Assistive Technology within Universal Health Coverage

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha and Naomi O'Reilly

Introduction[edit | edit source]

Before going into the topic "Assistive technology within Universal Health Coverage", it is very essential to understand the basic about Assistive technology and Universal Health Coverage.

Universal health coverage (UHC)[edit | edit source]

UHC is defined as all people having access to the quality health services they need, when and where they need them, without financial hardship in paying for the services. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.[1]

The member states of the World Health Organization (WHO) have endorsed UHC as a goal and stated that health systems must “be further developed in order to guarantee access to necessary services while providing protection against financial risk.” UHC was firmly endorsed by the World Health Assembly in 2005 and further supported in the World Health Report 2010. Since then, more than seventy countries have requested policy support and technical advice for UHC reform from the WHO.[2] UHC is also an essential target within 3rd goal of Sustainable Development Goals (SDGs).[3]Target 8 of SDGs specifically describes UHC and its key components:

"Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all."

To achieve UHC, countries must advance in at least three dimensions. Countries must expand priority services, include more people (ensure that vulnerable groups are not left behind), and reduce out-of-pocket payments.

  1. Expanding priority services: Services can be usefully categorized into three classes: high-priority, medium-priority, and low-priority services. Services to expand can be ranked based on cost-effectiveness, priority to the worse off, and financial risk protection. Attention must certainly go beyond treatment and curative services to also include prevention, promotion, rehabilitation, and palliative care.
  2. Include more people: Countries should primarily first expand coverage for low-income groups, rural populations, and other groups disadvantaged in terms of service coverage, health, or both. Health for all, no one left behind.
  3. Reduce out-of-pocket payment: Over 930 million people spend at least 10% of their household income on health care. Out-of-pocket payments lead a barrier to access to health services, especially for the poor. Along with that, for those who do use the services, out-of-pocket payments are often a substantial financial burden on them and their families and may even cause financial catastrophe. So to improve access and financial risk protection, countries should therefore shift from out-of-pocket payment toward mandatory prepayment with pooling of funds.[2][4]

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People with disability and UHC[edit | edit source]

People with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. There are globally 1 billion people with disabilities (PWDs) which is approximately 15% of the total population. In future days, PWDs is likely to be increasing due to the increase in non-communicable disease such as diabetes, hypertension, stroke and also due to increase in life expectancy leading older age related problems like dementia, increase in risk of fall, etc.[6]Importantly as evidence shows that 80% of people with disabilities live in low income countries, are poor, and have limited access to healthcare.[3]

Disability and poverty has a vicious cycle. PWDs often have higher healthcare needs overall and will require good general healthcare in all aspect of health like preventive, promotive, rehabilitative and specialized treatment based upon their impairment. Potential barriers for proper health care for PWDs include discrimination, physical inaccessibility, information inaccessibility, and poor economic status. PWDs incur greater costs when seeking healthcare causing financial burden in family as long term or life long treatments are required and cost for treatment is high. Poor health may reduce quality of life and participation (e.g. in education, employment or community activities). Poor quality of life and participation can exacerbate disability, poverty and exclusion in addition to increasing suffering, morbidity and early mortality. [6][3]

As a result of these different challenges, people with disabilities face specific and added difficulties across three dimensions of UHC: coverage (include more people), access to services needed (expand priority services), and at reasonable cost (reduce out-of-pocket payment). Therefore a focus on PWDs is essential to achieving UHC, as they are a large group, often not covered fully by health services, and vulnerable to incurring financial hardship.

A recent large study from Afghanistan showed that investments towards UHC led to very limited or no improvement in services for people with disabilities. So specific attention on people with disabilities should be given otherwise the opportunity provided by UHC will be in vain. Therefore, a twin-tracked approach is recommended to address the needs of PWDs. This approach means that there is a focus on including PWDs in mainstream services, as well as targeting them with specific services needed. Including PWDs in mainstream health services requires a focus on improving access to health care (e.g. providing accessible facilities, outreach services or assistance in transport). Specific services required by people with disabilities include rehabilitation and assistive devices.

Efforts are being made to scale up access to rehabilitation and assistive devices, such as through WHO’s REHAB 2030 program, or WHO’s Global Cooperation on Assistive Technology initiative, which is working to improve access to high-quality affordable assistive products globally.[6]

Assistive technology[edit | edit source]

What is assistive technology?[edit | edit source]

Assistive technology is any device, system or support used by individuals to maintain or improve an individual’s functioning and independence, thereby promoting their well-being. They enable people to live healthy, productive, independent and dignified lives, and to participate in education, the labor market and civic life. Some examples of assistive technologies are spectacles, hearing aid, cane, braille, wheelchair, etc.[7]

Why it is important?[edit | edit source]

Today, more than 1 billion people around the world need assistive technology: that means approximately 1 in 6 people. With populations aging and chronic diseases rising across the world, this number is likely to rise above 2 billion by 2030, with many people needing two or more products as they age. Assistive products are not accessible to the majority of people who need them. In fact, only 1 in 10 people worldwide have access to assistive devices.[8]

Assistive devices helps individual with their impairment and increase independency and participation which eventually increase quality of life of PWDs, their family and community. These services usually do not focus primarily on ‘cure’ per se, but on preventing secondary impairments and optimising function so that the person can live as active a life as possible with their impairment.[3]For example, person with spinal cord injury at T12 level may need wheelchair for ambulation which enhance in his participation and they are vulnerable for having pressure sore so a proper cushion and pressure relieving techniques play a vital role in preventing secondary complications.[6]

Assistive technology within UHC[edit | edit source]

Service coverage within the UHC address to ensure that services are not only open to all, but are actually designed to be inclusive and take into consideration the varying impairment-related and other health needs people have, tackling the range of barriers which currently prevent access. Crucially, for people with disabilities, rehabilitation and assistive devices must be explicitly included within essential healthcare services and consideration of achievement of UHC.[3]

The importance of assistive technology (AT) as a pillar of universal health coverage was recognized at the 71st World Health Assembly (WHA). This qualitative study published in 2020 regarding assistive technology in UHC also conclude with importance of access to assistive technology as a public health priority and is an essential health product to be covered under UHC.[9]

So to achieve the aim of UHC in context of assistive technology, many global initiatives has been carried out. One of them is GATE (Global Cooperation on Assistive Technology) global initiative in 2011.The GATE initiative aims to improve access to high quality and affordable assistive devices to those who are in need to enable individuals in need of such devices to lead a healthy, dignified and productive life (WHO, 2017).[3]

References [edit | edit source]

  1. Universal health coverage. World health organization. [Internet]. Available from: https://www.who.int/health-topics/universal-health-coverage#tab=tab_1 [Lasted accessed: 6th June 2021]
  2. 2.0 2.1 World Health Organization. Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage.2014.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Hashemi G, Kuper H, Wickenden M. SDGs, Inclusive Health and the path to Universal Health Coverage. Disability and The Global South. Disability and the Global South. 2017 Apr 1;4(1):1088-111.
  4. World Health Organization. Primary health care on the road to universal health coverage: 2019 monitoring report: Executive summary. World Health Organization; 2019.
  5. WHO: Universal Health Coverage - What does it mean? Available from: https://www.youtube.com/watch?v=pZHiIGFLN8Y [lasted assessed: 8th June, 2021]
  6. 6.0 6.1 6.2 6.3 Kuper H, Hanefeld J. Debate: can we achieve universal health coverage without a focus on disability?. BMC health services research. 2018 Dec;18(1):1-4.
  7. Assistive technology. World Health Organization.[Internet]. Available from: https://www.who.int/health-topics/assistive-technology#tab=tab_1 [lasted accessed: 6th June, 2021]
  8. Available from: https://www.who.int/phi/implementation/assistive_technology/gate-fact_sheet.pdf?ua=1
  9. Layton N, Bell D, Borg J, Steel E, Maclachlan M, Tebbutt E, Khasnabis C, Swaminathan S. Assistive technology as a pillar of universal health coverage: qualitative analysis of stakeholder responses to the world health assembly resolution on assistive technology. Disability and Rehabilitation: Assistive Technology. 2020 Oct 2;15(7):825-31.