Investigating assistive technology ecosystems in Southern Africa: lessons from Malawi

This thesis concentrates on three subsectors of assistive technology (AT) innovation ecosystems in Malawi: mobility assistive products, albinism skincare assistive products, and digital assistive products. The research focuses on how African AT ecosystems can be structured and managed to improve access and accessibility for individuals with disabilities, using Malawi as a case study. The study employs qualitative case study methods with 55 stakeholders across seven categories, combined with analysis of national policy frameworks. The theoretical approach integrates innovation ecosystem theory, frugal innovation models, community organising principles, and systems thinking to examine ecosystem functioning at micro, meso, and macro levels.Findings reveal that Malawi's AT ecosystem operates through multi-functional ecosystem anchors ¿ focal organisations that coordinate intermediation, advocacy, manufacturing, and distribution. These anchors enable ecosystem functionality despite universal barriers affecting 93% of participants, including resource limitations, infrastructure gaps, and expertise shortages. Organisations sustain innovation through frugal methods, collaborative partnerships, and community-driven solutions, using adaptive strategies and informal control mechanisms.The research identifies significant policy-practice implementation gaps where progressive legislative frameworks fail due to coordination challenges, insufficient data systems, and resource allocation inefficiencies. Analysis shows how these gaps prevent the translation of policy commitments into accessible AT services.This thesis makes three theoretical contributions. First, it extends innovation ecosystem theory by identifying "resilient innovation ecosystems" - systems that function effectively under persistent resource constraints through adaptive coordination and distributed innovation capacity. Second, it advances AT frameworks by highlighting critical post-distribution support requirements, advanced intermediation functions, and technology-specific infrastructure dependencies often overlooked in traditional models. Third, it develops a conceptual framework that synthesises culturally responsive frugal innovation, community organising, and value co-creation within a systems thinking perspective, providing a grounded approach for strengthening AT ecosystems in resource-constrained contexts.