From aid dependency to market transformation: harnessing international trade and innovative business models to revitalize the assistive technology ecosystem in Africa.

Africa faces a widening and largely unaddressed gap in access to assistive technology (AT). More than 240 million people on the continent require at least one assistive product, yet fewer than 3% of those in sub-Saharan Africa currently have access. The principal causes are four interlocking structural market failures: restrictive trade policies that inflate import costs, chronically underdeveloped local manufacturing capacity, inadequate national health financing for rehabilitation, and the absence of sustainable business models capable of maintaining AT services beyond the lifespan of time-limited humanitarian projects. These failures manifest with markedly different severity across the continent's 54 countries; this paper does not treat Africa as a uniform policy environment and distinguishes throughout between stable lower-middle-income contexts and fragile or conflict-affected states. This paper draws on more than 18 years of direct field experience in humanitarian and development programming across Ethiopia, the Democratic Republic of Congo, Mali, Algeria, Niger, Ukraine, and Nigeria, combined with a non-systematic review of peer-reviewed literature and institutional reports published between 2015 and 2024. Four interconnected policy solutions are proposed and analysed: (i) tariff reform and regulatory harmonisation under the African Continental Free Trade Area; (ii) expansion of local prosthetic and orthotic manufacturing capacity through diversified technology transfer, encompassing South South, triangular, and North South cooperation modalities; (iii) development of sustainable service delivery and financing models, including social enterprise with tiered cross-subsidy, output-based public private partnerships, and social health insurance; and (iv) systematic demand financing through national insurance benefit expansion and results-based financing mechanisms. The paper concludes with differentiated, time-horizoned recommendations short-term, medium-term, and long-term addressed to four distinct stakeholder groups: African governments and the African Union, development organisations and donors, the private sector, and the humanitarian community, with explicit acknowledgement that feasibility varies sharply by country context. The central argument is that durable access to AT in Africa requires deliberate, context-adapted market architecture, not simply expanded humanitarian aid.