adjusting the backrest straps (i.e. looser at the bottom and tighter at the top for a more erect position).

Now please enter your measurements into the fields on the product page before ordering. For more information about measuring, please refer to the RoughRider Fitting Sheet. You are responsible for choosing the right chair for yourself. If you are uncomfortable with determining your wheelchair size, please consult a professional.