Access to Assistive Technology
Introduction[edit | edit source]
Assistive technology (AT) is a broad term that encompasses devices that help individuals with disabilities to improve their function and live more independently. Common categories of AT include: vision, hearing, communication, mobility, self-care and cognition. Over one billion people globally need one or more AT.  This number is projected to increase beyond 2 billion by 2050 as a consequence of increased rates of non-communicable diseases and ageing populations. The impact of disability and disease increases without the use of assistive technology as these individuals often feel isolated, excluded from society.
Individuals who would benefit from AT include:
- People with disabilities
- Older people 
- People with non-communicable diseases such as diabetes and stroke 
- People with mental health conditions including dementia and autism
- People with gradual functional decline
Low-income Countries[edit | edit source]
Disability and poverty are linked in a cycle whereby disability can lead to poverty and vice versa. Low-income countries (LIC) have the highest population of disabled people and they are most likely to not have access to assistive technology. Many people in these countries are not aware of AT and how using it could help improve their condition. Once people are made aware of AT, they may need to wait for many years for it to become accessible to them. In addition, people living in LIC generally do not have health coverage and need to rely on out-of-pocket expenses supported by their families or NGOs for any AT. The World Health Organization estimates that 90% of people who would benefit from assistive technology do not have access. See below for statistics that back up this information:
- 5-15% of the 70 million people who need a wheelchair have access
- 10% of the global hearing aid population has access - in low-income countries only 3% have access
- 200 million people with low vision do not have access to glasses or other vision devices
- 5% of the 40 million amputees who need prosthetics have access
Orthotics and Prosthetics:[edit | edit source]
The global demand for orthotics and prosthetic services is expected to double by 2050.As the world sees a significant rise in diabetes, musculoskeletal conditions and stroke the need for prosthetics and orthotics will greatly increase. Accessibility is difficult in these countries due to the high cost of prosthesis and low availability of materials.In addition, many countries do not have orthotic or prosthetic services and if they do they are located only in the capital or large cities.
The video below by the World Health Organization demonstrates how assistive technology can change lives:
Access to Technology[edit | edit source]
The following are key findings from the Institute of Developmental Studies regarding assistive technology and lower income countries:
- Access and needs:
- General lack of awareness, governance and personnel with subsequent high costs and limited availability
- Inequality in accessing AT is seen in people of different cultures, impairments, genders, age and economics
- The majority of available AT is in high-income settings
- There is a short supply in low-resource countries
- Small producers and providers of AT in low-income countries cannot meet high demand
- Cost can be prohibitive
- Maintenance and other indirect costs cause further costs to user
- Design needs to be appropriate for the user and the environment / context in which they will be using it
- There is a cycle where lack of awareness about AT that could be beneficial leads to low demand and low motivation for supply
Solutions[edit | edit source]
In order to combat the issues related with inaccessibility of AT in LIC, the World Health Organization (WHO) has developed an action plan called the Global Cooperation on Assistive Technology (GATE). This mission by WHO is to help member states improve access to assistive devices that are culturally appropriate and tailored to users' needs. According to Tangcharoensathien et al., the GATE framework has four solutions targeted to improve access to AT:
- Adequate funding support by a national policy framework
- Research and development incentive strategies to encourage affordable AT
- Capacity-building through training of caregivers and undergraduates and health care workers
- Integrating the health system to enhance provision services
One of the first steps of the GATE programme was to develop a priority assistive product list (APL) which includes 50 priority assistive products based on impact on a person's life and widespread need. These 50 products should be available to citizens of any nation through universal health coverage. This list includes high-tech and low-tech products encompassing issues relating to hearing, vision, personal care, communication, cognition and mobility. Each country is encouraged by WHO to develop their own needs list, which includes items that are affordable and cost-effective and meet minimum quality and safety standards.
The video below by WHO describes the need for accessibility to assistive products and the APL:
Additional Solutions[edit | edit source]
In order to make APL successful, it needs the support of legislation, resources and personnel. WHO developed five additional tools for Member States to coincide with APL in order for it to have the best possible outcome. These three tools are listed below:
- Policy: Assistive technology policy framework
- Financing mechanisms to facilitate universal access
- Guidance of APL training, service and standards
- Monitoring and evaluation of programmes
- Personnel: Assistive products training package
- Training of existing health and rehabilitation personnel
- Training of caregivers
- Capacity building with Member States for specialist training
- Training will include four steps: assessment, fitting, training and follow-up
- Provision: Assistive products service delivery model
- Infrastructure related to primary health care referral centres needed to access AT
- Raising awareness about assistive technology
- Making it culturally appropriate
- Involving users and families
- Products: developing priority assistive device list
- Repairing and refurbishing products
- Research and development
Resources[edit | edit source]
References[edit | edit source]
- Oldfrey B, Barbareschi G, Morjaria P, Giltsoff T, Massie J, Miodownik M, Holloway C. Could Assistive Technology Provision Models Help Pave the Way for More Environmentally Sustainable Models of Product Design, Manufacture and Service in a Post-COVID World? Sustainability. 2021; 13(19):10867.
- Rohwerder B. Assistive technologies in developing countries. 2018
- Assistive technology factsheet. Geneva: World Health Organization; 2018 (https://www.who.int/en/news-room/fact-sheets/detail/assistive-technology, accessed 24 may 2021).
- Smith EM, Huff S, Wescott H, Daniel R, Ebuenyi ID, O'Donnell J, Maalim M, Zhang W, Khasnabis C, MacLachlan M. Assistive technologies are central to the realization of the Convention on the Rights of Persons with Disabilities. Disabil Rehabil Assist Technol. 2022 Jul 28:1-6.
- Willems EMG, Vermeulen J, van Haastregt JCM, Zijlstra GAR. Technologies to improve the participation of stroke patients in their home environment. Disabil Rehabil. 2022 Nov;44(23):7116-7126.
- Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low-and middle-income countries. International journal of environmental research and public health. 2018 Oct;15(10):2165.
- Karki J, Rushton S, Bhattarai S, De Witte L. Access to assistive technology for persons with disabilities: a critical review from Nepal, India and Bangladesh. Disability and Rehabilitation: Assistive Technology. 2021 May 14:1-9.
- Cote A. Social protection and access to assistive technology in low-and middle-income countries. Assistive Technology. 2021 Dec 1;33(sup1):S102-8.
- Clarke L, Puli L, Ridgewell E, Dillon MP, Anderson S. Regulation of the global orthotist/prosthetist workforce, and what we might learn from allied health professions with international-level regulatory support: a narrative review. Human Resources for Health. 2021 Dec;19(1):1-4.
- World Health Organization: Standards for Prosthetics and Orthotics. 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/259209/9789241512480-part1-eng.pdf?sequence=1&isAllowed=y
- Abbady HE, Klinkenberg E, de Moel L, Nicolai N, van der Stelt M, Verhulst AC, Maal TJ, Brouwers L. 3D-printed prostheses in developing countries: A systematic review. Prosthetics and Orthotics International. 2022 Feb 1;46(1):19-30.
- Boot FH, Owuor J, Dinsmore J, MacLachlan M. Access to assistive technology for people with intellectual disabilities: A systematic review to identify barriers and facilitators. Journal of Intellectual Disability Research. 2018 Oct;62(10):900-21.
- Tangcharoensathien V, Witthayapipopsakul W, Viriyathorn S, Patcharanarumol W. Improving access to assistive technologies: challenges and solutions in low-and middle-income countries. WHO South-East Asia journal of public health. 2018 Jul 1;7(2):84.
- Smith EM, Ebuenyi ID, Kafumba J, Jamali-Phiri M, MacLachlan M, Munthali A. An overview of assistive technology products and services provided in Malawi. Disability and Rehabilitation: Assistive Technology. 2020 Nov 24:1-5.
- World Health Organization. Priority Assistive Products List: Improving access to assistive technology for everyone, everywhere. World Health Organization; 2016.