Access to assistive technology in Africa: findings from evidence-informed deliberative dialogues on trade and fiscal policies.

Abstract

Access to assistive technology remains unequal in many countries, particularly in low- and middle-income settings, where high costs, dependence on imports, and fiscal and trade barriers can limit availability and affordability. This article aimed to present and analyze deliberative dialogues conducted with participants from Mozambique, Chad, Egypt, and Kenya, informed by an evidence synthesis on reducing tariffs and taxes on assistive technology. Three multilingual deliberative dialogues were conducted between August and October 2025, involving 35 participants from different stakeholder groups. The dialogues were used as a knowledge translation strategy to contextualize scientific evidence through structured discussions among different stakeholders. Representatives from the Republic of the Congo were invited but did not participate. Transcripts were subjected to thematic content analysis based on Bardin's approach and organized according to the domains of the SUPPORT tools. The findings revealed common challenges, including high costs, dependence on imports, weaknesses in the implementation of tax exemptions, limitations in local production, territorial inequalities, shortages of specialized professionals, and difficulties in coordination across sectors and institutions. Country-specific issues related to rural access, governance, territorial inequalities, device acceptability, and policy implementation were also identified. The options discussed included fiscal and tariff reforms, strengthening local production, international cooperation, and awareness campaigns. The deliberative dialogues enabled the contextualization of evidence across different national settings and demonstrated that expanding equitable access to assistive technology requires combined strategies adapted to the specific characteristics of each context.