This document is intended for professionals involved in AAC in higher income countries who are considering donating equipment to lower and middle income countries.

Sharing surplus resources around the world is an excellent way to ensure more people can use AAC to communicate. There are, however, some issues that must be considered before you send equipment and resources to lower and middle income countries.

Primarily it’s important to stop and think honestly about your motives. Is someone really going to benefit from the donation or am I just offloading some waste? Do I have close ties with the destination to fulfil my responsibility and ensure that the resources benefit those communities? If I am not very familiar with the destination how do I know that these resources are compatible with their needs and can be supported when required?

This guide looks at considerations for both paper-based and powered AAC resources.

Pictures provided by Drawn to AAC

Paper-based AAC

Low-tech tools such as paper communication boards, plastic aids such as eye-transfer (e-tran) frames, and low-tech tools such as the PicseePal have many advantages over electronic devices.

A communication book

Training & Support

All AAC requires a learning and support component to ensure that end users and their families can benefit. Before sending systems overseas consider who is going to provide this support to ensure that the aids are not abandoned. Professionals with experience of AAC capable of supporting schools and families are rare in countries with few speech and language therapists (Fuller et al, 2009). If you are thinking of donating these resources, can you also donate some of your time as well?

Modelling paper-based AAC

Facilitating an e-tran frame for communication

Language & Culture

It is important to consider whether the AAC aids you are donating are compatible with the languages of the targeted population.

It is also vital to ensure that content and images used in the tool are appropriate for cultural norms in that environment.

If translated, is the vocabulary culturally appropriate for the local environment in terms of priorities and layout?

Powered AAC

High-tech devices such as communication aids that work by touch, switch, head pointer or eye-gaze provide a great deal of flexibility and promise, but put much more demand on the user’s environment.

When considering the donation of these types of aids it is important to consider carefully the impact the device might have on the user’s immediate community.

A powered communication aid with eye-gaze

Technical Support & Maintenance

We are all familiar with the fact that technology fails due to software or hardware. Are individuals in the local community able to contact the support lines used to identify and correct the problem? If it is a hardware problem can it be fixed without easy access to spare parts? This second question is particularly important if you are considering donating a device which already has a fault that you are assuming can be fixed by the recipient.

Batteries and electricity are particularly important. Batteries begin to fail after a certain number of recharge cycles and the equipment you are donating is likely to have passed, or be very close to passing, that number. Are new batteries available to the recipient? Are they prohibitively expensive? Is electricity easily available and is it affordable?

Mounting & Positioning

High-tech assistive technology such as eye-gaze and head-pointing devices are sensitive to their position in relation to the user. The safe mounting systems that are readily available in most high-income countries typically cost hundreds of pounds. Is the mounting system being provided alongside your donation? Without it the device may be ineffective or, worse still, positioned in an unsafe manner that can cause serious harm to the user.

A safely mounted eye-gaze device

Language & Culture

As with paper-based resources it is important to confirm that the device you are sending is compatible with the language(s) used by the recipient. Consider:

Does the device have vocabularies that have been translated into the languages used? What types of vocabulary are available?
Does the device have speech output in the language(s) spoken in the community? Does it enable easy code switching?
Is the alphabet used by the recipient compatible with the device?
Can the device support right-to-left text if appropriate?
Can the device access culturally-appropriate symbols?

Current Donation Programmes

These are two examples of programmes involved in donating AAC to low or middle income countries.

Nika Project (USA)

The Nika Project, based in California, engages, educates and empowers communities around the world who benefit from augmentative communication. Although this includes donations of repurposed technology, this is combined with training in local communities and collaboration with universities, including the University Kebangsaan in Malaysia.

MEDICT (UK)

MEDICT is a charity based in the UK that focuses on transforming the lives of disabled children in under-resourced communities in Mexico. Their efforts cover a broader range of support, including education, healthcare, and other essential resources for children with disabilities. Working since 2001, Medict has provided over ten shipping containers of refurbished wheelchairs, orthotic equipment and augmentative communication aids. Forty UK-based health professionals (occupational therapists, speech & language therapists, rehabilitation clinicians etc.) have visited to provide training and support. MEDICT also emphasises the development of its partnerships, particularly with the Nuevo Amanecer Institute (NAI) in Monterrey, Mexico.

CTI contacted the current chair of MEDICT, Paul Hewett, to find out more. Paul, who took over as chairperson in 2022, has been reflecting on the approach used by the charity.

A great many children and their families have benefited from receiving equipment and training from experts from organisations such as Treloar’s, Chailey and Active Design, building skills in assessment and implementation at the NAI.

However Paul is keen to find a new direction. He pointed out that equipment donated to MEDICT is often broken, lacks spare parts or support is no longer available. A more sustainable approach would be to work with experts in under-resourced communities to manufacture local equipment using available resources and expertise. This would also reduce the financial and carbon costs of shipping equipment which can be very high and unpredictable.

Paul also considers that rather than UK professionals visiting less-resourced settings there is an argument for funding visits to the UK, for clinicians from overseas to work alongside those in the UK. This would bring the benefit of seeing the equipment embedded in settings that have developed to bring the most out of that equipment, through training, support and other resources.

Other Useful Contacts & Resources

Think Before You Give. For RCSLT members, have a look at this Bulletin article from Summer 2022 on page 40 about the challenges of resource donation.

PicSeePal donates PicSeePals to LMICS – contact them for further information.

Global Symbols is a UK-based non-profit organisation. They have partnered with UNICEF for extensive working overseas, helping to ensure that AAC systems are culturally relevant in language, symbols, speech and training approaches.

With Thanks to Drawn to AAC images