Problem addressed

France has high levels of expenditure on health for people with disabilities. According to the French Ministry of Solidarity and Health, public health expenditure for people with disabilities has increased by EUR 13.5 billion since 2005. Despite this increase, individuals with disabilities in France spend a substantial amount on medical equipment – EUR 1.4 billion in 2013 alone. At the same time, a large amount of viable medical equipment is abandoned every year and goes to waste.

Innovative solution

Run by the Envie network, Envie Autonomie recovers, recycles and reuses old medical equipment in order to lower expenses for disabled people. The innovative aspect lies in the fact that it offers employment opportunities to vulnerable people in the process.

The Envie network is made up of 50 companies from a range of sectors that are committed to social inclusion. The companies collectively employ 2 500 people (on a full-time or part-time/temporary basis) under the Envie Autonomie project for two years. These employees were previously either in a precarious work situation or long-term unemployed. Once hired, employees are trained in restoring medical equipment. They are responsible for finding and collecting medical equipment. If someone needs to dispose of any sort of medical equipment, they call the Envie Autonomie number and one of the Envie network employees will pick it up at no cost to the individual. Alternatively, people can dispose of the medical equipment at a voluntary waste drop-off site. Employees sort through the donated equipment and identify components that can be restored. They then restore and sanitise the materials, which can then be rented or purchased by anyone who needs them at a cost that is between 50% and 70% cheaper than the cost of purchasing new equipment.

Envie Autonomie’s customers include elderly people, people with disabilities who need specific and expensive equipment, people with long-term illnesses who need rapid renewals of their equipment, people at the end of their lives who need equipment for a short time and want to avoid a major cost, and parents of a child or children with disabilities who have limited capacity to purchase the equipment themselves.

Envie Autonomie also ensures that people with disabilities can access the equipment. It provides loans and financial services if needed and has partnered with specialist associations and institutions, such as economic foundations and social enterprises, to offer technical assistance for the delivery and installation of equipment, as well as instructions on how to use it.

The project was piloted in 2015 and formally initiated in 2018. It is implemented in eight locations across France: Angers, Rennes, Nancy, Strasbourg, Saint-Étienne, La Roche-Sur-Yon, Nantes and Montbéliard.

Key results and benefits

Since its pilot in 2015, the project has hired 50 employees full-time and 2 450 on a temporary basis. It has collected 14 000 items, distributed 2 500 items and equipped 2 200 individuals. By training employees to fix medical equipment, the project enables vulnerable people who have had trouble accessing full-time and stable employment to gain marketable and specialised skills. The project helps to move people out of unemployment and into sustainable employment.

The project has created and continues to develop a network of maintenance technicians who can repair medical equipment, thus reducing costs not only for people with disabilities, but also for the French healthcare system. The project also has a positive environmental impact as has created a new sector for the circular economy, increasing the amount of medical equipment that is recycled and reducing demand for newly manufactured devices.

Potential for mainstreaming

Envie Autonomie is financed by the French state, under a contract that is renegotiated each year. This contract covers all social costs of the project, training costs and other relevant personnel costs. This amounts to around 15–20% of total cost. The remainder is financed by proceeds from the sale of medical equipment. This model is financially sustainable and could be replicated in other contexts. Key conditions for a successful transfer to another context would be state funding to cover a percentage of the costs and the creation of a good cooperation network between key partners such as economic and social foundations, representatives of people with disabilities and trainers.

Envie Autonomie aims to expand across France and open a total of 10 new units by 2022, thanks to national funding from the Caisse nationale de solidarité pour l'autonomie (National Solidarity Fund for Autonomy, CNSA). New locations include Toulouse, Reims, Niort, Alenϛon, Lyon, Evreux, Brest, Metz and Belfort.

The project advocates for a policy change to allow reimbursements from social security to be applied to second-hand equipment. This would help it to further scale-up its activities and impact.

In 2019, Envie Autonomie was recognised as a ‘promising practice’ by French Impact, an organisation that raises awareness of projects making successful contributions to the social and solidarity economy.