In India, 10 million people are estimated to have loco-motor disabilities, and only 5% of these disabled receive a wheelchair, brace or prosthetic that would allow them to be mobile, reports a study by Disability India, an NGO. These underserved create makeshift devices, such as a wood plank atop rollers to push themselves with their hands through heavy-traffic streets. In most cases, the disabled, who suffer a double stigma of economic and social exclusion in societies that look down upon these “abnormalities,” stay indoors in an effort not to be seen. “The most basic thing that we disabled people lack in India is easy access to anything and any place. That’s why we are called the ‘invisible minority’ because we never move out of our homes,” said a wheelchair user in India.
Often, the reason the disability has occurred is the same reason why it is essential to overcome it: lacking access to proper water, sanitation and proper health services, the toxic environment of slums causes disfiguration or need for amputation, further disenfranchising the poor. Also, hazardous working conditions in some informal sector jobs often results in loss of limb. Each year in India, 25,000 people lose their limbs due to diseases, accidents or other hazards in unregulated job conditions.
These disabilities perpetuate a poverty trap and push the poor further from access to ever-important tools such as education, employment and healthcare. In India, 50% of people with a disability have never been to school. For children, the situation is even more dire: only 5% of children with disabilities regularly attend school. “Improved mobility is a crucial and necessary element in alleviating poverty throughout the developing world as it can allow people with disabilities to play an active role in society both economically and socially,” says Disability India.
With India’s increased emphasis on new initiatives to support the disabled since the launch of the National Policy for Persons with Disabilities in 2006, most policies, programs and entrepreneurial initiatives have been focused around providing employment. Little attention has been paid to helping the disabled—in particular, the poor—become more mobile themselves or making public transportation more accessible to them.
Enter Jaipur Foot
In Jaipur, India, Bhagwan Mahaveer Viklang Sahayata Samiti began developing and manufacturing the Jaipur Foot in 1968, a handmade artificial foot and lower-limb prosthesis. In the US, this new limb would cost US$8,000 at a minimum, but often as much as US$25,000. The Jaipur Foot costs only about US$30, but is provided free of charge to all BoP patients, which, says BMVSS, is 99% of their customer base. BMVSS was one of the first to respond to the needs of the physically challenged, and today, BMVSS fits 16,000 patients annually with its prosthesis. The organization as a whole serves 60,000 people in total with the Jaipur Foot, calipers, and other aids and appliances. The prosthetic limbs provide new opportunities for people who have often been immobile for many years.
The Jaipur Foot was designed with the poor and their lifestyles in mind. This means that the artificial foot needed to work well for squatting, sitting cross-legged, walking on uneven ground and barefoot walking. This type of patient and consumer-focused mindset has helped Jaipur Foot to be a successful business model in both India and around the world. The development of a plan for low-cost production and mass manufacturing had to take into account that fittings needed to be accessible and quick to reduce patients’ time spent away from engaging in livelihood activities. Also, the limited trained workforce in manufacturing prosthetics drove the development of a simplified manufacturing process using local materials to keep the costs down. BMVSS skilled artisans who manufacture the feet are paid INR 5,000 (US$110)—nearly double the estimated per capita income in India—and benefits are included.
While BMVSS has been a leader in reaching out to provide new mobility opportunities for individuals in need, few other NGOs or social enterprises have followed suit in this specific area for the loco-motor disabled. Similarly, public transportation—which is how most urban poor move about the city—has made very few concessions for people with wheelchairs, crutches or other aids. The government’s policy to improve access on trains and buses has been criticized for failing to make the necessary budget allocations, claims a DFID report “Enhanced Accessibility for People with Disabilities Living in Urban Areas.” The policy says that upgrades to the public transportation system should happen “within the limits of the economic capacity and development of relevant institutions.” The weak stance of this clause has perhaps perpetuated the lack of investment in assisting the disabled poor to gain access to the transportation services they need.
In addition, the poor are less likely to live close to public transportation, so even getting to a station or bus stop poses an issue. In Mumbai, a taxi service has begun catering to the disabled that claims to not be focused on profit but on providing a service to those in need. Founded by the Fulora Foundation, the taxi service has launched 20 modified cars as taxis for both long and short distances. Though improved mobility is helpful to the urban poor, they often cannot even afford the basic tariffs for door-to-door service. There is need for a system similar to that promoted by 1298 Ambulance service, which has a sliding price based on income. The poor are then subsidized by the users of the system who can afford to pay.
Also, since door-to-door systems are often relatively expensive, a system that adopts a model being promoted in Sweden may offer another solution. There, service routes for the disabled have been enacted, and as a first step towards creating accessibility for the disabled in countries with much less resources and infrastructure than Sweden, advocates in Mexico and Eastern Europe have also been working to implement this concept. This would reduce cost and be provide more flexibility in movement for the disabled poor living in urban areas of India.
As awareness around people living with disabilities has increased in India, so too must investment in innovations for assisting this population with being able to access the necessary medical and transport needs they have to be mobile. The ability to walk or roll a wheelchair in urban areas of India is difficult in the best of circumstances. But for the poor, mobility is a matter of accessing the resources they need to meet their daily survival needs. More enterprise, innovation and investment is needed in this area, and perhaps models being tested and developed both in Indian cities and elsewhere can be responsibly adopted to meet the needs of the poor. The Jaipur Foot has proven that these investments are not only needed in great numbers, but that they can be sustainable if the diverse circumstances of the poor are taken into account.