Ensuring access to mobility devices for all

When Shona McDonald’s daughter, Shelly, was born in 1982 with Cerebral Palsy, their family faced challenges most families have never had to consider. Unable to sit up unsupported or move around independently, with few workable support options, Shona created Shelly’s first mobility device. Her family experienced first-hand how difficult it was to find appropriate assistive devices.

Shona, together with the Biomedical Engineering Department at UCT designed the first South African paediatric posture support wheelchair in 1984 she understood that wheelchairs were about more than transport, more than ensuring that children did not develop secondary (often life threatening) complications, wheelchairs are about independence, dignity, access to school and inclusion.

Assistive devices allow people to live their human rights. During her appointments with Shelly, she met families who were not able to access the support they needed. This spurred her life-long commitment to address the lack of appropriate wheelchair provision, holistic support services, parent empowerment and adequate policy for people with mobility disabilities as every wheelchair user should be correctly fitted in an appropriate wheelchair and actively included in school and all levels of their community. The customised postural support made Shelly’s care both safer and easier and her new mobility opened possibilities for fun and learning.

Our work focuses on designing and manufacturing a range of environmentally appropriate assistive technology (AT) , wheelchairs and 24hr posture support devices and therapeutic equipment that not only prevent and delay the development of secondary health complications but also open opportunities for inclusive learning and social justice.  To ensure we are able to make lasting change we work with government and other stakeholders to influence policy and strengthen Provincial, National and Global practice, delivery mechanisms and quality standards.  

The harsh reality is that in most countries in Africa children never receive the equipment they need while in South Africa, children wait up to 6 years for an appropriate wheelchair, often spending their formative years lying on a bed or on the floor.  

A device that is unsuitable for the environment in which it needed or does not fit a child’s body will lead to ongoing exclusion and serious secondary health complications.   In South Africa at least 1/3 of donations are abandoned within a year because they are inappropriate to the user’s needs.

Shonaquip Social Enterprise (SSE) is a high-impact South African hybrid organisation that drives social change towards a more inclusive and cohesive society where people with disabilities are welcomed, empowered, and enabled to live to their full potential.

We believe that with appropriate assistive devices, knowledge to make informed choices and the agency to action them, a family of a child with a disability will never need to experience their child as less valued.

Our work focuses on ensuring that i a child is correctly seated in a wheelchair that is appropriate for the environment they need to use it in, and appropriate for their individual physical needs, their ability to maximize their function and their learning development opportunities are dramatically increased. Not only is their independence improved, but they will also no longer be at risk of developing spinal deformities, contractures, pressure sores and aspirating pneumonia.   

Because they are no longer left to lie on a bed or the floor and are more mobile, the burden of care placed on their primary caregiver is reduced, freeing them up to invest time in the other members of the family and carry out basic daily responsibilities.   Because the child is correctly seated the cost of care placed on the family and the local health system is reduced. The child can attend school, the primary caregiver can work.    

Wheelchair and posture management is a postgraduate study and a scarce skill in the communities where children need the most support. With our training we can upskill thousands of therapists, improving their quality of practice, creating centres of excellence which align with WHO guidelines.  

Access to appropriate Assistive Technology (AT) enables people to participate more in education, work, family and community life. Today, over 1 billion people need at least one form of AT, but over 90% do not have access to the AT they require. Without AT, individuals can experience isolation and exclusion from education, work, family, and community life; poorer health outcomes including premature death, deteriorating mental health, chronic health conditions, and other secondary health complications; increased costs and lower incomes, leading to higher risks of poverty and unrealised economic potential from the individual to the country level.

Research demonstrates that, in contrast, increasing accessibility and affordability of Assistive Technologies unlocks unrealised economic potential and provides socioeconomic benefits for individuals, families and countries.  Globally more than 75 million people need an appropriate wheelchair, however 85-95% of those in need do not have access. Four in five people who need a wheelchair live in low- and middle-income countries (LMIC) and these countries account for the highest unmet need. 

While 90% of people with a need in high income countries (HIC) are estimated to have a wheelchair, this number is likely closer to 5% in LMICs (ATScale 2020). Appropriate wheelchair services, provided by trained personnel, play a critical role in matching the user’s needs to the appropriate type of wheelchair throughout the user’s lifespan.

Our in person mobile outreach clinics support thousands of wheelchair users and upskill both government and private therapists, community healthcare workers and parents in all nine South African provinces and five surrounding countries. Our online training, tele-Rehab and advocacy programmes help communities to understand, support and include children with disabilities and their families across seven countries.

We use a holistic ecosystem approach in what we do. This includes the design, manufacture and provision of locally appropriate assistive devices, mobile clinics and remote telehealth support services, disability awareness and corporate inclusion training, inclusive early childhood education programmes and training, social support services, advocacy, research and influencing policy development and implementation.    

SSE’s four key elements for inclusion:

•  Change in perception of people and strengthening referral pathways 
• Increase in access and appropriateness of devices and services in both public and private sectors
• Inclusion of more children with disabilities in early play and learning
•  Parent/caregiver mobilization, support and skills transfer and inclusive employment

There are 8 850 000 People with Disabilities in South Africa, directly affecting 28 320 000 family members. Over 370 000 are children who need an appropriate wheelchair and ongoing service to access their basic human rights – on average these children wait 3 – 6 years to receive such a device. By the time “it is their turn”, many children have outgrown their device, have developed irreversible deformities that will require a new assessment, more clinical intervention, and a more rigorously supportive wheelchair, or worse, have passed away before ever receiving the basic health needs, they are entitled to – in short, the time children spend waiting often renders them unable to use the wheelchair they were waiting for. This cycle is costly to our health system and costs whole families additional (and avoidable) financial burden and trauma. 

Mainstreaming disability in society has been well articulated at global, regional, and national levels. It is widely recognised that such efforts can only be realised if statistics on disability prevalence, patterns and levels are availed at all levels of society. Disability statistics provide the basis for measuring progress in realising the rights of persons with disabilities. In South Africa, current and future policies, and interventions to ensure that persons with disabilities have equal access to education, employment and basic services require statistical evidence. 

The SSE adopts an ecosystemic framework through which services and products are delivered. It acknowledges that inclusion is not linear or simple. For change to occur it requires both tools and knowledge to be applied in an enabling environment. It also recognises that a shift in perception and patterns of thinking is vital to transform historical behavioural patterns. This solution to system innovation could result in changes on an individual and family level. Building on these solutions and approaches by Shona and her start-up team from the early 1990s, the ShonaquipSE has developed a multi-prong approach to building ecosystems for inclusion.

This includes development of a critical mass of therapists, teachers, caregivers and parents who understand the importance and possibility of education, the importance of appropriate devices, the procurement and budget allocation processes and how to access them on the national tender. At the same time, it requires parents to be aware of the valuable role appropriate devices play in their children’s lives. Parents should be equipped to identify when the device is no longer suitable, and empowered to raise any queries with healthcare providers. This role is undervalued and undeveloped in the current system.

Our holistic model of care serves the following beneficiaries:

Children and adults with mobility and multiple disabilities, their parents, caregivers and family members (including foster parents, safety parents/homes/centres). 

Healthcare Providers (and students) that include therapists, clinicians, assistants, orthotists/prosthetists, community service therapists, technicians, CBR and Community Health Care Workers.

Community-based workers, Community leaders & members, ECD Teachers, Auxiliary & Social Workers and volunteers.

Police service, Department of Justice, Department of Health, Department of Education, Department Social Development,  EPWP, LSPID, Government Tender officers, Transport drivers.

The Shonaquip Social Enterprise, a hybrid  organisation, comprising separate 3 entities, Shonaquip, Uhambo Foundation NPO, and more recently, the  the Parents’ Champions Trust, has been at the centre of changing the disability narrative for 30 years.  Three boards sit together to oversee the delivery of joint projects rolled out by a skilled and trained  team of 78 therapists, social workers, seating practitioners and wheelchair technicians.      

since our inception in 1992 Shonaquip has been address the shortage of appropriate AT and  the lack of policy and aspiration society has for children with severe disabilities. Uhambo Foundation was born as a response to system and service failures which left families of children with disabilities to fend for themselves, often alone, without any meaningful appropriate support. The Parents’ Champions Trust is the culmination of the selfless, relentless advocacy of parents across the country, regardless of where they live and how they live, and the realisation that unity is strength if they are to take back power over their lives and the lives of their children with disabilities.

ShonaquipSE has always been innovative and cutting edge, expanding our understanding of what the Convention on the Rights of Persons with Disabilities call ‘the evolving concept of disability’, redefining what meaningful social protection should look like for families with children with disabilities, conceptualising what an inclusive ecosystem should look like in the South African context, pioneering the concept of social enterprise within an African context, changing lives, making the impossible look easy.

We are best placed to deliver our holistic ecosystemic approach to building inclusion in South Africa (and Southern Africa) where we have built extensive networks of support, experience in partnering for sustainable impact (not dependency-building service delivery), and a knowledge base rooted in active community input and research.

Our seating team provide both hand on capacity building as well as e-health assistance and are regarded as the regional experts in paediatric seating services. We have developed healthy partnerships and collaborate with multiple organisations to expand the reach and capacity of our  multidisciplinary team, through AT provision, maintenance and repair, inclusive education, psychosocial support, disability awareness, advocacy, policy development, local referral pathways and economic development programs.

We work with a wide range of wheelchairs appropriate to the African terrain  to ensure that  AT is never provided in isolation from  training and capacity building through our mobile outreach seating support services model,.

The “Let’s Talk Parents” app is a Human Rights Monitoring App used by the Parent Champion Trust across South Africa, and has grown rapidly to over 800 parents after its launch in 2020. The Human Rights Monitoring will continue to monitor and advocate for appropriate services in AT provision (and other areas) – keeping ourselves, policy makers, government and other organisations accountable to children with disabilities through their parents.

The Parents’ Champions Trust as a vehicle for emancipation, liberation and empowerment of families of disabled children in general, mothers of children with disabilities in particular, and as change agents for social and economic justice in their local communities. The ShonaquipSE provides the Trust with a nurturing home where parents will be able to gain strength, gather knowledge, contribute to quantitative and qualitative research and data collection, and grow into a wave for change to enhance the lives of families with children with disabilities in meaningful ways as integral and valued members of their communities.

We require both funding and advocacy and awareness support of the critical work that we do. ShonaquipSE builds and supports sustainable ecosystems that enable inclusion. Through our work  children with disabilities and their families will be equipped with the knowledge and tools to make informed choices and the agency to action these choices. This can result in children with disabilities and their families experiencing equal and meaningful participation in a supportive and enabling environment.

With your support we will be able to increase the understanding of barriers and participation in developing referral processes, increase the number of children seated appropriately, with confident and competent therapists and parents supporting their seating needs towards inclusion, increase the competence of therapists to assess, fit, and order devices, increase the knowledge about the learning potential of children with disabilities and increase the number of parents joining the Parent Network as monitors and advocates keeping government and NGOs accountable.

Innovation through product design: Africa Appropriate, robust devices: Our product design has won numerous international and regional awards and grants for innovation including acknowledgement of our modular product design that allow for complete customisation (fitting various seating systems with various bases). Our seating systems and base design are consciously manufactured from materials that are locally available in developing countries, and we use materials that can be repaired in-field (welded, re-upholstered etc) easily. Our devices are also designed to “grow with the child” – having expandable seat length and width and adjustable back support systems so that one size devices will serve a child for up to 3-5 years of bodily growth before the child needs to move to the next size device. We have found devices in the field as old as 15-20 years that have been re-upholstered and repaired so that one wheelchair is able to serve multiple users in its lifetime.

We do not view a wheelchair as a wheelchair, but as a tool to inclusion that impacts lives beyond the person using it: our clinically trained team connect whole families to support services and networks during interventions, and we pair other programmes (such as inclusive education) into the same geographic area where children receive wheelchairs and seating services – to ensure that once a child has the correct device, they are also able to join their local pre-school, play groups or be referred into primary education. We also connect parents (most often mothers or other female family members are looking after children with disabilities) to an accessible network of support using free technology – linking them to peer support, referral, and ongoing training.

Innovation through approach: Wheelchair and AT provision is traditionally regarded as a medical intervention, and while our approach acknowledges the medical importance of appropriate AT, and the need for thorough training, we view this work form a human-rights lens. Our holistic approach to all we do, results in much more impact than a ‘child gets a wheelchair’: We include disability awareness training on family and community level in our approach, ensuring that a wheelchair is not viewed as a device only, but as a tool to inclusion – enabling children to take part in their own lives. Our design and delivery model of Outreach Seating Clinics uses free and available technology as well as in-person, hands on mentoring to ensure skills transfer and accessible services into remote and rural communities so that EVERY child can access what they need to become included in their own life.

Over the next five years our impact goals include - 

1. Communities as a whole should be able to identify and action local referral pathways.

2. Professionals are able to refer appropriately to both private and government services. 

3. Children with disabilities have access  appropriate assistive devices and accessible support services and professionals are able to deliver accessible services in line with WHO principles, with clear understanding that assistive devices are key to improved function and prevention of secondary complications. Caregivers understand their children’s condition and recognise the support required and have agency to translate their new knowledge into action. 

4. Educators start to  acknowledge that all children can learn, and are able to provide access to appropriate, inclusive education with welcoming, capacitated teachers and practitioners 

5. Youth and adults with disabilities, their parents and caregivers recognise that learning opportunities are possible and start trying to access them 

6. More people with disabilities are acknowledged for their skills and competencies and have  access to decent and welcoming inclusive work 

7. ShonaquipSE together with partners are building opportunities for sustainable income streams and work for  members of the households of the person with a disability. This recognises the holistic nature of families and the importance of capacitating this sector as a means to alleviate poverty of the family 

8. Both qualitative and quantitative data is being  captured in order to document a shift in perception and service support and reflects the voices of people with disabilities, their caregivers and service providers to influence policy.

ShonaquipSE measures the following qualitive data in addition to our quantitative  data

Increased understanding of the barriers to inclusion

Increased participation in the development of official referral processes within the Government

Increased successful referrals to benefit from equitable service delivery

Increased knowledge to advocate for and providing appropriate seating services that encourages participation in inclusive play activities

Carers and children show increased confidence to participate in the home and community activities

Increased student knowledge to assess and order devices or action an appropriate referral

Increased knowledge to position a child appropriately for participation

Increased knowledge about products in order to increase the quality of life of both the clients and their families

Increased competence & confidence to run outreach clinics

Increased knowledge about the learning potential of children with disabilities.

Increased # of parents joining the parent network

Increased # of LTTs submitted

ShonaquipSE believes that with an appropriate assistive device, knowledge to make informed choices and agency to action them, a family of a child with a disability will never need to experience their child as less valued.

Impact hypothesis:

If the SSE supports sustainable ecosystems that support inclusion, children with disabilities and their families will be equipped with the knowledge and tools to make informed choices and the agency to action these choices. This might result in children with disabilities and their families experiencing equal and meaningful participation in a supportive and enabling environment.

KPI’s per ecosystem:

• Increased understanding of barriers and participation in developing referral processes
• Increased # of children seated appropriately, with confident and competent therapists and parents supporting their seating needs towards inclusion
• Increased competence of therapists to assess, fit, and order devices
• Increased knowledge about the learning potential of children with disabilities.
• Increase # of parents joining the network and using the LTP

The assistive technology we design, manufacture and supply are context relevant and context responsive. Through years of innovating and testing, the technology we are producing is being used in South Africa's most rural and remote areas and our team work hard to make use of solutions and approaches that will empower, rather than alienate, rural communities. 

As technology (largely through wider telecommunication service and smartphone use) grows within rural and remote areas, we have incorporated free and accessible communications technology (WhatsApp, data free Apps, google forms etc) to enable remote support and mentoring that reduces costs and enables us to provide our assistive technology into areas in a more affordable and sustainable way.  

"We practice inside what we want to build outside" is a statement from our Founder and Director. Our belief in inclusion stretches beyond the services and programs we deliver into communities: internally we are an inclusive, diverse organisation. 

Our inclusive team represents the diversity of the areas and communities in which we work, More than 20% have disabilities themselves and we celebrate a strong female led culture. Our teams include experts in Assistive Technology design, assembly and customization, cross-disciplinary therapists, social workers, community development workers and facilitators. Our leadership team includes experts in finance, compliance, production, project management, impact, research and enterprise development.

Shonaquip Social Enterprise (SSE) is a globally recognised hybrid social enterprise whose purpose is to ensure that with an appropriate assistive device, knowledge to make informed choices and agency to action them, a family of a child with a disability will never need to experience their child as less valued. It has been in operation for more than thirty (30) years and consists of Shonaquip (Pty) Ltd, a for-profit entity, Uhambo Foundation (NPC) a non-profit and public benefit organisation, and the Champions of Change Trust a non-profit organisation.

Shonaquip (Pty) Ltd was founded in 1992 as a ‘business for good’ to design, prescribe, manufacture and sell posture support and mobility devices and use its profit to carry out community work. It currently has an annual turnover of +/- R 30 000 000.00 and is a Broad Based Black Economic Empowerment (BBBEE) Level 2 Qualifying Small Enterprise (QSE). It was first registered as a Close Corporation with the Companies and Intellectual Property Commission (CIPC) in 1992 with the following registration number: CK 1992/012669/03, CIPC then converted it to a company in 2010 with the following registration number: 2010/020028/07.

After Shonaquip CC was formed, it was soon realised that a business structure limited the potential to raise additional funds for much needed community work and training. Uhambo Foundation (NPC) was therefore founded in 2010 to grow Shonaquip’s community- focused programmes and reach more under-resourced communities. Uhambo Foundation is also registered with the CIPC as a non-profit company with registration number: 2010/004598/08. It is registered with the Department of Social Development as a non-profit organisation under registration number: 085-124-NPO and is registered with the South African Revenue Authority (SARS) as a Public Benefit Organisation with registration number: 930033521. Since Uhambo Foundation was formed in 2010, its revenue has increased year on year to +/- R 9 000 000.00. It is also a BBBEE level 1 Exempted Micro Enterprise (EME) as +/- 85% of its beneficiaries are black persons.

The Champions of Change Trust was registered with the Department of Justice and Constitutional Development in 2016. It was launched in 2020 and enables parents to support one another, provide and access information and advice, and to become inclusion champions in their own communities. This gives parents the power to become active decision makers in their child’s life. The Trust is a Disabled Persons Organisation (DPO) and is in the process of registering as a non-profit organisation and a Public Benefit Organisation with the Department of Social Development and SARS, respectively.

Both Uhambo Foundation and the Champions of Change Trust are shareholders in Shonaquip as follows: Uhambo Foundation 35% and Champions of Change Trust 20%. Shona McDonald, the founder of the SSE holds the remaining 45% shares in Shonaquip. While Uhambo Foundation and the Champions of Change Trust hold dividend bearing shares, Shona McDonald holds non dividend bearing (B) shares and does not claim any dividends from Shonaquip.

As a Hybrid Social Enterprise, ShonaquipSE’s Boards ensure that all surplus generated are reinvested back into achieving our purpose of social impact
The work of the SSE is funded through multiple streams of income including a national tender that was awarded to Shonaquip by the National Department of Health for the provision of medical devices to children who are on the national list as well as private clients who order mobility and posture support equipment from Shonaquip. Uhambo receives donations and grants from local and international institutions as well as contracts for the delivery of services from national and provincial government. 

The grants, donations and contracts awarded to Uhambo Foundation include the provision of mobility and posture support equipment, which Uhambo Foundation purchases from Shonaquip through arms-length transactions. Funding for the Champions of Change Trust is mainly derived from philanthropy and research funding.

The SSE registered the name “Shonaquip Social Enterprise” as a defensive name with CIPC in January 2022. This will allow the three legal entities to achieve its purpose under one brand name. However, for legal and financial reporting purposes they remain three separate legal entities.
In addition to the three entities in the South Africa, Uhambo USA was established in 2011 as a section 501(c)(3) entity and as a Friends of Uhambo Foundation entity.

Shonaquip Social Enterprise embraces a distributed leadership model.

Shonaquip Social Enterprise is made up of three legal entities that share a common purpose and joint delivery team  who focus on  capacitating the ecosystem around a family in order to remove the barriers that face children with disabilities and their families.

Shonaquip has been financially sustainable for 30 years . We achieve this though diversifying  our income stream.

Shonaquipdesign, assembles and sells  AT to governments, INGO’s and private individuals. We raise grant and project funding to support our outreach programs , training, advocacy and community development initiative .  As a Hybrid Social Enterprise, ShonaquipSE’s Boards ensure that all surplice generated are reinvested back into achieving our purpose of social impact.

Shonaquip Social Enterprise (SSE) is a globally recognised hybrid social enterprise whose purpose is to ensure that with an appropriate assistive device, knowledge to make informed choices and agency to action them, a family of a child with a disability will never need to experience their child as less valued. It has been in operation for more than thirty (30) years and consists of Shonaquip (Pty) Ltd, a for-profit entity, Uhambo Foundation (NPC) a non-profit and public benefit organisation, and the Champions of Change Trust a non-profit organisation.

Shonaquip (Pty) Ltd was founded in 1992 as a ‘business for good’ to design, prescribe, manufacture and sell posture support and mobility devices and use its profit to carry out community work. It currently has an annual turnover of +/- R 30 000 000.00 and is a Broad Based Black Economic Empowerment (BBBEE) Level 2 Qualifying Small Enterprise (QSE). It was first registered as a Close Corporation with the Companies and Intellectual Property Commission (CIPC) in 1992 with the following registration number: CK 1992/012669/03, CIPC then converted it to a company in 2010 with the following registration number: 2010/020028/07.

After Shonaquip CC was formed, it was soon realised that a business structure limited the potential to raise additional funds for much needed community work and training. Uhambo Foundation (NPC) was therefore founded in 2010 to grow Shonaquip’s community- focused programmes and reach more under-resourced communities. Uhambo Foundation is also registered with the CIPC as a non-profit company with registration number: 2010/004598/08. It is registered with the Department of Social Development as a non-profit organisation under registration number: 085-124-NPO and is registered with the South African Revenue Authority (SARS) as a Public Benefit Organisation with registration number: 930033521. Since Uhambo Foundation was formed in 2010, its revenue has increased year on year to +/- R 9 000 000.00. It is also a BBBEE level 1 Exempted Micro Enterprise (EME) as +/- 85% of its beneficiaries are black persons.

The Champions of Change Trust was registered with the Department of Justice and Constitutional Development in 2016. It was launched in 2020 and enables parents to support one another, provide and access information and advice, and to become inclusion champions in their own communities. This gives parents the power to become active decision makers in their child’s life. The Trust is a Disabled Persons Organisation (DPO) and is in the process of registering as a non-profit organisation and a Public Benefit Organisation with the Department of Social Development and SARS, respectively.

Both Uhambo Foundation and the Champions of Change Trust are shareholders in Shonaquip as follows: Uhambo Foundation 35% and Champions of Change Trust 20%. Shona McDonald, the founder of the SSE holds the remaining 45% shares in Shonaquip. While Uhambo Foundation and the Champions of Change Trust hold dividend bearing shares, Shona McDonald holds non dividend bearing (B) shares and does not claim any dividends from Shonaquip.

As a Hybrid Social Enterprise, ShonaquipSE’s Boards ensure that all surplice generated are reinvested back into achieving our purpose of social impact

The work of the SSE is funded through multiple streams of income including a national tender that was awarded to Shonaquip by the National Department of Health for the provision of medical devices to children who are on the national list as well as private clients who order mobility and posture support equipment from Shonaquip. Uhambo receives donations and grants from local and international institutions as well as contracts for the delivery of services from national and provincial government. The grants, donations and contracts awarded to Uhambo Foundation include the provision of mobility and posture support equipment, which Uhambo Foundation purchases from Shonaquip through arms-length transactions. Funding for the Champions of Change Trust is mainly derived from philanthropy and research funding.

The SSE registered the name “Shonaquip Social Enterprise” as a defensive name with CIPC in January 2022. This will allow the three legal entities to achieve its purpose under one brand name. However, for legal and financial reporting purposes they remain three separate legal entities.

In addition to the three entities in the South Africa, Uhambo USA was established in 2011 as a section 501(c)(3) entity and as a Friends of Uhambo Foundation entity.