Manual Wheelchairs - World Health Organization

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5.4 Funding strategies polIcy and plannIng I 121 An important part of setting up a wheelchair service comprises costing and establishing sources of funding in order to ensure the financial sustainability of the service. 5.4.1 Costing The first step towards financial sustainability is the accurate calculation of the direct and indirect costs of wheelchair services. It is important that the cost of service delivery and the cost of the product are accounted for. Initial costs of setting up a wheelchair service should also be provided for but do not need to be included in the calculation of running costs. When estimating funds needed to establish and sustain wheelchair services, planners are advised to consider the total cost of wheelchair provision. The total cost is the sum of all direct and indirect costs. Direct costs Product • Manufacturing cost or purchase price of wheelchair • Shipping and transportation of wheelchair Initial service • Personnel costs (clinical, technical, training) for assessing, ordering, fitting and training • Personnel costs for ordering and inventory of wheelchairs • Materials and equipment for assembly and modifications • Supplies (assessment forms, record-keeping, etc.) Follow-up service • Personnel costs • Maintenance and repair Indirect costs • Management • Administration • Overheads • Capacity building – training of service personnel 5.4.2 Sources of funding Many individuals who need a wheelchair cannot afford to buy one. Nevertheless, everyone who needs a wheelchair is entitled to one, regardless of his or her ability to pay for it. Thus, funds will need to be made available to users needing financial assistance. Different funding mechanisms are described below. Government funding Government funding is usually the most reliable funding source where the government is committed to wheelchair services. Where wheelchair services are being established or provided by nongovernmental groups, it is recommended that there be continued consultation with the relevant government departments. Consultation should include long-term planning to determine when, how and to what extent the government is able to assume overall responsibility for the service in the future, including financial contributions. 5
122 I guIdelInes on the provIsIon of manual wheelchaIrs In less resourced settIngs Donor funding In many contexts, the initiation of a wheelchair service may depend on funding from national and international donors. Owing to its usually short-term nature, donor funding should be complemented by advocacy for government and other more sustainable sources of funding. Wheelchair funds managed by committee A local “wheelchair fund” may be established to subsidize the cost of wheelchairs for individual users. Wheelchair funds exist to source funding and equitably manage donations secured for wheelchair provision. Users apply to the fund committee for a full or partial subsidy of the cost of a wheelchair. It is recommended that such funds apply a means test to determine how much financial assistance should be given. Government funding may also be channelled through a wheelchair fund. Committees should comprise a cross-section of individuals who have a vested interest in sustainable wheelchair provision, such as (though not limited to) users, representatives of disabled people’s organizations, clinicians and technicians, government representatives and local dignitaries. Contributions from users Unless full government funding is provided for wheelchair purchase, it is recommended that any financing system incorporates an element of financial contribution from users themselves. Contribution programmes should be run in conjunction with individual means tests to ensure that users contribute no more and no less than they can realistically afford. Users’ contributions also stimulate demand for products and services of appropriate quality. A credit scheme is an option that allows users to borrow funds to purchase a wheelchair and to repay it over a period of time. Another option is an employment scheme, linking wheelchair provision with the opportunity for the user to obtain a job or funds to start a business and to pay for the wheelchair over time. Fees on donated or imported wheelchairs Even when a wheelchair is donated free of charge, there are costs associated with its responsible provision to the user, including follow-up with the user and maintenance of the wheelchair. <strong>Organization</strong>s that import wheelchairs on a large scale without ensuring the necessary services, as described in Chapter 3, could be required to pay a fee to support the services. Income generation Wheelchair services can be subsidized through income from the sale of other products such as canes, crutches, walkers, and toilet and shower chairs. Voucher system A voucher system may enable users to make their own purchasing decisions. The user is assessed and receives a prescription for a wheelchair with certain features. The user is given a voucher to the value of the cheapest wheelchair that fits the user’s prescription and that also meets minimum standards for safety, strength and durability. Users who want a more expensive chair that meets the prescription have to find the additional funds themselves.
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Manual Wheelchairs - World Health Organization

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