Intellectual Disability and Assistive Technology: Opening the GATE Wider

The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE). The objective of the GATE program is to improve access to high quality, affordable assistive technology for people with varying disabilities, diseases, and age-related conditions. As a first step, GATE has developed the assistive products list, a list of priority assistive products based on addressing the greatest need at population level. A specific group of people who can benefit from user appropriate assistive technology are people with intellectual disabilities. However, the use of assistive products by people with intellectual disabilities is a neglected area of research and practice, and offers considerable opportunities for the advancement of population health and the realization of basic human rights. It is unknown how many people with intellectual disabilities globally have access to appropriate assistive products and which factors influence their access. We call for a much greater focus on people with intellectual disabilities within the GATE program. We present a framework for understanding the complex interaction between intellectual disability, health and wellbeing, and assistive technology

Assistive technology for older persons – analyses of data from WHO's rapid assistive technology assessment

With a growing population of older persons globally, the need for mainstream assistive technology (AT) as well as assistive technology specifically intended for older persons is on the increase. The association between age and functional limitations strongly indicates a growing demand due the current demographic development. There was however until recently limited data that can describe the situation, monitor development and compare between countries and populations. Quality data is essential for developing regional, national and international responses to current and future need for AT globally. The Global Report on Assistive Technology (GReAT) was launched on 16th May 2022 and highlights both substantial gaps in provision of AT and AT related services globally and in particular in low- and middle-income countries. As part of the process leading up to the GReAT, World Health Organization and partners developed the "rapid Assistive Technology Assessment" (rATA) survey to enable data collection that for the first time can provide estimates of AT use and need in a global perspective. The purpose of this presentation is to present key indicators from rATA among older persons in the countries that participated in the global data collection.publishedVersio

Impact of prosthetics and orthotics services on the quality of life of people with disabilities in India

The aim of this study was to investigate the thoughts and feelings of the person who received a prosthesis or orthosis rather than evaluating the actual device which was prescibed and fitted. It was eveident from the study that people with disabilities find it challenging to access prosthetics and orthotics services. People with disabilities can have a better quality of life with an orthosis or prosthesis which leads to empowerment, inclusion and participation

Opening the GATE to inclusion for people with disabilities

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Participation and Achievement in the Summer Paralympic Games: The Influence of Income, Sex, and Assistive Technology

Global participation at the Paralympic Games has been steadily growing in the past 60 years. However, inequities in relation to geographic representation of Paralympians, sex representation, access to assistive technology, and medal success remain. The objectives of this research are to describe and compare trends in Paralympians’ participation and achievements in the Summer Paralympic Games by income level and sex, including in events requiring assistive products (wheelchairs, hand cycles/trikes, and prostheses). A retrospective secondary analysis of publicly available data was conducted. Participation, sex, and medal tally data were extracted from data available on the International Paralympic Committee website and archives. Data regarding income and population were collected from publicly available data available from the World Bank website. Participation in the Summer Paralympic Games differs significantly by income level (p = 0.000) with high- income countries sending, on average, more Paralympians than low- and middle-income countries. There is a significant difference between male and female participation (p = 0.00), with approximately 29% of all Paralympians being female. High-income countries demonstrate significantly higher achievement than low- and middle-income countries (p = 0.000), including in events requiring assistive products (p = 0.007). Despite growth in overall participation, low- and middle-income countries remain severely underrepresented in both participation and achievement at the Paralympic Games, especially in the events that require high quality assistive products to succeed. More equitable participation and achievement in the Paralympics may be supported by addressing the barriers for females, for people from low- and low-middle income countries, and for those without access to high quality assistive products required

Assistive products and the Sustainable Development Goals (SDGs)

The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale

Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study

In 2018, the World Health Assembly adopted a resolution on improving access to assistive technology (AT), and mandated the WHO to prepare a global report on assistive technology based on the best available evidence and international experience. As limited data on access to AT at country and global levels were available, there was a need to conduct representative population surveys in order to inform the development of the global report, national AT programs, and global initiatives. The objective of this protocol is to describe a multi-country study of access to assistive technology in six self-reported areas: use, source, payer, satisfaction, unmet need, and barriers. In collaboration with WHO Regional and Country offices, Member States, and other stakeholders, the Assistive Technology Access team in WHO coordinates the study. Data are collected through household surveys using the rapid Assistive Technology Assessment (rATA) questionnaire. Findings from the surveys will be published in the global report

Sustainable and equitable provision of wheelchairs in low- and middle-income countries : an economic assessment of the models for wheelchair provision in Tajikistan

Introduction: Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Tajikistan has recently adopted several policies and national strategies to strengthen the rights of people with disabilities and improve the provision of assistive products. However, Tajikistan faces a number of challenges, including ensuring sustainable funding for the provision of wheelchairs in the medium and long term. Methods: This study presents the results of a recent analysis of the economic aspects of the provision of wheelchairs in Tajikistan to inform policy making in other low- and middle-income countries. The study draws on several sources of information, including local cost data, consultations with national and international experts and stakeholders, and reviews of the existing evidence. Results: Countries are advised to adopt an incremental approach to wheelchair provision. In the short term, countries may wish to import wheelchairs to move towards universal coverage. In the medium-to-long term, countries may wish to invest in national capacities for local production. Conclusion: Countries will need to continue implementing strategies to ensure universal access to wheelchairs without the risk of financial hardship for users, regardless of the approach to provision that has been chosen.Implication for Rehabilitation Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Countries are advised to adopt an incremental approach to wheelchair provision. The model of wheelchair importation may be a realistic model over the short- to medium-term for many LMICs countries to ensure effective and equitable provision of wheelchairs. In this article, we identify that sufficient funding needs to be allocated to the provision of wheelchairs regardless of the model of provision

A systematic review of the effectiveness of alternative cadres in community based rehabilitation

Background: The Millennium Development Goals (MDGs) aim to improve population health and the quality and dignity of people’s lives, but their achievement is constrained by the crisis in human resources for health. An important potential contribution towards achieving the MDGs for persons with disabilities will be the newly developed Guidelines for Community Based Rehabilitation (CBR), launched in 2010. Given the global shortage of medical and nursing personnel and highly skilled rehabilitation practitioners, effective implementation of the CBR guidelines will require additional health workers, with improved distribution and a new skill set, allowing them to work across the health, education, livelihoods, social, and development sectors. Methods: We conducted a systematic review to evaluate existing evidence regarding the effectiveness of alternative cadres working in CBR in low and middle income countries. We searched the following databases: PUBMED, LILACS, SCIE, ISMEAR, WHOLIS, AFRICAN MED IND. We also searched the online archive of the Asia Pacific Disability Rehabilitation Journal (available from 2002 to 2010), which was not covered by any of the other databases. There was no limit set on inclusion with regard to how recent a publication was in the general search. Results: The search yielded 235 abstracts, only 6 of which addressed CBR through some type of evaluative component. Three of the studies explored the effects of CBR interventions, mainly related to physical disabilities, while three explored issues concerned with the work performance of rehabilitation workers. Altogether the studies covered four different countries. Conclusion: All six studies related to specific service delivery in local contexts, using outcome measures that were not comparable across studies. We do not, therefore, feel that the current results provide adequate methodology or evidence for reliably generalizing their results. Due to the dearth of evidence regarding the effectiveness of alternative cadres in CBR, systematic research is needed on the training, performance and impacts of rehabilitation workers, including their capability of working across sectors and engaging with and making use of health systems research

National priority assistive product list development in low resource countries : lessons learned from Tajikistan

Introduction: Developing a national assistive products list is an important part of an assistive technology policy and requires knowledge of total population need, and product costs and benefits; information is not always readily available in low-income countries. Our experience in Tajikistan of developing a national assistive products list provides guidance for others. Methods: Two hundred people with disabilities participated in a survey on self-reported need for assistive products, user experiences and barriers to access; 12 focus groups, of over 100 people with disabilities and older adults, conducted discussions on assistive technology. Major providers of assistive technology (government, nongovernmental organizations, local producers) were interviewed. Results: These results were presented at a meeting with government and other stakeholders, which led to a consensus on 30 assistive products for the national assistive products list. Conclusion: We identified the essential stakeholders responsible for developing the assistive products list, and discussed the data needed (total need, cost-effectiveness, unmet need, resources, barriers, system analysis) to make an informed decision on which products to include. This work can be used as a case study for developing an assistive products list quickly on a small budget without compromising on a user-centred approach or active participation of stakeholders.Implications for Rehabilitation Incorporating rehabilitation and assistive technology in universal health coverage. Establishing and strengthening networks and partnerships in rehabilitation and building on existing resources (stakeholders, knowledge, government policy documents) to strengthen rehabilitation and assistive technology particularly in low- and middle-income countries. Developing a national assistive products list is an important part of an assistive technology policy. Creating a national assistive products list requires knowledge of population need, and product costs and benefits; information that is not always readily available in low-income countries. In this article, we identify the essential stakeholders responsible for developing the assistive products list and the data needed for informed decisions. We demonstrate that developing an assistive products list can be carried out quickly and on a small budget