Is any wheelchair better than no wheelchair? A Zimbabwean perspective

Abstract

BackgroundWithin a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation.ObjectivesThis paper aimed to describe a group of Zimbabwean wheelchair users’ satisfaction with wheelchairs, wheelchair services and wheelchair function.MethodA mixed method, descriptive study was done. Quantitative data was collected from 94 consecutively sampled wheelchair users, who accessed wheelchair services at 16 clinics in five Zimbabwean provinces between October 2013 and February 2014, using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase.ResultsMore than 60% of participants were dissatisfied with the following wheelchair features: durability (78.6%), weight (75.6%), ease of adjustment (69.1%), effectiveness (69.0%), safety (66.7%), reliability (66.7%), and meeting user needs (60.6%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69.0%), follow-up (67.0%), and service delivery (68.3%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53.2%) and outdoor (52.7%) mobility.ConclusionFindings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that policy and minimum service standards which incorporate evidence and good practice guidelines for wheelchair services and management of wheelchair donations are developed for Zimbabwe.

A description of assistive technology sources, services and outcomes of use in a number of African settings

“…Co-ordinated efforts by communities, service providers, researchers NGOs, DPOs, charity organizations, the private sector and government is required to improve the situation and ensure everybody in need access to devices and proper services. [14] The lack of information and/or training of participants and proper maintenance shown in the study results strongly indicate problems with service delivery. Support in how to use and regular follow up and maintenance is of great importance for effective use of the devices in many cases and reduce possibilities for development of even more serious health problems and activity limitations due to improper use, poor fitting, insufficient adjustments and lack of repairs.…”

“…However, in poor contexts where demand for assistive devices are not met, even access to devices that are not of prime quality or the most appropriate may be seen as advantageous compared to not having access. [14,22] The finding that a third of the participants had difficulties even when using their device may indicate support for such an interpretation or may be because not all devices were in good working order.…”

“…This might provide an explanation for the finding that respondents' assessments of their devices were largely positive and the opinion that the devices improved their quality of life. Existing knowledge about assistive devices in sub-Saharan Africa [5,10,11,14,21] strongly indicates substantial quality problems with both devices and services. However, in poor contexts where demand for assistive devices are not met, even access to devices that are not of prime quality or the most appropriate may be seen as advantageous compared to not having access.…”

“…While international donations from charity organizations, international non-governmental organizations (NGOs) and other private sources are well meant and cater for some of the needs of their partner/recipient individuals and organizations, this may easily turn into a disservice to individuals in need. [10,11,14,16,17] Users from Umbada and Kassala in Sudan who mainly received their devices through formal health care providers received complete information, and showed on the whole less difficulty in functioning when using the devices and better quality of life outcomes than users from Ntchisi in Malawi who received devices from NGOs and other sources only. NGOs and other sources do not have national responsibility for services.…”

“…[9] Where support services are lacking, negative outcomes such as poorer functional and community integration, injury of the user, secondary complications, breakdown of the device or devices being discarded are common. [9][10][11]14,15] In addition these sources might not be sustainable since donors have no obligation to provide a service on an ongoing basis. [10,16,17] Eide and Oderud [11] analysed several service delivery quality indicators and showed that the service delivery systems among the four African countries were fragmented, devices were of poor quality, maintenance was left to the user and often devices were not maintained.…”