RAD Lab: Establishing an Assistive Technology Testing Facility in Africa

The development and distribution of wheelchairs for use in Global South countries (also referred to as developing or less resourced settings) is a challenging and complex task. The problem is huge, with an estimated 75 million people in need of a wheelchair. Of this group only 5-15% can access what they need, leaving close to 64 million children and adults without the device they need to work, learn, play, or safely move around their community. 

The same problem exists for other types of assistive devices designed for users with physical impairments/limitations. Walking aids, crutches, posture support and seating solutions etc.

In the communities where we focus, this problem translates to additional financial burden and social stigma for whole families, and to wasted potential as many children never leave their house, slowly becoming too heavy for their parents to carry. 

Many international organisations have approached this problem by donating large quantities of wheelchairs – usually imported in bulk from large scale manufacturers in Global North countries (also referred to as developed countries) while few local organisations are creating innovative new products to meet the needs. Both of these approaches present numerous concerns for the end-user, their family, and the environment. 

Firstly, these products are often not suited to rugged terrain and international donations are tested according to European or ISO (International Organization for Standardization) standards, which prioritize urban terrain use. As a result, they frequently fail in rural environments, leading to injuries and secondary health complications (pressure sores, spinal curvatures, respiratory complications). The devices are often donated outside of WHO guidelines, leading to inappropriate or no prescription process followed, inappropriate use due to lack of training, lack of part availability, and limited repair options. Local innovations hold potential but are not regularly tested against any standards.

Secondly, the short lifespan of these donated products leads to environmental pollution as they are discarded prematurely: In South Africa one third of donations are abandoned because they are inappropriate to the user’s needs. In India a staggering 60% of devices are abandoned due to discomfort and unsuitability of the device to the environment. 

These negative impacts cannot be curbed if donated and locally produced devices are not held to appropriate standards that protect the end-user and environment.

There is a critical need for appropriate testing facilities and standards that can ensure the durability and suitability of assistive devices for African and other rural countries’ terrain. However, challenges such as limited funding, lack of awareness about standards, and foreign regulatory standards pose barriers to improving the quality and effectiveness of these products. 

Addressing these challenges is essential to providing accessible and sustainable assistive technology solutions for individuals in less resourced settings.

We have established an Assistive Device (AD) Laboratory, Testing and Research Centre in Cape Town, under the Shonaquip Social Enterprise ecosystem of organisations, with the primary objective of enhancing the quality, durability, serviceability, comfort, and efficacy of AD in less-resourced settings. RAD (for Rural AD) aims to establish a testing facility with the resources to investigate the failure modes of wheelchairs in less resourced settings and compare empirical data from the field to simulated failures created in a controlled laboratory environment through use of emerging technologies such as data acquisition systems. This can help to develop accurate testing criteria that can better predict in which conditions these AD could fail and identify ways in which assistive products can be designed to function in less resourced and rural settings. 

Moreover, the RAD test laboratory aims to become an approved Conformity Assessment Body (CAB) for assistive products through accreditation of the quality management system, ISO 17025, a quality manager system accreditation for testing and calibration laboratories. This ensures that there is an audited and certified management structure to the facility. 

This status will allow the laboratory to introduce novel tests, test methods and techniques through research and collaborations with other tertiary institutes to provide research for master’s students specialising in AD targeting the African and other rural countries’ context – addressing the massive gap in data currently available. Such collaborations will enable the collating of technical data which will lead to capacity development for the design and test for improved AD, as well as contribute rural focussed data and insights to standard’s technical committees globally. 

Shonaquip Social Enterprise has a dedicated Impact & Learning department which has developed tools that align with the WHO guidelines on the provision of wheelchair services in lower-middle-income countries, which are monitored and evaluated against the pillars of local policy documents and standards. These monitoring tools serve as a channel feeding into the data pool for the test laboratory research. These tools and processes are designed to be replicated in other similar contexts. 

1. Adults and children with disabilities who use wheelchairs and other Assistive Devices, particularly those in developing/rural contexts and countries that face compounded marginalisation and discrimination at community, wider society, and systemic levels. Our solution looks to protect their health and wellbeing by ensuring that appropriate Assistive Devices are provided.
2. Manufacturing businesses, Social Entrepreneurs, and innovators in and around developing/rural regions - by providing more affordable testing services (compared to exporting devices for testing in Europe). 
3. The Rehabilitation and Health fields, specifically individuals trained as wheelchair technicians and wheelchair seating practitioners (usually Occupational and Physical Therapists). Research data and tests from partner organisations and collaborators can be used to inform study material used to train local service providers.
4. Developing/less resourced countries. Regions that receive donated Assistive devices – especially those without current capacity to provide local solutions i.e. donation is the only current pathway for end users to receive wheelchairs. Appropriate standards can be used to approach new donors and educate existing donors about the negative impact of donating inappropriate devices.
5. Technical committees (such as the International Society of Wheelchair Professionals (ISWP), Red Cross, and UN offices) need reliable standards to input to their tender requirements for Assistive Device provision in developing countries. 

Shonaquip Social Enterprise (SSE) is a dynamic organization based in South Africa that is committed to delivering innovative, terrain-appropriate Wheelchairs as well as other class one medical devices, and accompanying support services that enhance the lives of individuals living with disabilities. With over 40 years of experience, SSE has earned a reputation as a trailblazer in the quest for a more inclusive ecosystem for people with disabilities primarily in the Southern African region. As a brand that prioritizes social impact and human-centric design, SSE is dedicated to making a meaningful difference in the lives of those it serves.

CEO Shona McDonald forms part of the Design Department and leads the Innovation and Development team. Shona’s journey in disability inclusion started years ago when her second daughter, Shelly, was born with severe disabilities. Outraged at the advice she received from medical professionals to “put Shelly in an institution and have another baby” Shona set out to provide Shelly with every possible opportunity to be an active participant in her own life. For Shelly and Shona this started with home-made posture support solutions, inclusive learning material design, and advocacy work. Shona is now recognised by various international organisations and awards for her work in the sector, most including from the World Economic Forum, African Business Hero awards, Schwab Foundation, Ashoka and the EY Social Enterprise of the year award. 

Together with a diverse, inclusive team of technicians, seating practitioners, social workers, engineers, designers, and parents of children with disabilities the Shona has made a significant mark on the disability sector.

Dean Mubaiwa joined this team 5 years ago as a student intern. After which he joined the Design Department as the mechanical engineer who would later develop the first components of RAD Lab. 

Shona has introduced Dean as the lead in international committees such as the SA Bureau of Standards Technical Committee 173 and ISWP Quality and Reliability Committee - where he has now become a technical advisor and key stakeholder in establishing the subcommittee for rural standards.

Dean has actively engaged in testing and demonstrations for ISWP, providing invaluable data on products like the double drum wheelchair and the drop test for wheelchair fatigue test. He took charge of RAD Lab as project manager, spearheading the establishment and design and building of test equipment. He is the Test Laboratory manager ensuring compliance with ISO 17025:2017 quality management system for which he drafted the Quality Management System. 

In RAD Lab, Dean's responsibilities include managing daily operations: testing, report writing, liaising with clients, providing quotes and ensuring the maintenance and calibration of laboratory equipment.

His achievements in mechanical testing, understanding product durability, and contributing to the development of international standards, guided by his own internal motivation of helping children and adults with disabilities to realise their human rights, underscore his readiness to lead in this solution.

Shona and Dean drive RAD Lab’s mission forward together. 

Below we have shared a list of our accomplishments to date including details about testing laboratory hardware solutions that were built from scratch. These processes were led by the head of RAD Lab, Dean Mubaiwa. 

• The following equipment was designed and constructed in house: A static test rig, an impact test rig, a double-drum testbed, and a drop-test rig and tilt table, as well as 2 test dummies. The construction process was complex, as the designs all aligned with strict ISO (International Standards) and EN (European Standards) standard requirements. 

• RAD Lab has 3 fee paying clients to date, described below (Income value: value of ZAR125 810.00 / 6500.00 USD):
  

  • The Central University of Technology in Bloemfontein - Department of product development technology station. Working with an individual wheelchair user who has developed his own wheelchair – research & prototype – RAD Lab gave technical assistance and testing services. 

  • Shonaquip PTY ltd – testing of pressure support cushions for a UN tender & NHS standard for export to the UK. RAD Lab provided technical assistance and testing services for Design Analysis – lab-based tests to investigate product failures taking place in the field. 

  • Paratrend – organisation who have secured funding to design wheelchairs with unique suspension features. RAD Lab will provide technical assistance and testing services. 

• The head of RAD Lab currently sits on two standards-influencing committees:

  • ISO Technical Committee TC173: for Assistive Technology. This committee is responsible for developing and maintaining international standards related to assistive products, systems, and services that assist people with disabilities. These standards cover a wide range of areas, including mobility aids, communication devices, accessibility features, and more. The standards developed by TC173 aim to ensure that assistive technology products and services are safe, effective, and accessible to users worldwide.

  • International Society for Wheelchair Professionals (ISWP) as technical advisor, as well as a key member of the sub-committee focussed on Quality and Reliability – where RAD Lab has been tasked with the role of capacity development for appropriate test methods and test information globally.

We are applying to Solve as the barriers we are facing are complex and not related to funding support. Much of the work we are doing is new, with data gaps and little-to-no existing solutions to learn from. Without existing guidelines, we are in the exciting but intimidating grey space of innovating to solve an urgent, complex, and multi-layered problem, and our team needs support to move forward. We believe that the Solve network is a space to which we can both contribute and from which we can learn and grow:

• The MIT CITE Wheelchair Evaluation Report published in September 2019 noted the lack of appropriate quality standards for wheelchairs distributed in low-resource settings.  The RAD lab specifically aims to fill this gap by ensuring devices used in these settings are of good quality and are appropriately tested for use in rural environments.  Becoming a Solver will create opportunities for shared research and implementation in this field with MIT and other similar partners in the network.

• The emphasis on cost-effectiveness, often at the cost of quality, can have a negative effect on the end-users of assistive devices.  Oftentimes sub-standard or inappropriate devices are imported into LMIC after the suppliers beat out local competition with better price points.  With no quality standards to hold these suppliers accountable, this cycle can continue unchecked.    

• Holding governing bodies, manufacturers, and suppliers/procurement offices to account to update standards and practices to match end-user inputs is a big barrier that we are struggling to overcome. 

• Policy makers, procurement offices and funding partners are oftentimes unaware of the negative impact an inappropriate wheelchair can have on the end user.  By becoming a Solver it will offer us a platform to address these issues. 

• Lack of data from lived experiences of wheelchair users means that the case for appropriate wheelchairs is not necessarily on the foreground when these policies are written and decisions are made.  By partnering for research with other like-minded partners through the Solve initiative we might have a bigger impact in this arena.