Persons with intellectual disability in Malawi are more disadvantaged and pushed to the margins of society. These may consist of mental illness, Down syndrome, autism asparagus syndrome, epilepsy, some types of cerebral palsy, and severe cases of hydrocephalus. Persons with intellectual disabilities, therefore require support because of the characteristics like slow learning, uncontrollable body movements, slurred speech, problems in decision making, and memory problems¹. It is, therefore, very important that the government should initiate and improve services toward their inclusion. It includes access to appropriate technologies that are very essential for them to have equal opportunities like anyone else².

The Community Based Inclusive Development (CBID)³ program that was introduced in 1988 as a pilot project in Blantyre district (1) and is now extended to half of the country has not made a noticeable response to the diversity of disability and needs. In general, most of the support is delivered to persons with mobility and other physical challenges, visual and to a limited extent persons with hearing impairments. As a result, insufficient consideration has been given to persons with intellectual difficulties and those with developmental impairments (2). Limitations include lack of responsiveness to diversity; priority to access medical, education, and livelihood interventions; most CBID models that were fragmented were not aligned to the Government development structures at the community, district and national level⁴. On top of these there were also other challenges like sustainability being depended on the goodwill of volunteers; limited coverage and dependence on donor funding.

However, Malawi has developed a new National Harmonized CBID Model (2) whose main features are diversification and inclusiveness; partnership and collaboration; capacity building; participation of persons with disabilities; ownership and sustainability by district councils; and compliance with national and international standards. The new model that has adopted the World Health Organization CBR Matrix⁵ also has a monitoring and evaluation framework targeting the district councils; has mechanisms for data collection and management, and is responsive to the local context (see Figure 1).

Since CBID is a rights-based approach to disability issues, it will ensure that persons with intellectual disabilities are included in all the intervention done under it comprising access to assistive technologies by persons with an intellectual impairment. This will be through identification of persons with intellectual disabilities, assessment and referrals to appropriate service providers depending on their needs using the CBID mechanism that uses the local Government structure⁶ and has volunteers who move door to door at the village level (see Figure 2).

The Malawi Disability Act, 2012, defines disability as a “long-term physical, mental, intellectual or sensory impairment, which in interaction with various barriers may hinder the full and effective participation of a person on an equal basis with other persons”⁷. Thus, the advancement of inclusive development by mainstreaming disability would be demonstrating an understanding that persons with intellectual disabilities have to enjoy human rights like other persons other than taking them as objects of charity. Since Malawi signed and ratified the United Nations Convention on the rights of Persons with Disabilities (CRPD) in 2007 and 2009, respectively⁸ there is need of policy, legal and systemic reforms to ensure that persons with intellectual disabilities access appropriate technologies in Malawi.

Therefore, section Situation Analysis of this paper highlights the challenges faced by persons with intellectual disabilities in Malawi. It includes negative perceptions of them and the lack of technical know-how available to this type of disability. Section Overview of the Legal and Policy Framework analyses the current disability legal instruments and policy frameworks in comparison to the international standards in the provision of assistive technologies and its implications on persons with intellectual disabilities. Section Recent Developments justifies why CBID is the best way forward to improve the situation, followed by section Actionable Recommendations and the paper concludes.

Persons with disabilities in Malawi, just like in numerous other countries, have many challenges. These result in getting them marginalized from the mainstream society that makes it problematic for them to realize their essential social, political, and economic rights⁹. “The majority of them have a difficult life since they are poor, abandoned, uneducated, malnourished, discriminated, neglected, and vulnerable. The factors contributing to this pathetic situation are many and varied but include poverty, unemployment, and social isolation, environmental, institutional, attitudinal, and economic barriers” (as above).

The most recent development in Assistive Technology that Malawi has experienced was attending the summit on Assistive Technology in Geneva Switzerland from the 3rd to 4th August 2017. The summit was initiating a “Global Priority Research Agenda for Improving Access to High-Quality Affordable Assistive Technologies and Devices.” In short, it is called the GREAT Summit. Following the summit, a report was submitted to the Principal Secretary for the Ministry of Gender, Children, Disability and Social Welfare so that action is taken in Malawi so that it can move together with the rest of the world.

This prompted during the drafting of the Disability Bill 2019 for Appropriate Technologies to be included⁴⁷. The Bill includes broader strategies for appropriate technology in Malawi to developing sectoral policies and legislation on health in line with the National Policy on Equalization of Opportunities for Persons with Disabilities (2006) article 4.12⁴⁸ and the Disability Act 2012 section 26⁴⁹.

The other broader strategy is strengthening networking among public and private service providers in the areas of promotive, preventive, medical, and rehabilitative services to ensure a more coordinated case management. A good example under CBID is the Community Training on making and repairing of simple assistive devices (e.g., Appropriate Paper Technology -APT)⁵⁰.

Despite the numerous policies and legislation that would enable persons with intellectual disabilities to access assistive technology, there is though little happening on the ground ⁵¹. There are numerous challenges like level of access and quality of the services for persons with disabilities for the past years; lack of data and statistics in the Malawi Growth and Development Strategy and previous absence of a Healthy Policy and legislation; limited access to mobility and other devices due to no decentralization of rehabilitation services within the Ministry of Health delivery structure; and inadequate number of specialists such as orthopedic surgeons, ophthalmologists, physiotherapists, and occupational therapists, rehabilitation technicians, medical social workers, and community nurses⁵².

Nonetheless, the Community Based Inclusive Development (CBID) promises to be a solution to the problem. CBID is a rights-based approach that is focused on development with an aim to mainstream disability in development work and in the Governments development agenda. Dissemination of appropriate technology information is already taking place through CBID. Therefore, there are features that would make CBID a recommended tool to remove the challenges of intellectual disabilities and access to appropriate technology.

The features of CBID that would assist this cause are diversification and inclusiveness that give answers to a wide and specific social-economic requirements of persons with varied types of disabilities, age groups and different cultural contexts; partnership and collaboration that permit sharing of best practices and accountabilities as well as gives a wide-ranging service delivery. Features also include the capacity building that consists of the transfer of skills for mainstreaming disability in development work from the grass-roots up to the national level; participation of persons with disabilities in CBID that calls for their active involvement and participation as rights holders in the spirit of “Nothing about Us without Us.”

Data collection and management, which gives effective planning, implementation, monitoring and evaluation of the programme is an important aspect hence Malawi has come up with a National Disability Monitoring and Evaluation framework, Inclusive Education Strategy and the National Mainstreaming Strategy. The National Coordination and Consultative Committee on Disability Issues

(NACCODI) has also been re-instituted by the Honorable Minister of Gender, Children, Disability and Social Welfare. This is a committee of Principal Secretaries to ensure that there is coordination among all Government sectors so that mainstreaming of disability is done.

Enhancing international cooperation as per the United Nations Convention on the Rights of Persons with Disabilities would be very important. For example, after the GREAT Summit in Geneva, the African Commission considered the possibility of concerted efforts to address issues of appropriate Technology in Africa⁵³. Similarly, a provisional position paper was drafted at the University of Southern Queensland in the United Kingdom toward an international framework to ensure the availability and accessibility of affordable high-quality assistive technologies globally.

The provisional paper highlighted the need for states to develop national policies on appropriate technology provision that includes a policy on appropriate technology manufacturing; use of appropriate technology mainstreaming technologies to intensely stimulate appropriate technology and services; ensure evidence-based information on appropriate technology and allied services available. On top of that develop training programmes in appropriate technology like has been done in Malawi in the development of training packages for CBID that has included appropriate technology.

Malawi has picked the cue since the issue of appropriate technology was also discussed with the Principal Secretary for the Ministry of Gender, Children, Disability and Social Welfare in a meeting on the 25th of October, 2018 at Mount Soche Hotel in Blantyre, Malawi, where the Principal Secretary implored organizations like the Ministry itself, the Malawi Council for the Handicapped and the Federation of Disability Organizations in Malawi to greatly include appropriate technology in their programmes and services.

The introduction of the new harmonized CBID model in Malawi that matches the principle of the Sustainable Development Goals to “Leave No One Behind” is a great milestone. There is now hope that the aspect of intellectual disability and access to assistive technologies will improve further using the Mainstreaming Strategy, the CBID and other informal community structures. NACCODI will also play an important role to ensure that nobody is segregated from realizing his or her rights.

There is, nonetheless, need for reinforcement of legal policy instruments that are already in place and systemic reforms to ensure inclusive programming and development to achieve inclusivity of persons with intellectual disability.

Progressively, the challenges may be declining but it needs concerted efforts from all key partners and the much-needed coordination from the CBID programme.

The author confirms being the sole contributor of this work and has approved it for publication.