How can we promote access to assistive technology for individuals with disabilities in low- and middle-income settings?

Challenge #1: Lack of awareness and knowledge about assistive technology

• There is a need to educate people with disabilities and their families about various types of assistive technologies available and what these technologies can offer for people with disabilities. Studies have shown that people with disabilities who own and use assistive technology experience better participation in social activities, greater life satisfaction, and improved overall quality of life.
• Most rehabilitation education programs in LMICs lack rigorous training on assistive technology, which is a major contributing factor to the gap in appropriate assistive technology services in LMICs. Hence, it is pertinent to provide more integrated and standardized education and training for assistive technology service providers.

Challenge #2: Lack of affordability of services

• Assistive technology services are rarely covered by health insurance available in most LMICs. People with disabilities have to pay for such services from their pockets, which in most cases the individuals cannot afford due to high out-of-pocket costs.
• People with disabilities in LMICs are placed at a greater disadvantage, the majority of these individuals are poor, uneducated, and unemployed. Thus, it is difficult for them to afford assistive technology that will aid them in their daily activities.

Challenge #3: Lack of user engagement

• Design and development of assistive technology are generally made in HICs, which are then imported to LMICs settings for delivery. These assistive technologies were not designed to reflect the context of different settings as well as the needs of people with disabilities in LMICs. For example in a survey of people with disabilities in India, 22% of people with quadriplegia felt that the assistive technology does not solve or address their needs. High abandonment rates were reported as a result of incongruence between the design of the assistive technology and the needs of people with disabilities in LMICs.
• The assistive technology service delivery process rarely includes people with disabilities, hence to achieve a positive outcome (for instance, increase in acceptance of assistive technology and empowerment of people with disabilities to engage in matters that affect them directly) people with disabilities need to be involved in the service delivery process.

Challenge #4: Inadequate assessment and support

• Professionals involved in assistive technology service delivery do not provide adequate assessment and support needed by people with disabilities. It is important to train professionals involved in the delivery of assistive technology services about the relevance of pre and post-assessment for assistive technology prescription in order to recognise changes in health conditions and comorbidities among people with disabilities.
• Capacity building for users of assistive technology is necessary to provide the support required by people with disabilities on how to use and maintain their assistive technology devices. Easy-to-read pre-assessment booklets, leaflets, and questionnaires can be considered to overcome the challenges of inadequate assessment and support.

Challenge #5: Presence of attitudinal and environmental barriers

• Stigmatization contributes to the challenges in access and use of assistive technology. A community that discourages users of assistive technology due to negative attitudes presents a serious challenge to the use of assistive technology.
• Moreover, the presence of structural and or physical environmental barriers in the community such as lack of sidewalks, ramps, access doors, or unpaved roads, further confounds the problem and prevents effective use of assistive technology.

Challenge #6: Inadequate policy and research

• Most countries in LMICs lack robust national policy on assistive technology despite ratifying the UNCRPD and its optional protocol. The UNCRPD recommends that assistive technology should be equitably available, accessible, and affordable. The 71st World Health Assembly (WHA.71) provided specific calls for the development of policy on assistive technology.
• Governments should create room for collaboration among stakeholders locally and internationally to promote the local production of assistive technology for long-time sustainability. To promote access to assistive technology, the WHO GATE policy recommended five interlinked areas, people, policy, products, provision, and personnel.
• There is a lack of adequate funding for research needed to generate an indigenous pool of evidence on targeted design of assistive technology.