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A wheelchair suitable for rough terrain that can be locally repaired was among 23 low-tech innovations recently shortlisted for an award organised by a charitable arm of technology firm Siemens.
Publicity for low-tech solutions such as the shortlisted wheelchair is excellent  news for disabled people. But while this particular assistive device has been designed with the end users in mind, many others are not and so fail to deliver on their potential usefulness and longevity in low-income countries.
Wheelchairs are a politically charged subject in disability circles. This often surprises non-disabled people. Many believe that, when it comes to wheelchair provision, something is better than nothing; that exporting used wheelchairs or sending wheelchairs using design that wouldn’t be approved in the West to developing countries will wholly transform physically impaired people’s lives.
But some specialist organisations, including NGOs Motivation and Whirlwind Wheelchair, have long campaigned that the ‘something-is-better-than-nothing’ attitude can harm physically impaired people.
An ill-fitting wheelchair can cause serious and potentially fatal health problems such as pressure sores, spinal curvature and spinal contractures. [1] When I highlight the fact that wheelchair donations made with good intentions can unintentionally cause harm, people tend to be shocked.
Wheelchairs are like shoes: they should fit the user well. This means that local fitting services are important. Good practice examples of such services are the Association for People with Disability (APD) in India, and Comprehensive Community Based Rehabilitation (CCBRT) in Tanzania, which both offer a range of support services to their local populations. [2, 3] But many wheelchair donation programmes do not ensure local fitting services are part of the provision package.
Donated wheelchairs designed for Western hospitals or evenly-surfaced roads are rarely robust enough for the rough terrain found in most low-income countries. The Leveraged Freedom Wheelchair from the shortlist is adapted for these conditions — a good design feature.

“When I highlight the fact that wheelchair donations made with good intentions can unintentionally cause harm, people tend to be shocked.”

Sue Coe, development and disability inclusion consultant   

Wheelchairs should be maintained — and ideally produced — locally to avoid them quickly becoming redundant. The article on the awards shortlist reports that standard wheelchairs last six months on average. The shortlisted wheelchair uses commonly available bicycle parts so local bike shops can repair it — another great feature that means the chairs should typically last five years or more, according to the news.
By making the wheelchair locally repairable the designers have sought to put its end users at the heart of its design. This practice is similar to the Appropriate Technology concept that organisations such as the NGO Practical Action (formerly ITDG) have promoted for decades. All wheelchairs should be designed according to these principles; that technological choice and application should be decentralised, people-centred and locally maintained and controlled.
The WHO has produced excellent guidelines on good practice in wheelchair provision, consistent with Appropriate Technology approaches. The guidelines were the result of extensive consultations with wheelchair providers and users globally. [4] The WHO is rolling out a global training programme based on these that is designed to promote good wheelchair provision throughout the developing world.
This award has offered an opportunity to confirm that assistive technologies including wheelchairs need to be low-tech and maintained locally to be of significant use to disabled people in developing countries. I urge all those involved in technology provision in and to the global South to adopt these principles.
Sue Coe has worked in international development for 25 years across Africa, Asia, Europe and the Middle East. Now a development and disability inclusion consultant, she previously worked for World Vision, Practical Action (formerly ITDG), VSO and Action on Hearing Loss (formerly RNID). Coe can be contacted at [email protected].


[1] Motivation Fact Sheet 3: Can I donate a used wheelchair to Motivation? (, accessed 12 November 2013)
[2] Association for People with Disability Health, Therapy and Assistive Devices (APD, accessed 12 November 2013)
[3] Comprehensive Community Based Rehabilitation in Tanzania Rehabilitation department (CCBRT, accessed 12 November 2013)
[4] WHO Guidelines on the provision of manual wheelchairs in less resourced settings (WHO, 2008)