Rajib Dasgupta, Shweta Sharma, Balram Bhargava write:

The UN Convention on the Rights of Persons with Disabilities came into force in May 2008 to bring disability to the fore as the intersection of health, human rights and development priorities. Subsequently, the World Health Organization (WHO) and the World Bank jointly produced the World Report on Disability in 2011 to provide evidence of innovative policies and programs.

In his foreword to this report, Stephen Hawking — who suffered from motor neurone disease — noted that while people with disabilities face attitudinal, physical and financial barriers, he was fortunate to have the help from computer experts who helped him with an assisted communication system and a voice synthesizer that allowed him to compose lectures and documents. The aids Hawking refers to are examples of highly sophisticated assistive technologies (ATs) – they can include any element, piece of equipment, software or product system used to augment, maintain or improve the functional abilities of people with disabilities. These aids can also be “physical” products such as wheelchairs, glasses, hearing aids, prostheses, walkers or incontinence pads; “digital” such as software and applications that support communication and time management; or adaptations to the physical environment, for example, portable ramps or grab bars. Different disabilities require different assistive technologies, and these are designed to help people who have difficulty speaking, typing, writing, remembering, seeing, hearing, learning, or walking.

It is currently estimated that one billion people worldwide need assistive technology (AT); this figure is expected to double by 2050. Building on the World Report on Disability 2011, the 71st World Health Assembly decided on May 26, 2018 to prepare a global report on effective access to assistive technologies in ‘by 2021. There were two fundamental concerns: first, 90% of those who need assistive technology do not have access to it, and second, the inclusion of assistive technology in systems of health was essential to progress towards the targets of the Sustainable Development Goals (SDGs) relating to universal health coverage (UHC). . Despite the challenges posed by the pandemic over the past two and a half years, it is an incredible achievement that the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have jointly launched the first Global Report on Assistive Technology (GReAT) on 16 May.

The GReAT report is based on surveys conducted in 20 countries. These indicate that the proportion of the population currently using at least one assistive product ranges from less than 3% to around 70%. Those who report using or needing at least one assistive product range from about 10% to nearly 70%; the extent to which these needs are met ranges from about 2% to almost 90%. Universal coverage of assistive technologies means that everyone, everywhere gets the AT they need without financial or other hardship.

Barriers to access and coverage, in the context of AT, are best understood when viewed from the following five parameters.

People: This is related to the age, gender, type of functional difficulty, location and socio-economic status of people in need of AT.

Some products: The range, quality, affordability and availability of assistive products continue to pose significant challenges. Quality and standards issues such as safety, performance and durability are major concerns. Repairing, refurbishing and reusing support products can be faster and more cost-effective than buying new.

Arrangement: Information and referral systems remain complex and services are not available in all geographic areas and in all populations. The range, quantity and quality of support products purchased and provided, as well as the effectiveness of the services provided, remain below average.

Personal: Labor gaps are not just about numbers, but also about proper training and education.

Policy: A survey of over 60 countries indicated that they had at least one ministry or government authority responsible for AT access. Nearly 90% of them have at least AT access legislation. Even so, current access levels imply a long road to universal access to AT.

Disadvantaged groups and communities face challenges in seeking affordable and quality healthcare in India, and more so in obtaining AT and related services – the estimated unmet need is about 70%. AT distributed in camps or through social service initiatives is a sporadic activity without the use of statistics as a basis for unmet need. Products are often substandard and lead to poorer health outcomes. The inclusion of assistive technologies in universal health and social protection services is a key imperative. The responsibility of the health system in providing equitable access to AT, as well as to essential medicines and vaccines, is increasingly recognized and national plans are being developed to finance and provide TAs in the context of UHC. Until AT solutions are integrated into existing primary healthcare packages, the current top-down approach has limited benefits. The GReAT report provides this roadmap.

Dasgupta is Chairman of the Center for Social Medicine and Community Health at Jawaharlal Nehru University; Sharma is an independent public health consultant, formerly with the Indian Council of Medical Research; Bhargava is the Chief Executive of the Indian Council of Medical Research and Secretary of the Department of Health Research. Authors contribute to the GReAT report and Bhargava is also Chair of the Editorial Advisory Group


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