In May 2022, the first Global Report on Assistive Technology was released by the WHO and UNICEF. The report was released to fulfil a commitment made four years ago during the 71st World Health Assembly. Among other things, the report brings to light the various facets related to assistive technology like policy, access, among other things.
Assistive technology is an umbrella term used for products and related services such as spectacles, hearing aids, wheelchairs, and prostheses, that make the lives of persons with permanent or temporary functional difficulties easier. Not only does this include people with disabilities, but also persons with communicable and non-communicable diseases, elderly people, persons with mental health conditions, and persons who face a gradual functional decline of their organs and require support to enhance it.
WHO defines assistive technology as ‘the application of organized knowledge and skills related to assistive products, including systems and services.’ An assistive product has been defined by the organization as ‘any external product (including devices, equipment, instruments, or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence, and thereby promote their well-being.’ This includes products used to prevent impairments and secondary health conditions.
2.5 billion people require at least one assistive product which is expected to touch 3.5 billion in 2050
Globally, more than 2.5 billion people need at least one assistive product. This number is expected to increase to 3.5 billion in 2050 due to ageing and the increase in the prevalence of non-communicable diseases. Despite being a matter affecting billions globally, it was only recently in May 2022 that the first Global Report on Assistive Technology was released by the WHO and UNICEF, indicating that this has not been discussed as it should have been. The report was released to fulfil a commitment made four years ago during the 71st World Health Assembly when the member states requested WHO to prepare such a report to study the access to assistive technology. The report has been prepared based on a survey across 70 member countries, including India.
Assistive technology has many benefits
Assistive technology has a wide range of benefits- from individual to community and society-level. It enables people to live an independent and autonomous life while improving their access to education, healthcare, and labour market. While it helps improve their social relationships and mental health, it also comes with socioeconomic benefits such as enhancing inclusive culture, increasing rates of employment and productivity, better educational outcomes, unpaid family support providers taking up more paid work, etc.
Despite multiple conventions and programs, access to assistive products is low
In 1982, the World Programme of Action Concerning Disabled Persons (WPA) was adopted. This was the first UN document which defined disability as a consequence of the relationship between people with disabilities and their environment. The WPA emphasized on approaching disability from a human rights point of view. A central theme of the programme was “Equalization of opportunities”, aimed at full participation of persons with disabilities in all aspects of social and economic life. The Convention on the Rights of the Child (CRC) which was adopted in 1989 also stipulates that children with disabilities should be given special care and assistance, free of charge whenever possible.
Later, in 2006, the United Nations Convention on the Rights of Persons with Disabilities was adopted. This has been ratified by 181 states out of the total 197, including India, as of June 2020. The states are obliged to promote, protect, and ensure the rights of persons with disabilities. The convention also calls for research and development of technologies for aiding persons with disabilities at an affordable cost, and international collaboration to do so.
The 71st World Health Assembly, 2018 adopted the resolution entitled ‘Improving access to assistive technology’, in connection with which the report has been published, and urges all member states to take action to improve access to assistive technology.
‘Seeing’ was the most common functional disability affecting 1 in 5 persons
Despite these conventions & measures, the global need for assistive technology is far from being met. As pointed out by the report, more than 2.5 billion people globally require at least one or more assistive products but about one billion simply have no access to them. About 900 million needed other or more assistive products than spectacles. Among the population aged 60 years and above, two-thirds needed at least one assistive product, while the prevalence of need is lower in younger age groups. The need for multiple assistive products was also more likely among older people.
According to representative self-reported population surveys in 29 countries, about 10% to 69% of people reported that they needed assistive products. The survey also found that the most common functional disability reported was ‘seeing’ with a prevalence of 20.9% among the participants. This was followed by mobility (12.1%), cognition (6.4%), hearing (4.8%), self-care (4.1%) and communication (2.4%). The prevalence of need is more among older people. Similarly, the prevalence of need was more among females as compared to males.
The need for spectacles was the highest among all types of assistive products, the prevalence of which ranged from 9.9% to 68.9%. Additionally, it was observed that the need for spectacles was higher in countries with higher HDI. Devices to support mobility like canes and crutches, wheelchairs, etc., and hearing aids were among the other most needed assistive products. Access to certain assistive products is given in the following chart, the data of which is sourced from the report.
The access to these needed assistive products ranged from 3% in poorer countries to 90% in richer countries. In countries with very high HDI, 16.6% of the population needed assistive products (excluding spectacles). Of them, 79.3% had access to the product. At the same time, in countries with low HDIs, 8.2% of the population reported that they needed assistive products (excluding spectacles) and only 7.6% of them had access to it. Across genders, the access for males was also higher than that for females, which increased in countries with lower HDI.
Affordability and availability are the main barriers to access
Affordability was reported by 43.5% to be the most significant barrier to accessing assistive products. Lack of support and unavailability were other significant barriers as stated in the report. About 65.5% of the respondents spent money out of their own pockets on assistive products. About 65.4% (excluding spectacles) reported having travelled up to 25 km to obtain the device while in some countries, more than 20% of the users reported having travelled more than 100 km.
Of the 70 countries surveyed, 62 had at least one piece of legislation on access to assistive technology. The majority of the countries covered it under health or social services while 20 countries had separate legislation. In almost all countries surveyed, there was a ministry or other authority responsible for assistive technology.
The report recommended that governments invest in research, and innovation, and develop enabling ecosystems. Further, it recommended that public awareness be made to combat stigma. The inclusion of assistive technology in humanitarian responses, investment in data and evidence-based policy, and involvement of users of assistive technology and their families was also recommended.
ADIP Scheme and RVY are being implemented by India to provide assistive products to the poor
India has a Department of Empowerment of Persons with Disabilities (Divyangjan) under the Ministry of Social Justice and Empowerment. Scheme of Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances (ADIP Scheme) is being implemented to provide aids and assistive devices to eligible persons with disabilities.
Similarly, Rashtriya Vayoshri Yojana (RVY) implemented since 2017 is a central sector scheme for providing Physical Aids and Assisted-living Devices for Senior citizens belonging to the BPL category. Artificial Limbs Manufacturing Corporation of India (ALIMCO) is the major implementing agency of both schemes.
According to a parliament response on 08 February 2022, the Ministry stated that aids and assistive devices were provided to 10.85 lakh Divyangjan across the country, worth Rs. 713.12 crores during the last three years and the current year. According to another parliament response on the same day, it was stated by the Ministry that there were a total of 1,98,666 beneficiaries under the RVY scheme.
An action taken report on the recommendations of the parliamentary standing committee in 2021 noted that the procurement policy of ALIMCO is being changed to encourage Indian manufacturers to produce assistive devices indigenously under the ‘Make in India’ program. The committee also recommended that surprise audits of distribution camps across states be conducted to ensure that the quality of products being distributed.
Featured Image: Global Report on Assistive Technology