Abstract
Introduction
Assistive technology (AT) holds the potential to transform lives. With need projected to reach 3.5 billion by 2050 while access remains at only 10%, even basic AT is out-of-reach for most. Expanding access to AT is a complex systems challenge: AT markets are often small, underdeveloped and fragmented, particularly in low-income settings. Addressing market failures is essential to expand access, and market shaping has been introduced as a core tool since 2018.
Methods
This paper presents a scoping review and a case study examining how market shaping for AT has progressed. The case study explores how UNICEF, one of the world's largest procurement actors, has conceptualised and implemented it. Fifteen publications were included in the scoping review and four themes emerged: systems-thinking; unintegrated innovation; governance and financing; and data gaps. The UNICEF case study draws on eight interviews, complemented by early procurement data provided by UNICEF on selected countries.
Results
A recurring contestation was the need to move beyond siloed thinking to a coordinated and coherent systems perspective, recognising the multidimensional, interdependent factors influencing AT markets. To achieve this, several publications introduce “missions-thinking” as a complementary perspective. Evidence indicates that UNICEF's market shaping has had transformative impact to-date. Early data shows an average price reduction of 84% for hearing aids, and 34% for wheelchairs (the latter reduced by one county's outlier score of 5%).
Discussion
Sector challenges persist, including funding and logistics, yet evidence suggests that oversight and leadership by a body such as UNICEF can support transparency to move towards fair and healthy AT. The paper concludes that market shaping for AT holds significant promise, but achieving its greatest impact requires coherent and bold stewardship, with market shaping as one tool within an “AT mission”. This has begun, and UNICEF's new strategic commitment to AT access shows promise for the future.