Improving access to assistive technology

*Smart devices moving from fitness tracking to monitoring patients with chronic illnesses

Scientists have made advances in assistive technologies/products including hearing aids, wheelchairs, communication aids, spectacles, artificial limbs, pill organisers, memory aids and other essential items that improve quality of life.

Assistive technology enables people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life. Assistive technology reduces the need for formal health and support services, long-term care and the work of caregivers. Without assistive technology, people are often excluded, isolated, and locked into poverty, thereby increasing the impact of disease and disability on a person, their family, and society.

According to the World Health Organisation (WHO), globally, more than one billion people need one or more assistive products. The WHO said that with an ageing global population and a rise in non-communicable diseases (NCDs), more than two billion people will need at least one assistive product by 2030, with many older people needing two or more.

WHO estimates that one billion people globally need at least one assistive product but that only one person in 10 has access due to high prices, lack of awareness and a shortage of trained staff.

For example, 75 million people need a wheelchair today but only five per cent to 15 per cent of them have access to one. 466 million people globally experience hearing loss. Hearing aid production currently meets less than 10 per cent of the global need. And 200 million people with low vision do not have access to glasses.

Who can benefit from assistive technology? People who most need assistive technology 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; and people with gradual functional decline.

Assistive technology can have a positive impact on the health and well-being of a person and their family, as well as broader socioeconomic benefits. For example, Proper use of hearing aids by young children leads to improved language skills, without which a person with hearing loss has severely limited opportunities for education and employment.

Manual wheelchairs increase access to education and employment while reducing healthcare costs due to a reduction in the risk of pressure sores and contractures.

Assistive technology can enable older people to continue to live at home and delay or prevent the need for long-term care.

Therapeutic footwear for diabetes reduces the incidence of foot ulcers, preventing lower limb amputations and the associated burden on health systems.

A systemic review of assistive technologies for ageing populations in six low-income and middle-income countries published in the journal BMJ Innovations concluded: “Assistive Technologies (AT) for ageing populations have received some attention in Low and Medium Income Countries (LMIC). AT that assisted older adults with existing impairment and disability have received more attention than AT that is designed for preventing impairment and disability among older adults who are inevitably at high risk for impairment and disability as a result of ageing.

“More systematic planning and efforts are required to design, produce and ensure the availability of affordable, acceptable, accessible and adaptable AT to support older adults in meeting specific functional and cognitive limitation needs of a rapidly growing ageing population in the midst of advancements in assistive technological innovations globally.

“With rapidly increasing ageing populations in LMIC, as exemplified in the six countries selected for this review, AT for the entire ageing population including older adults with existing disabilities and without existing disabilities, but are at high risk for impairment and disability, are necessary with the support of national enabling legislation.

“Analysis of review findings indicate the need for comprehensive, integrated health and social system approach to increase the current availability of AT for ageing populations in LMIC. These would entail, yet not be limited to, work on promoting initiatives for low-cost AT; awareness-raising and capacity building on AT; bridging the gap between AT policy and practice, and fostering targeted research on AT.”

Meanwhile, there are also advances in the first generation of wearable devices, like smartwatches and activity trackers, were aimed at helping generally healthy people track their physical activity. Now, the medical industry is looking for ways to use smart gadgets to monitor patients with chronic illnesses.

Meanwhile, the WHO, on August 22 and 23, held a global consultation on assistive technology to gauge global demand and supply, bottlenecks to access and ways to improve the availability of quality-assured, affordable assistive products for everyone who needs them.

WHO Assistant-Director General for access to medicines and health products, Mariângela Simão, explained: “Appropriate assistive technology provision reduces the need for formal health and support services, long-term care and the work of caregivers. As well as improving the lives of millions it saves precious health resources.”

WHO used the consultation as a platform to advocate for all countries to prioritise assistive technology and establish the necessary policies and regulations to enable greater access.

At a global level, WHO would be underscoring the importance of innovation, especially for service delivery systems and workforce, to meet the increasing needs, as numbers of people living with a disability, non-communicable diseases and ageing populations continue to rise globally.

Participants in the consultation include representatives from national health ministries and parliaments, professional organizations, academia, user groups and other civil society, and industry. Best practices and country case studies will be showcased as well as academic papers containing the best available evidence to date.

The outcome of discussions would be captured in the first-ever global report on effective access to assistive technology, which will inform WHO’s future agenda on this topic along with a roadmap for country actions.

What are the challenges? The assistive products industry is currently limited and specialized, primarily serving high-income markets. There is a lack of state funding, nationwide service delivery systems, user-centred research and development, procurement systems, quality and safety standards, and context-appropriate product design.

In high-income countries services are often stand-alone and not integrated. People are forced to attend multiple appointments at different locations, which are costly and add to the burden on users as well as caregivers, and on health and welfare budgets.

In many low- and middle-income countries, national service delivery for assistive products does not exist. Those who can afford them buy assistive products direct from a pharmacy, private clinic, or workshop.

People from the poorer sectors of society must rely on erratic donations or charity services, which often focus on delivering large quantities of low-quality or used products. These are often not appropriate for the user or the context, and lack mechanisms for repair and follow up. A similar scenario is also common in emergency response programmes.

Trained health personnel are essential for the proper prescription, fitting, user training, and follow-up of assistive products. Without these key steps, assistive products are often of no benefit or abandoned, and they may even cause physical harm (as is the case of providing wheelchairs without pressure relief cushions for people with spinal injury).

The 2030 Agenda for Sustainable Development places good health and well-being at the centre of a new development vision. It emphasizes universal health coverage (UHC) to ensure sustainable development for all so that everyone everywhere can access the health services needed without facing financial hardship.

Universal Health Coverage can be advanced inclusively only if people are able to access quality assistive products when and where they need them.

Addressing the unmet need of assistive products is crucial to achieve the Sustainable Development Goals, to provide UHC, and to implement the UN Convention on the Rights of Persons with Disabilities, ratified by 177 countries.

‘Leaving no one behind’ means ensuring the people with disabilities, the older population and those affected by chronic diseases are included in society and enabled to live a healthy and dignified life.

WHO is coordinating the Global Cooperation on Assistive Technology (GATE), which exists to improve access to high-quality affordable assistive technology for everyone, everywhere. The GATE initiative is developing four practical tools to support countries to address the challenges described above.

WHO sees the GATE initiative as a concrete step towards realizing the goals of the UN Convention on the Rights of Persons with Disabilities, universal health coverage and the Sustainable Development Goals.

The GATE initiative will reinforce WHO’s the global strategy on people-centred and integrated health services across the lifespan, as well as action plans on non-communicable diseases, ageing and health, disability and mental health.