World Vision International
Blog • Thursday, November 30th 2017

From Intimidated to Integrated

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Children in Uganda play together

From Intimidated to Integrated: How one World Vision project director learned that collaborating with technical experts is key to improved services and disability inclusion

By Chandra DeNap Whetstine, ACCESS project director

It is a beautiful spring morning in 2014, and I find myself sitting in a conference room in Washington, DC, looking across the table at representatives from some of international development’s leading experts in wheelchair service.  My organization, World Vision, has called a meeting to launch the start-up of the Accelerating Core Competencies for Effective Wheelchair Service and Support (ACCESS) project, a three-and-a-half-year, $9 million, USAID-funded project to support wheelchair service and disability inclusion in five countries.  Looking around the room that morning, I am thoroughly intimidated.

The task sounded simple enough: World Vision would mobilize rural communities to identify and refer clients who may need wheelchairs and the technical experts would support local service providers to ensure that service was provided in accordance with World Health Organization’s Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings.  Once clients received wheelchairs, community members would conduct follow-up to support disability inclusion, and World Vision would spearhead advocacy and awareness raising to build an enabling environment for wheelchair service.

The challenge was that this had never been done before.  Not to this scale.  Not with these partners. Technical partners rely on community referral and follow-up actors, but never had they partnered with an organization as large as World Vision to integrate not only referral and follow up but also disability inclusion.  Never had three long-standing experts in wheelchair service partnered to provide a harmonized approach to service development across five different contexts.

The biggest challenge was that World Vision was accustomed to a one-off distribution approach to wheelchair programs, not the WHO’s 8 Steps of wheelchair service. Our organization imported high numbers of a single model of wheelchair and distributed them to those who seemed to be in need. There was no assessment, prescription, or modification to ensure the wheelchair was appropriate for the client’s condition.  What we were to learn, and what the World Health Organization already knew, was that this kind of distribution is not only inappropriate but could be harmful to wheelchair users who may develop dangerous pressure sores that could be life threatening.  The ACCESS program would not only be innovative for our partners, but it would be revolutionary for World Vision, which was just learning what it meant to support wheelchair service—and that was scary.

Over the next six months the project rolled out in El Salvador, India, Kenya, Nicaragua, and Romania with no shortage of bumps and revisions along the way.  In the fall of 2014, I was appointed as project director and I found myself in the middle of this conundrum—how do we make appropriate wheelchair service stick?  How do we get World Vision’s 44,000 employees and more than 100 independent national and support offices to commit to ensuring that any wheelchairs donated through our organization will be provided in accordance with the WHO Guidelines?  It felt like trying to turn the Titanic.

I realized that due to World Vision’s existing relationships with wheelchair donors, our sheer size, and our federated structure, the ACCESS project wouldn’t be able to influence the organization to change all the wheelchair programs not following the new model. We would have to find ways to continue programming, but do it appropriately. We didn’t have the technical expertise to provide appropriate wheelchair service ourselves, but we could partner with those who did. We just needed to determine our unique role in wheelchair service support.

Over the next year, ACCESS researched World Vision’s existing wheelchair programs, conducting over 60 interviews in 11 countries to identify our best practices in wheelchair programs.  From this research, we were able to identify how community development organizations like ours could leverage strengths to support wheelchair service and ensure disability inclusion.  

The 8 Steps + model emerged.  In this new program approach, the WHO mandated 8 steps of wheelchair service are combined with 4 key pillars of community development support: Education, Facilitation, Collaboration, and Advocacy. These were the elements that ACCESS was already doing, and not coincidently are some of World Vision’s key strategies in local community programming around the world. 

In India, the ACCESS project was able to educate communities through strong referral and follow up training, helping the team to refer the right clients, calibrate client expectations, and follow-up on wheelchair service.  This resulted in 78% of clients referred being prescribed an appropriate wheelchair, with only 22% referred on for other services or devices.  With this training, 1,508 follow-ups were conducted with clients in India, 82% of which were conducted by World Vision and community members.  

In Kenya, where wheelchair services were offered in an outreach model, World Vision could leverage local relationships to facilitate the 8 steps of wheelchair service.  ACCESS partners developed an expanded outreach model, Outreach +, that brought not only trained service providers but also wheelchair peer mentors, trained bicycle repair artisans, and local government officials to provide wrap around services to those who came for wheelchair service. In this way clients could easily access disability registration, school screening, wheelchair repair, and peer mentorship while service providers focused on clinical and technical needs. 

Across ACCESS, Citizen Voice and Action (CVA) groups were mobilized to advocate for disability inclusion, accessibility, and appropriate services.  In Romania, these groups worked alongside government to build ramps to people’s homes and public spaces.  In Nicaragua, they held awareness and anti-bullying campaigns. In Kenya and El Salvador, CVA influenced governments to mandate and budget for accessibility. Because of these efforts, not only were communities made inclusive, but wheelchair users themselves felt empowered by the training and support offered in raising their voice to claim their rights. 

Most importantly, the ACCESS partners learned to collaborate.  The team realized that to support wheelchair service development and disability inclusion, we would have to work together on each activity, not silo ourselves into functional mandates.  World Vision led in developing a strong referral network, but technical partners supported training referral actors to ensure a minimum level of technical understanding.  Service providers delivered wheelchair services, but technical partners supported the process to reach a high standard of service.  Technical partners led capacity building, but World Vision supported through databases maintenance and training for all involved.  In the end, collaboration was key to success.

As I sit here now, our innovative project has come to an end.  Under this grant we were able to provide 7,255 wheelchairs, a modest amount, compared to large-scale distributions.  But I realize that quantity isn’t the point – quality service, along with community support for disability inclusion, is what matters in wheelchair programs.  We also trained 937 wheelchair service professionals, and because of our collaborative approach, increased the level of social inclusion for 93% of surveyed clients.  Children in particular benefited, with increased participation in education the highest ranked domain of social inclusion.  Service providers profess a commitment to adhering to WHO Guidelines, and local communities and governments look for ways to include people with disabilities.  

The 8 Steps + isn’t just about the wheelchair – it is so much more. It is about building trust and working smarter across partnership to leverage our strengths and those of experts to ensure the best possible outcomes for people with mobility limitations. Was I right to be intimidated, sitting in the conference room that spring?  Yes, but I am also right to be proud of what we accomplished together, not only for wheelchair users, but for the wheelchair sector.  Supporting wheelchair service doesn’t have to be left to a handful of experts—community development organizations have a role to play, too. Understanding this, and maintaining an attitude of collaboration, there is so much more we can do together. Are you ready to come along, too?  Check out The 8 Steps + Handbook, our learning briefs (coming soon), and the external evaluation of ACCESS to find out more about how we did it.

Learn more about ACCESS and other World Vision programs addressing disability inclusion here.

This project was made possible by the generous support of the American People through Advancing Partners & Communities (APC), a cooperative agreement funded by the United States Agency for International Development (USAID). The contents are the responsibility of World Vision, Inc. and do not necessarily reflect the views of USAID or the United States Government.