How can we promote access to assistive technology for individuals with disabilities in Low- and Middle-Income Settings
About 800 million people live with disability in low and middle-income countries (LMICs). Only 10-15% of people with disabilities who require assistive technology have access to them, especially in LMICs settings. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) mandated the provision of assistive technology as a fundamental right of people with disabilities. However, despite the ratification of the UNCRPD by most countries including LMICs, the issue of limited access to assistive technology among people with disabilities in LMICs remains unresolved. The assistive technology delivery process typically involves multiple steps including taking initiative, assessment of needs, selecting the assistive solution, authorization, implementation, management, and follow-up in each setting. Any challenge along the delivery process could be problematic. This brief aims to identify strategies that promote access to assistive technology in LMICs.
- Livelihood & Social Protection
- Increase awareness about assistive technology and service delivery methods, especially among people with disabilities and their families.
- Integrate assistive technology services into the universal health system
- Provide client-centred services and assistive technology.
- Set up robust training and assessment for assistive technology service providers.
- Provide adequate financial support to enhance affordability.
- Remove barriers and provide individual support for assistive technology use.
- Set up effective collaboration among stakeholders of assistive technology.
What works to improve healthcare professionals’ competency on disability?
People with disabilities are at a higher risk of developing poorer health outcomes, due to their primary underlying health conditions or impairments, and unmet health needs due to access and attitudinal barriers to health services and quality care. Evidence suggests that when seeking healthcare or accessing healthcare services, people with disabilities are more likely to find the health care professional’s skills and confidence to be inadequate to meet their health needs. Moreover, healthcare professionals’ unfamiliarity with disability may lead to negative attitudes and stigma towards people with disabilities. Consequently, contributing to delayed diagnosis and treatment, lower quality of care and ultimately poorer health outcomes. As specified in the UN Convention on the Rights of Persons with Disabilities (UNCRPD), people with disabilities have the rights to the same high quality of care as all, therefore, it is imperative to improve healthcare professionals’ competency, confidence, and attitudes in treating patient with disabilities.
- Identify potential barriers and enablers to healthcare professionals’ knowledge updating and skill training
- Ensure continuous knowledge and skill updating on the issue of disability, especially for those working in primary healthcare centres.
- Implement immersive learning for healthcare professionals with people with disabilities, caregivers, and representing organisations.
- Introduction to concepts of disability should be part of the health professional training curricula.
- Future research should focus on the long-term outcome of knowledge and skills intervention.
How can we promote the effective implementation of Legal Capacity as outlined in Article 12 of the UN CRPD in LMICs?
The Convention on the Rights of Persons with Disabilities is valued as one of the most revolutionary human rights legal instruments. The CRPD follows decades of work by the United Nations to change attitudes and approaches towards persons with disabilities, from viewing persons with disabilities as “objects” towards viewing persons with disabilities as “subjects” with rights. The development of the CRPD involved close consultation and active participation of persons with disabilities and their allies, which resulted in an advanced and innovative human rights treaty. Article 12 in the CRPD focussed on legal capacity and challenged the very idea of what it means to be a person: to have rights and to be able to exercise those rights. However, doctrine remains uncertain about the real consequences of the implementation of Article 12 in the CRPD. Most of these discussions have been conducted by Global North scholars on their practices and policies. Policies and practices from the Global South are rarely included in these discussions. However, countries in the Global South have started Reforms (radical legislative changes) on the matter: comprehensive reforms (on several aspects of life) or specific reforms (on certain issues, like mental health). It is necessary to take into account their experiences and discussions in order to implement correctly Article 12 CRPD, having in mind their socio-economic context and the realities of their legal systems.
- Livelihood & Social Protection
- Promote law reforms that recognize and regulate the legal capacity of persons with disabilities, in accordance with the “standards” of the CRPD
- Train public officers in the use of CRPD “standards” or guidelines
- Provide alternative support approaches that engage with social services and community mental health services
- Monitor and report on the experiences of support and implementation promoted by state funded initiatives and civil society funded initiatives, irrespective of their size and scope
- Monitor and report on the implementation of the reforms
- Raise awareness about the importance of legal capacity with different key actors for the Reform
How is the sexual health of men and women with physical disabilities in low- and middle- income countries promoted?
Sexual health is a person’s right to freely express their sexuality as a sexual being, to engage in consensual intimate sexual experiences, to obtain information regarding sexual issues, as well as access adequate sexual healthcare. This right has not been attained for all – particularly for physically disabled people; especially those living in low- and middle- income countries (LMICs). Physically disabled people face barriers to living full and healthy sexual lives because their sexuality is treated as a taboo subject; furthermore, they are often desexualised: perceived to be unattractive, asexual, or lacking sexual ability. This brief explores what sexual health resources and services physically disabled people in LMICs can access; and provides evidence-based recommendations to encourage the full, healthy sexual lives of physically disabled people.
- Negative attitudes towards the sexuality of physically disabled people need to be addressed.
- Educate physically disabled people on sexuality issues and rights.
- Include physically disabled people in development of sexual health services and policies.
- Train health workers to provide relevant and inclusive sexual healthcare and information to physically disabled people
- Sexual healthcare buildings and services to be accessible for all.
What is the evidence for utilising community resources to detect and support children with disabilities?
Children with developmental disabilities have the greatest risk of poor development in the early crucial years. There is a substantial difference between the comprehension of early childhood development and the implementation of intervention services for children with disabilities in High-Income and Low-and-Middle Income countries (LMIC). The grave lack of trained health professionals (particularly in far and remote regions) is limiting service provision for intervention services, and support for families whose children have disabilities. Medical models of service provision at health facilities, patchy community follow-up, limited expertise among community health workers around disability and lack of acceptance of disability, leaves families isolated and unsupported. Consequently, the child’s disability is poorly understood, support to the family is fragmented, leading to exclusion and poor development. This brief aims to understand the evidence for utilising community resources to detect and support children with disabilities.
- Integrate disability into childhood services that is inclusive of different sectors e.g. education
- Expand access to therapy and intervention service resources in communities
- Develop and validate appropriate screening tools for disabilities in LMICs
- Developmental surveillance in children should be routine, regular and early
- Engage families and non-specialist community resources to improve awareness and identify, support and promote acceptance for children with disabilities
Sanitation and Water For All. World leaders' Call to Action on COVID-19 (2020)
Institute of Development Studies. Handwashing Compendium for Low Resource Settings: A Living Document (2020)
UNICEF. Mitigating the impacts of COVID-19 on menstrual health and hygiene (2020)