Prof Bala: Professor Catherine Holloway. So now we know her for I think almost five years now so and we have been interacting regularly. Prof Katherine and we call her Kathy I’ll will refer to her as Katherine so she’s very active in this field and perhaps involved with one of the largest initiatives in terms of the Global Disability innovation hub that is in UCL  in University of London, and she is one of the co-founders of that and working on various spaces and one of the most important agenda for them is to look at technologies and solutions which have global applicability. So they are looking at those technologies which can actually also have you know from the point of view of the type of solutions we talk about in our space, both in terms of affordability and also in terms of challenges that can occur in many places like for example there is an activity that is happening at IIITB which looks at the Global South. So this is also to look at of course not just south it looks globally but it has many interesting projects that are going on and I’m sure in her talk she will refer to some of them. So without further wasting time on describing her work, I welcome Kathy for the talk.

Prof.Catherine Holloway: Thank you. It’s a great honor to be here and to have the chance to talk to you I’ve got quite a lot of slides and at the beginning, I’m going to go through the start of it and the end of it quite quickly then more can be shared with you later. In case you want more information. And in the middle part I’ll spend a little bit more time on things. So one of the things I want to introduce today is this idea of disability interactions and it’s a new framework that we have been developing for how we design technologies for people with disabilities. And I’m going to explain that in the context like Professor Bala said of this of the Global Disability Innovation Hub and also we have a big program that we’ve been running called AT 2030 which stands for Assistive Technology 2030 which is funded by UK aid.

So just the start a little bit of background. I think nearly everybody I had a quick look at the participants who are here and I think everybody will recognize the diagram that’s on the screen which shows the valley of death from an idea that the technology readiness level one up to they go down you have an idea and you try to validate that idea and then to validate you get bigger and deeper into the valley of death, you begin to feel a bit despondent. And then at some point, you’ve managed to validate things, and actually people are beginning to believe in you. And you see growth and sustainability and I think if you were to ask Professor Bala and people like Professor Bala or myself you would say that disability innovation is a movement as a whole movement for many, many years. We were at that validation stage where people like festival Professor Bala myself to a lesser extent we were trying to validate to the greater world that people need to take notice of the 1 5% of people who are disabled or live with disabilities. And we have to have a better inclusive environment for those people. And for a very long time and nobody listened to us. And we were in that valley of death as a movement. And then over the last sort of 10 or 15 years from the point of the UN Convention of the Rights of Persons with Disability, the movement has begun to grow. And I believe we’re now in that growth space. And so those of you that are lucky enough to just be joining the space you’re joining at the right time because a lot of the hard work has been done. But for every venture that comes and joins the journey, you will go through this valley of death you will have an idea. You’ll be very excited, you’ll go to validate it, you’ll it’ll be hard work, and then you will have to start to grow and you’ll have to get other people excited about your ideas and then you need to sustain the work. So this some of this understanding the value of death for assistive technology and accessible solutions is basically what I tried to do. And one of the ways we’ve tried to do that is through this program called Assistive Technology 2030. And on this slide, you’ll see a flowchart on the one hand you see a screenshot of a document of a wheelchair which is a product narrative, a product narrative is produced by people like the Clinton Health Access Initiative, and what they do is they look at the market that globally wherever we’re at who makes wheelchairs, who produces wheelchairs, where do they get shipped to how do they get delivered to people and then they look to see how can you shape that market. So for example, if we removed tariffs on assistive technology, it would be much cheaper for new innovators to be able to import and export materials to build assistive technologies and to export the end products. And so we have a series of these product narratives as an example of some of the landscaping documents that we have done. We’ve also done landscaping documents with the GSNA to look at the mobile disability gap to understand how many persons with disabilities globally have access to mobile phones, and what kinds of users they have. So we have these landscaping documents. But we also in the bottom left you see a young man with crutches about to go and play some football he’s a great young leader in Sierra Leone and in Sierra Leone, in particular and in Kenya and a couple of other countries. We’ve been working at the community level to really understand what people believe they need in order to get the assistive technology they need. And both of those inputs, landscaping and underground research flow into this light bulb in the middle of the slide and then out of the light bulb, you get the four clusters of activity, which is A T 2030. We run data and evidence programs mostly to support the World Health Organization. We house the club Collaborating Center on assistive technology. So Japan brings us and asked us to do things and we do it basically, we also have open research calls for others. If they need evidence in an area you can you can ask us to find it for you. We’ve got an Innovation Cluster where we run investments and Innovate Now calls and they should talk a lot about that in a second. We’ve got a country implementation, which I look a bit less at but it’s important I think for entrepreneurs in the space of assistive technology to know that the systems in which assistive technology live and work are very important to understand whatever region you’re working in. And then finally, we work in capacity and participation in particular supporting at scale the Global Partnership for assistive technology. So that’s a little bit of background and if you go to our website, this is just a few screenshots from the website. But if you go to www.at2030.org, you’ll begin to see the impact that the program is having GDI has just one part that we might run the program but we’re one partner. There are over 50 partnerships in this program. Some of them were in India. We’re working closely, for example, a professor, Professor Bala. And, and but we’ve reached 22 million people, which is great. And we’re beginning to build these impact story examples as well, which helped explain the impact of assistive technology, as one of the things we found with venture capitalists is that they don’t understand the space. So we’re trying to build a library of resources for people around the world to be able to use to explain. I see there are some questions coming in. I can’t see those. So unless Professor Bala interrupts me with them, I’ll just continue for the time being but I’m happy to there’s clarifications or if you want me to slow down, just let me know. Yeah, I’m monitoring the chat, please. Okay, so I think everybody in this room knows that the WHO the World Health Organization describes assistive technology as an umbrella, an umbrella term, which covers both products and the services needed to deliver assistive technology and then an assistive product is any physical or digital device which is external to the human body and helps people with disabilities maintain or improve their independence and well being. The reason I include this slide in nearly every talk I give is to emphasize the service component and I’ll explain why in a second. So one of the papers that I often use MAC’s paper for many of the universities looked at the assistive technology market from the point of view of what the market characteristics and what’s the system’s level of operation. So if you look at this slide in the bottom left-hand corner, you see an individual micro level, look at the individual level, and you look at an individual with a disability and a minimally functioning market. What’s their experience? Well, their experiences they get difficulty matching assistive products to their needs. The service isn’t person-centered and may feature products that are too expensive for people to access. Whereas if you go to an optimally functioning market, users are the drivers of the development. They’re feeding back what they want into the system. They’re normally co-designing this list of products, and those products then match their needs. And again, if you’ve got the system’s level to the international level, you see that in a minimally functioning market, that there are difficulties in national procurement, that the government is unable to procure the products that it needs. Whereas in an optimally functioning market, you have universal coverage. So assistive technology is embedded into universal health care coverage and universal education. And people have no problem or governments have no problem providing their citizens with the infrastructure that they need to live their lives. Now, this Systems Thinking is important when you look at the world of innovation, especially within health because oftentimes assistive technologies are just looked at from a health perspective and from a health perspective.

For example, digital assistive technology might not seem like assistive technology, and that we constantly have these battles where, where maybe one government understands wheelchairs and mobility products, a different person understands vision products and a different person set up the world understands the communication needs of people with cognitive impairments. And the problem is that the needs of the people are different. And we all know that as designers, and as engineers, we know that somebody with cognitive impairments has different needs to somebody with mobility impairments. But what we sometimes forget is that the markets for the products are different, that there are different people that buy the products, there are different ways in which the products are given to the people. And if you don’t understand that system, then you’ll never be able to get your product to scale. So we’ve been looking at developing the definition of AT innovation and this paper will come out and in a couple of weeks. Professor Rao helped us write it. We began to look at the OECD, which really mapped all of innovation across the world. And so what does that mean for assistive technology and what we ended up with was 80 innovation can be broken down into innovation around the product innovation around the supply and innovation around the provision of the product. And we did a full systematic review which will be published but I pulled out just just just a highlight which is to show that we did a case study so we had an open core for case studies. Many case studies came from India, we had adjacent innovation when we looked at literature that wasn’t necessarily for assistive technology but was a bit broader. But could be useful for assistive technology. And then we looked AT innovation itself. And what you find is that the world is publishing and a lot of the case studies and even the adjacent work is all around the product, and the supply is lacking. And then we wonder why we don’t scale products. Well, it’s probably because we’re not innovating in that supply and provision space as much as as needed.

We also looked within the same paper as a second study where we had interviews with people from people who provide eyeglasses, innovators, and eyeglasses right from the big manufacturers down to small innovators. The same with prosthetics. The same with digital. Across those interviews. We analyzed and found that there were two overarching themes that people felt we could unlock the markets. One was open innovation, and we don’t mean open source innovation here. We mean, making sure that you’re open to partnerships in enabling any product or service to scale and beginning to look at radical or disruptive innovation so beginning to look at potentially AI or mobile money, or different mechanisms to completely transform the way that products and services are provided.

So go back to that valley of death. That paper that review paper basically gave us a bit of evidence as to why a lot of the assistive technologies get stuck at the bottom of this valley of death. It’s not that their product isn’t good, their product is good, and in some cases, they spend too long, developing and nuancing the product offer without looking at the provision and supply elements of their business case. And so for that, I just want to quickly describe the disability interactions framework, and then I’ll give a couple of case studies to finish off.

So the disability interactions framework comes with these circles. There’s two The diagram shows two rings, and the first ring is principles. I’m going to speak through each of the principles. And I’m not going to speak through the interview, which are the mechanisms for measuring things because that’s a bit too detailed for today. But there’ll be a book upcoming that you can read about it or I’m happy to tell you about it offline. But around the principles the first principle is that we need to understand the innovating for disability inclusion is a wicked problem. Now, a wicked problem doesn’t mean you should give up. Wicked Problems can seem impossible to solve and they remain in flux. And they’re also they’re also unmeasurable in terms of success often, so sometimes people get lost in the complexity of disability inclusion. And what I find is it’s really useful to understand that it is complex and it is really difficult and that you probably can’t or you won’t be able to fix it all and that your product or your solution will be integrated in a complex mix of problem space. So the first thing is that it might be that it’s a healthcare product and an education product, or it might be an employment product and the community product, but also you’re going to have the intersectionality of disability with poverty, which is nearly everywhere. It doesn’t matter if you live in the United Kingdom or if you live in India, you will find that people who are poor are more likely to live with a disability and people who live with a disability are more likely to be poor. And that makes innovating in this space particularly challenging. Now I tell my students, I tell my the innovators I work with you acknowledge that and then you move on from it. You realize that you’re innovating in a really difficult place and you accept that and that helps you frame solutions to your problems. So then we will look at the next principle which is always to apply applied research with basic research. So a very good example of this is a product that we’ve been working on with between IIT Delhi and GDI hub with a PhD student called Tigmanshu. And Tiggy has been looking at a new product for visually impaired so the visually impaired people can create their own content, maybe draw understand stem subject that graphs more easily. And in order to do that he’s had to go back to basic science research understand and develop a new material science approach that will then develop a new applied research agenda. So he started in applied research, spent a lot of time in schools trying to understand the problem space, realized that the problem with the current product offering was that they it couldn’t scale because there were individualized motors it’s very difficult to make that very cheap. So therefore go back to look for new basic science approach spent a long time of material scientist thinking how they could do that, and then has gone back into the applied research mode.

The second or the third principle is co-created solutions. Now, oftentimes when you say co-created solutions in the space you think, Oh, yes, well, I work with people with disabilities. So tick box tick, but we’re not talking about just working with people with disabilities. We assume that you’re going to do that because you’re a good designer. We’re, what we’re talking about is how do you work with all of the actors in the space? So how do you make sure you’ve got a manufacturer that can bring your product to scale? How do you make sure you’ve got someone that can do the research for you if you’re not a researcher? How do you make sure you’ve got someone who helps you with the IP that you’ll be getting to co-create all of these solutions right from the very beginning.

Now, when you’re talking about co-creation, as I said, I take as a given that you will be working with people with disabilities. Now there’s a very good paper called the Crip Technoscience manifesto, which might sound a bit strange, but in the Crip Technoscience movement that people with disabilities are reclaiming language like cripple and using it to say that they want a change in language they want to stop being pandered to, and they want. They want to stop two things. They want to stop the people who still think of them in terms of medical problems, they want that stop, but they also want the people who are in the social model of disability but somehow have this utopian view of complete independence and totally quality because there is no totally quality we live in an absolutely unequal world. And so there was no point in pretending otherwise we have to work within what’s actually true which is, which is that we have a world that’s not going to be equal anytime soon. And people none of us are truly independent. So there is no point in pretending that they are. So they have these phone calls to action. The first is you send to the work of disabled people and knowers and makers. So not just ask their opinion of the lived experience but you know that their expertise and their ability to create is is is something you have to work with. Secondly, this idea of friction between inclusion. So rather than thinking you want to do a lot of the research, for example, for people who are autistic look at trying to make autistic people be more like nonautistic people. So autistic people maybe don’t make eye contact, I make a technology that helps them make eye contact, but why should they have to make eye contact? People who have deaf communicate through sign language? I don’t, I don’t ask them to get a cochlear implant. That’s not my choice. And we shouldn’t be forcing an ableist view into our designs. What we should be doing is maybe making a translation device that says okay, this person doesn’t have eye contact. This person does have eye contact. How do we make a technology that enables them to more easily communicate and learn from each other? The third principle is to abandon ideas of independence and realize that we’re all naturally interdependent on one another, we’re interdependent on each other’s countries, as people I rely on, you know, on lots of people around me to help me live a good life and commit to driving principle of disability justice, which I think we’re all aligned with.

So, from there, we begin to look then at this, one of the last principles which is on radically different interactions and that ideas as mentioned, just now with the idea so for example of developing this translation device between different forms of people who communicate in a different way. So if we begin to think in the space, we begin to come up with completely new ways of maybe designing technology, and that’s the space we want to push as much as we can with this idea. And finally, we want to value we need to measure the value and the usefulness of technology. So for anybody who’s tried to scale and assistive technology or an inclusive design approach before, you’ll find that people will say because what value does it bring a new sale people like it, and that doesn’t mean anything, not to somebody that’s got half a million dollars to invest. They don’t invest in things that are likable, they invest in things that make money well, they invest in things with social impact. And we are not good as a community at measuring that at a level that is scalable. And so we have to start working better together to find those measures.

And one of the ways we can do that is by making our technologies open and scalable. So working more collaboratively. That’s what I mean by open that we try and make sure that we work with each other to make technology more open, not necessarily open source but more openly available to each other and that we think about how things are going to be scaled right from the start. I’ve seen many entrepreneurs tried to scale something only to be told that their manufacturing method won’t scale. We had an entrepreneur recently, we helped pivot completely their manufacturing technique so that the product could be scaled and that took a lot of time and if we’d if they’d been thinking about scale from the start, that wouldn’t have been necessary.

I said, unpack this a little bit, do some case studies examples. You’ll see a slight change in the branding of the slides in a minute. So when you see that that means it’s funded by AT 2030. So one of these programs funded by AT 2030 was looking at the motivation wheelchair project. They have a new wheelchair called Innovate, and they at Motivation and created the wheelchair. But they had an issue with understanding a couple of those last principles, but how do they value? How do they measure the value of this new device and its usefulness? The wheelchair charity, they are excellent, but they don’t have research expertise, but they’re open so they were open for collaboration in that area. And so GDI hub worked with Motivation and University of Nairobi to help build this out.

So, research on the value of assistive technology. You see the brand has changed means that this was funded by AT 2030. So as I’ve previously mentioned, assistive technologies are often designed with the aim of bridging some sort of functional gap.

So you know that somebody can’t walk so you think of technology or you help design a technology that helps somebody move but oftentimes social considerations are not considered and I don’t know about you, but most people wouldn’t like to have an outfit, for example, chosen for them by anybody in the world. They wouldn’t necessarily like to wear something their next-door neighbor tells them they should wear they probably certainly wouldn’t like to be told by a healthcare professional, what to wear or how to present themselves. And yet, and assistive technology is part of a person a lot of the time and so there are quite large social aspects that are necessary to break down in terms of assistive technology, design, and also assistive technology. Links to your idea of identity embodiment and sort of self-expression. So there are some people with disabilities I mean, the language of disabled persons versus persons with disability for example, in the UK, if I said persons with disability, I would, you know, people would shout at me, don’t have seen people shout at other people. Whereas if I was in the United States, and I said disabled people different people will shout at you so, so different people have the same people that they identify as persons with disability or people with disability, but their expression of that identity is very different. And I think we’d all agree that our identity shapes and our sense of self are important in the design. Of the life that we design for ourselves.

So if you look at the design world, so for example, Norman’s emotional design, he talks about why do we love and hate everyday things? Why do I like this glass but I don’t like that glass, for example. And there’s sort of some sort of visceral level it’s based on initial sensory information, we produce a sort of emotional response to something we like it, we’re scared of it, we’re attracted to it. And then we’ve got a behavioral level, which is sort of rooted in the functional performance of the device and once you start to use it if it becomes very useful to you, even if you didn’t really want attracted to at the beginning, you might continue to use a device just because it’s useful. And then there’s sort of a reflective level of meaning that after a while of things you sort of becomes almost a part of your something that you have a deep relationship with. You might might sound strange to have a deep relationship with I don’t know people have deep relationships with their cars or with the sofas or with the laptops. I have a deep relationship with my laptop, for example, which is probably quite a sad reflection on me. But in any case, we looked at this from the point of view of what those kind of more visceral elements of design mean in the world of assistive technology and so over five months, we had various training and independent delivery of this program, but we manufactured eight new types of wheelchair, I’ll show you a picture of the wheelchair next. We had eight wheelchair users as well as five wheelchair providers. So thinking again about that systems approach. We wanted to make sure that the people that would ultimately be delivering these wheelchairs were also comfortable with a new type of design and a new type of manufacturing that would be needed. And so our overall research question was how do wheelchair users and providers evaluate the innovative manufacturing model and the wheelchairs produced? We and we collected data as to observations training and final interviews as well as interviews with the wheelchair users and a focus group.

I won’t go into the details of the innovation itself, but what it manages to do is digitalize the measurements from from an occupational therapist into a computer which allows for a CAD model to then develop the wheelchair and the wheelchair dimensions can adapt to the local materials. So you have local materials you put this material properties into the CAD model and then it will allow the components that are going to be 3D printed to adjust in shape and density in order to support the strength of the overall design. Now one of the things that came out of this was like this, this woman, for example, didn’t in any way wanted a three wheeled wheelchair, but at the end of having Tisshy was involved in the entire design process. And she felt like it was her personalized wheelchair to be made for her that it she lots of the participants talked about the fact that it presented more of an image of themselves that they wanted. It wasn’t just about a functional thing anymore. It was like it this is me this is who I am. They talked a lot about pride and empowerment. And also the added increased agency meant that they could get adequate support for users and for providers.

There was clarity over kind of shared values. So in the design process, there were lots of conversations where wheelchair users would talk about their values and that would be incorporated into the design. And it showed this successful level of emotional design. That could be applied to assistive technology.

Whilst we’re doing the motivation work, we also worked not so much on the values led Design Thinking piece but on the post the problem of prosthetics provision. So for those of you that are in India, or across the world, you will find that sometimes and these photographs were taken, I think I’m trying to remember it was Uganda, and some in Kenya, where we went to workshops and none of the equipment works. So one piece of equipment fails and it takes maybe a year to get it fixed. So you know, then they can’t provide some prosthetic limbs because they don’t have the machine that will allow them that happens. That’s a global problem and a company a startup called Amparo had developed thermoplastic again looking at that basic science research would be applied. So they took this basic science approach to how do we mold a prosthetic limb in situ to the persistent problem is that people can’t get to clinics, and the equipment breaks. And they’re waiting up to six months for a limb because they can’t get there or the equipment breaks. So what if we could just go there, wherever they are, and hold a clinic and be able to fit them in within a couple of hours.

So that’s what they did. And we’ve it’s taking a nightmare just nightmare to get published at the moment for various reasons due to COVID. But we’ve now got data of 40 knee amputee amputees below the knee amputees who are successfully walking on Empower limbs and also evidence of the technicians feeling confident in the limb fitting process and this is our node and not sure if they do work. But you can see Arnold jumping. He goes off to play football this is literally 10 minutes after the limb was fitted and then this is him playing football but half an hour later we drove to his home and he was delighted with his new limb.

So those were some of the studies that we did early on into 2018 in 2019. And we began to realize that we could build an accelerator. So we wanted the accelerator to be built in India and around these areas. So we wanted to give access to technical expertise to make sure that the entrepreneurs could build partnerships that they had ready access to assistive technology users to get rapid feedback and that they had facilities where they could test their devices in real world settings. So we’ve worked with our mirth who’ve delivered it so the curriculum that is delivered by the Global Disability Innovation Hub, we created an inclusive entrepreneur toolkit and curriculum, which will be going live as an open source resource for December 3 this year. And we then worked with AMREF to make sure that was suitable for the African entrepreneurial space. And then we partnered with people like CRE and APDK to run clinical trials with prosthetics and mobility devices. And then we worked with Kilimanjaro blind trials to coordinate a lot of the use of interface that was not so clinical. So when you just wanted rapid user feedback on your device, Kilimanjaro blind trust provided that to people we conducted a number of studies, for example, in slums in Kenya, to really understand the bottom of the pyramid piece of work with KPTI.

And so by 2019, we’d learned that startups and NGOs benefit from assistance in developing detailed protocols. for clinical trials and how to implement them that a partnership approach was necessary and ensures a robust strategy to collect strong evidence that obtaining ethics approval requires time and support and that’s something that has to be fed back to funders as well. They want quick results, but you can’t get robust results quickly without ethics and ethics takes time. Setting up collaborations for site trials are very difficult, but they could be facilitated perhaps by the Innovate Now ecosystem, and that’s what we then built out and demonstrated, and we and we developed guidelines and walkthroughs explaining requirements for research and study. designs for people. So we took those learnings, we developed the Innovate Now platform, as I just said, we deliver that platform virtually for the last two cohorts. And we now have 28 African startups. We have four acceleration cycles, we have our live lab networks coordinated by KVTA and we have the entrepreneur toolkit and the and curriculum which is available. So we like to say it’s sort of powered by GDI hub, but delivered by AMREF and that model is now continuing into digital skills and digital devices. And one of the things we embedded into this was understanding if we actually were doing any good in the world. So we got Maynooth University to do some independent research on whether the curriculum we had developed made any difference. This is a snapshot that results will be published later, but ultimately, we found that people learnt across every all of the entrepreneurs learned across each of them, each of the training modules. For the first eight weeks, they learned a lot that they increased and then for the next eight weeks, it didn’t go any further. That was as much as they could get to as they maintained the knowledge but it didn’t increase and we think that’s for two reasons. One is that the next level of understanding needs a lot more time. Once you’ve got the basics of how to grow a business you can go quite a way with that. But then you have to do another jump. And we’re realizing that takes a lot longer. And that was one of the insights that brought us to develop the assistive technology Impact Fund just before I talk about that these are all the startups that have been supported by GDI hub and MF to Innovate Now. And so these are some quotes which I’ll leave here for you. But some highlights are things like signs media got 160,000 equity investment after participation in Innovate Now, Lukas got another 150,000 from the Jessimae Assistive Technology Fund. We also have signs media have also successfully raised funding, whereas others have focused more on their user base. So they’ve managed to grow their user base to maybe 1000 people and over 40 Partners, which is beginning to they’ve got a different route to entry maybe then equity investments. So we’re growing these success stories, which is wonderful. And of course, that’s all down to them really they’re the people doing the great work.

And but one of the things we realized at the end of all this was you know, some people are getting 150 grand 140,000 You know that they’re getting some money, but they still need more support. And so we design the assistive technology impact fund with Brink, an innovation behavioral innovation team Catalyst Fund who have evidence of building teams. So GDI Hub, Brink and Catalyst Fund came together to say Could an Impact Fund work for assistive technology but is that a good idea?

And we looked at what our investment thesis would be and we thought we would invest in things that would be end-to-end service provision, looking more innovative nanomanufacturing and distribution and financing. So those were our four things end to end service provision, innovative manufacturing, distribution and financing and I’ve left the full slides on I didn’t cut them back because I thought you might like to see that. So two things. One is things like the miracle feat. They got some 5000 pounds from us, but they also get 30,000 pounds of venture building support for six months. So we are helping them get to doctors. We’ve managed to get contracts sorted for them. We’ve managed to get shipping sorted. We’re beginning to look at your payment models within miracle feet. And looking at how they are paying for some things in some countries, and how they could pay for others in other countries. Wazi Vision got slightly more money they have that’s partly because they had kits that they had to buy a CNC milling machine in order to transform the manufacturing practice. But one of the things that Wazi has done is actually invested in African designs for their glasses. They now have a new brand. They have a new website they have a new manufacturing process and they have a new business model and things they’re now getting sales beforehand there was struggling to get sales. And now they are doing a very good job.

hereX, they look at screening for hearing loss. And the big thing here is how do people pay for it? The technology exists. It’s been used in South Africa. It’s been used in America, it’s being used, but how do people with very limited income pay for it for this? So what we’re looking at here is mainly around pay-go financing, or pharmacy distribution or corporate fund financing. So testing three to two-three different financing models to see which one might be possible for people who maybe can’t buy their own hearing aid immediately.

OADCPH is going to be working in Kenya and they are purely looking at distribution, how to effectively set up distribution channels in Africa. They have a successful business in West Africa and the money is helping them to move to East Africa

And Koalaa has developed a new lower limb prosthetic device and this will now be trialed in Sierra Leone. It has the support of the Sierra Leonean government as well as NGOs and it’s kind of critical I think here is that the Chief Innovation Officer of the country is determined to have flagship programs that demonstrate the comeback from the Civil War and from the war and from the effect the wars had on on citizens. And so we are testing this model, but with the idea of could we then get evidence for an entire sector so that value and usefulness part that I spoke about at the beginning? How do we how do we use that?

Unknown 7:07:02

So that was a kind of a whistle-stop tour through all things GDI Hub AT 2030. I just conclude with looking back at the model that we’re developing GDI  hub and thinking again, to you all or asking you all to think about these things that what we’re proposing this model, there’s a book that’ll be forthcoming, hopefully before Christmas, that evolves and unpacks these ideas, but like any framework, I hope it’s wrong. I hope you guys tell me where it’s wrong and that we then make it better together. But I do think that in order to move to shift the needle and where we are right now, we really do need to begin to look at those radically different interactions at making more of the applied research areas and making sure they’re attached to the basic science and we’re making things open and scalable and that we measure the value and usefulness.

So thank you. Quick thanks to UK Aid for funding the program and you can catch us there. I’ve put my various Twitter handles which I hope are correct in there. So hopefully we’ve got some time for some questions.

Prof Bala: Thank you, Kathy, for covering a very large scope of TDA in a very short period of time. So, you know, do we have any questions please? I didn’t see anything on the chatbox. So please, you can unmute yourself and ask the question if you want to ask orally or you can type it on the chatbox.

Okay, before people warm up and ask any questions, let me ask one question. So, in terms of these innovators that have worked with the various NGOs, various organizations, how do you identify them? Like do they come to you or is it through our partners or how do they know this? Intrapreneurs How do they make the first contact?

Prof Holloway: Good question. First of all, if I’m honest, when we started in 2018, we went looking nobody knew we were new. So we went to Kenya and we had a particular focus on Kenya because Kenya the Government of Kenya and the government of the UK have co-sponsored the Global Disability Summit. And so that was the main driving force for focusing Kenya. We went to Kenya and I think in six days, I visited something like 50 people at you know, 10 universities different labs, different startups spaces, and began to think about who were the right mix of people that could come together. And generally, you know, my ideas at that time were more around people who were willing to collaborate and willing to concede the overall vision if that makes sense, even if maybe there might be someone else that was shiny and looked better. That makes sense, but, but if they wanted to be, I care about people who do the doing and want to share, you know, so So we’re, so that’s those are sort of our principles, and then we develop the partnership around that. Nowadays, we get too many, I would say, requests, and actually it’s bought us to we’re going to launch may launch the side of Christmas what maybe after Christmas, an idea of GDI Accelerate. And the idea of GDI accelerate is to start to streamline some of these requests, because we think there are too many. And so some simply, some entrepreneurs simply need access to people like a master’s student to help them do a small piece of research. Some people need access to they need an introduction to a UN organization. They’re very different things and they’re all coming into the same space. And so we’re going to have a new thing within a bank now we had an open call start. And since then, we’ve just been building I think we’ve got maybe four or 500 companies in a spreadsheet that have contacted us over the time that we’re, you know, that we’re trying to do our best with but it’s what we think of as GDI accelerate we’re hoping is that it won’t be your last. Does that make sense? It’d be like okay, this person is coming to talk to us hang on. IIT Delhi would be better at handling or helping there. Let us just be the conduit to that. So, that’s our hope.

Prof Bala: Okay, so there’s this one question on the chat. So, can you elaborate on ‘abandon the idea of independence?

Prof Holloway: So, people maybe speak about independence as something that’s a very positive thing, right. If I’m independent then somehow I’m very positive, that’s a very positive thing. And it masks the fact that nobody is independent. So maybe it’s that we want to have any quality of level of independence. But you know, the way I get to work is, for example, via a train that is built by a country’s tax system that enables me to get somewhere. So rather than thinking of independence, per se, we need to think of that intersection, that kind of the fact that we’re all interdependent. And I think one of the stories that stand out for me is David Constantine, who set up a motivation for a long time ago having dinner with him once and he was talking about this idea of he gets really annoyed at people thinking he should be fully independent. He said I can’t be fully independent. You know, my, I have a very high spinal level injury. I know what it was like to feel fully independent. I knew what that was like just before I jumped into that pool and broke my neck when I broke my neck from that moment on. It’s you telling me all the time or somebody telling me all the time that I should be independent, it’s ridiculous I need I can put my straw into my cup. I can drink from my cup, but I can’t move that cup. I can’t. And I don’t want a load of robots to help me with that cup. I just want this guy who helps me move the cop. And then the cop gets moved. I get on with my dinner.

Because the ultimate aim is I want to have a nice dinner with you. Not I want to be able to move a cop. So So I think the idea is sometimes we think about independence as independent of every single operation in our life. When actually it should be independence of thoughts, independence of action, independence, overall gains in life, but not necessarily needing to develop technologies that make every single movement independent, but we are dependent on one another. No matter what you you think.

Attendee: I’ve two questions. One is an extension of the question of independence itself, when it comes to prostheses and exoskeletons which focus on making people walk from one place to another, but isn’t it that we are trying to fit them into the normal definition of what humans are supposed to do. What are the frontiers in this particular field where we able them in their way, in a way which they would like to live their lives? Not in a way we think the world should be all day should operate, so that’s my first question. The second question is we are a startup working on upper limb prostheses and is there any way to collaborate with you? How do we get in contact with you?

Prof Holloway: I think the first question I’ll repeat to check I’ve got it correct. But I think the first question was around things like say exoskeletons that might help somebody with a spinal injury walk and that is if you think about this independence, or what might be considered an ableist view. It’s like seeing somebody and trying to make them fit the criteria that we’ve designed in the world, which is you should walk, is that a question? And what are the thoughts on that?

Attendee: Yes, that is the question. And now what are the upcoming startups and technology which work against the abelist view, in this current field?

Prof Holloway: Okay, so I think that’s a really, really good question. And exoskeletons, I mean, some people I’ve spoken to some people who are wheelchair users that would love to use exoskeletons and I’ve spoken to some wheelchair users that think it’s the most waste of money they’ve ever seen. That why would they want to use an exoskeleton? I think the fundamental question though, does people want to walk and for some people, that’s part of their identity. They might have been a runner. Before or they might have, you know, like, they liked hiking, or they like doing something where it’s, it’s fundamentally very difficult to change the environment to allow a wheelchair to do that. Or for some reason, yeah. It’s tied to their identity. They feel like walking is important to them. That’s very different from me saying walking should be important to you. So people should have the choice. Fundamentally, in an ideal assistive technology provision system, you would have exoskeletons at an affordable price for people who wanted exoskeletons and wheelchairs for people who want wheelchairs, and maybe you’d have both for different scenarios. The standing wheelchair the wise wheelchair, that allows you to have the choice of being seated or being standing. I think for some people who wish to stand who are wheelchair users. It’s far more to do some practicality reasons but also to do with, you know, getting bone density, trying to get blood circulation to keep your bone density. And so there are some reasons for wanting to do it, which might be not walking but I do think that there’s this sort of idea that proliferate around the world that people just want to walk. I mean, I’m really honest, whenever I speak to people who’ve had high-level spinal injury unit it’s been its funny injuries, they care more about going to the toilet and having sex than they do about walking. That’s what they actually care about. And we try and design exoskeletons. So and then the second answer questions about startups upper limb?

So I’m very happy to help you, if you send me something now you’ll be put a in the spreadsheet which will mean that I send you something when we launched GDI accelerate. And once we launched that, hopefully, there will be mechanisms for you to be able to engage with us, but we’re going to formalize it more.I can put you on a list of people that we tested with if you if you drop us an email or line, I’ll put my email in here. And at the moment, the easy ways are things like student projects, and also she showed it to you and also just you know, help with technical advice on protocols and things.

Dr. Prasad: Hello, my name is Dr. Prasad. We have I’m a neurosurgeon we met in Geneva at the great meeting. And since then, I’ve been working with Professor Rao and met Dr. Professor Bala once but WHO regional office here suggested that would I be able to set up a skills lab, an AT skills lab. So we are in the process of setting up two and we thought it will be easier. I mean, the question will come at the end of what I’m going to have a little bit of an introduction. So there are two skills lab in we are trying to set up one in Delhi and one in eastern part of India.

Now, the problem is a so so we started with the idea that we will come to start with mobility which is easier the technical part of it and then Vision with IIT Delhi with their help. The problem we faced and then is with AAC and the communication and what do we have with like we this at skills lab will be an extension of our neuro rehab facilities that we run for the poor. And we have a special school for special needs a school for special needs children. We already have children with autism and cerebral palsy and learning disabilities. And the reason why CP children were not attending school this special school is that there were no specially designed wheelchairs for children. And so the more we got into this, I realized that there was a need for this lab. But the problem was so so as I said, for Vision, we’ve been working with IIT Delhi for wheelchairs with Motivation UK. With AAC, we had a problem. So we’ve been in touch with David Bains and he’s given some suggestions of how do we go about setting it up. But there’s still a problem with what is locally available to get it free or at low costs. And then there is this huge problem is that who will pay so we did a project at Sheffield, where we looked at a few years ago at what were the assistive technology needs for the urban poor in Delhi. And so we went around 500 households found out what we need, what they needed, but didn’t have any answer to their problem. We did not provide them with the solution or the solution. So one of two things I’m asking you, one is about AAC and how do we go about setting up because we already have 33 children on our roll and the more will join the moment we start a number two would be about getting who how do we go about paying for these 80 products and particularly let’s simplest thing is wheelchairs and then the tablets and the communication devices on tablets where there are some things locally so does GDI happen? Do you have any solutions to our two problems? One is about communication. And the other is about how do we get somebody to pay these poor children and we can only raise so much and we have a problem with AT buying them for the poor. And by the time the government decides to help us, it’ll be several years down the line that we really wouldn’t have gotten very far.

Prof Holloway: So AAC devices. I mean, we can we can help in like identify some low cost, you know, communication devices. I’m sure that there are people in Prof Bala’s team as well, like between us all we could come up with a list of devices. I mean, it sounds to me, though, that you’ve got a sort of a double edged sword. One is if you just buy some technology to help these 30 Children, you’ll solve one problem which is 30 children will get education and that’s a very good thing. However, you might be better off spending time and energy in trialing a business case for how that gets done. Does that make sense? So we’ve got this problem, which is 30 people find that steady children. How do we develop a genuine business model that’s sustainable for this? So is there a way either for the parents to pay. So one of the things we’re doing without Koalaa, that Sierra Leone is a very poor country, and compared to India, I know there are there are obviously people population of India that that will be poorer than they are as poor as people in Sierra Leone. But we’ve got this idea of chipping away at the problem. Where what if the person could only pay two pence towards something you know, and we chip away at it but we built a business model that that’s chipping away so I think it needs a bit of thought. We can help you think it through. We have money. Not that it’s for something like this, but we have money from the next financial year in the UK to work with the IIT with the new center. Professor Bala I don’t know how proper that is but with Professor Bala and with Professor Rao to work sort of on trying to strengthen innovations in South to South innovation between Kenya and India. So I mean, I suspect what’s probably needed Dr. Prasad is that maybe me, you and Professor Bala and Professor Rao could have a conversation offline about how that that maybe could work, and then we could see what resource we were able to find between us to help things. You know, things have to be in a business plan back to FCO like we changed any funding. It takes a while to change funding routes, and I don’t think just paying for 30 sets of technology is a good idea without a business model around it. It doesn’t, that just becomes charity and that’s not a sustainable business model. So I am very happy to help you think through the problem. And I’m very happy to it’s nice to see you again. So it’d be a good problem to think that sounds interesting. And on the AAC devices, we’ve got got a lot of expertise within that. We have speech and language therapists in our team. A lot of UK-based expertise. So obviously, the context is very different. But I know, for example, it might sound silly, but Google is now launching a number of products that are all available on Android that are free, which allow you to begin to develop your own AAC, and you know, it’s free. I mean, obviously, you need to own an Android phone, which is not free. And you need access to the internet, which is not free. I do appreciate those things. But there are a few, maybe a few things we could brainstorm together to see what is possible.

Dr. Prasad: That’s great. And thank you. Just one other thing. I mean, people like Motivation who raised funds in UK for wheelchairs, do you also fund them to or help them to raise funds somehow? Or are we on our own with wheelchairs?

Prof Holloway: Um, no, so we don’t GDI hub don’t help anybody directly raise funds. That’s the first thing we help people develop business models. And we help people validate their, their business models but also validate their technical offering. And we try it we sort of almost as a principle don’t get involved in fundraising. Because if we start to fundraise for Motivation, and somebody else would say, well, why aren’t you fundraising first, and then the next person would come along, and all of a sudden, we’re fundraising agency. And that’s not what we want to be. There are lots of fundraising agencies which are great and good, but they’re not, you know, a Collaborating Center for WHO that they’re different, right? And that’s good. It’s good that they exist. So yeah, we don’t fundraise and we don’t normally pay for any products unless it’s part of a larger validation exercise. Until this part of the larger validation exercise that can give value back to the wider ecosystem. Then there is a business case to be made, and then we can try and find a funder for it. If we’re able to make that business case, but we’re not in… there are two things we don’t do. We don’t pay for COVID burials and we don’t pay for that’s another thing I keep being asked to do recently. I can’t unfortunately pay for people’s burial costs. And I can’t pay for Assistive Technology. That’s not as sad. As much as I might like to be able to change the world. If it’s not, it’s not the best way for us to use our funds to make sure the world becomes a fairer place.

Dr. Prasad: Thank you for your answer, just one in one sentence. Where is the business model in this kind of thing for a poor person? Who needs AT? And if there are lots of such people were his business. I mean, as a doctor, neurosurgeon, I don’t understand the economics of this business. I’m sorry for taking the time. Please carry on. We will connect again.

Prof Holloway: I will Dr. Prasad. I won’t forget you.

Prof Amit Prakash: Shall I ask a quick question? So thank you, Kathy, for a very informative talk. And it was good to hear complexity, systems thinking and wicked problems in your model. Just wondering how does that translate into measurement indicators because somehow efficiency is so ingrained inbuilt into our systems that we straight away get into scale ups, and we want everything to be very efficient. And that somehow conflicts with complexity and this notion of co creation and this notion of redundancy, that complexity would require as a design feature. How do we build that into a model like this?

Prof Holloway: Yeah, I think that’s a good question. I think that openness and co-creation can be done at the very beginning to help define the the kind of more clarity over the user needs. Does that make sense of a user needs at different aspects. And then it’s like, I like it to when I used to work in Medtronic, if I designed an angioplasty catheter, that was brilliant angioplasty. catheter, but no surgeon would use it, then it was never going anywhere. So when we were developing, you know, the user needs metrics for the next angioplasty catheter we would have this is what the hospitals the finance people are telling us, this is what the surgeons are telling us and this is what the users seem to need. Does that make sense? And then we have a matrix, and then we prioritize it across those. So I think you don’t need to have multiple levels of redundancy in a design you might have it might lead to design decisions where you have one element that’s more flexible for example, does that make sense? Or you might decide on, you know, three or four levels of a product rather than just one, just as an example. So I think that this trade-off between complexity and efficiency, don’t, you don’t need to keep all of the levels you need to look at the entire system. And then quite quickly develop that that that matrix that takes account of all of that and then I think the main thing is setting up a system of feedback and design. So either you have one or two people which are known Professor Bala has, you know has an in the, in his projects. We’ve got users as part of the design team, almost you know that they’re giving feedback all the time, which is different from you as an engineer going off for six months developing something, perfecting it, and then going back and showing it to people and if they’re part of people are part of the team then it sort of autocorrects as you go, if that makes sense. It corrects itself. So I don’t know if that fully answers your question. Does it admit?

Prof Amit Prakash: Yes, it does. It does. I know it’s not very easy. And I said as it needs to build in that flexibility and I creativeness second, but I guess what you say does make sense. Thank you.

Prof Bala:

Any other questions or inputs?

Okay, there are no other questions. I think we’d like to thank Kathy for a wonderful talk. And also the discussions that followed all the people who participated in the discussions and all the people who attended. So we had a very good question. So Thanks, Kathy.