A modified hybrid hub-spoke model for assistive technology: institutional design for procurement, financing, and...

Access to assistive technology (AT) is often constrained by fragmented governance structures, inconsistent procurement mechanisms, and unequal regional capacities, resulting in gaps in service quality and limited equity for users. To address these systemic barriers, this paper introduces a modified hybrid hub-spoke model developed as an integrated organizational solution for optimizing AT delivery.

The model is grounded in comparative insights from mature AT systems (Norway, Italy) and evolving systems (Armenia, Ukraine), as well as an applied feasibility study conducted in Serbia. It combines the efficiency and standardization benefits of a central hub, responsible for procurement, quality assurance, training, advanced assessment, data systems, and refurbishment, with the accessibility and user-centred support provided by regional spoke centres. These centres deliver local evaluation, maintenance, follow-up, and everyday user assistance, ensuring that service quality remains consistent regardless of geographic location.

The model is designed to enhance stakeholder coordination, strengthen supply chains, support transparent catalogue-based procurement, generate cost savings through reuse and refurbishment, and reduce territorial disparities. By articulating the operational, financial, and market-shaping mechanisms of the model, the paper positions it as a scalable and transferable framework applicable across diverse contexts.

The modified hybrid hub-spoke model offers a viable pathway toward more equitable, efficient, and sustainable AT provision systems, of direct benefit to AT users, particularly children and adults, and of practical relevance to ministries, resource centres, and international partners responsible for the design of such systems.