International cooperation is critical for developing an overarching policy to ensure equitable access to assistive technology, especially in fragile and conflict-affected situations.
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During the 2024 World Economic Forum, a global campaign called ‘Unlock the Everyday’ was launched with various stakeholders to improve awareness and access to assistive technology to address global inequity through cooperation. As a critical component in the population's well-being, Assistive Technology (AT) comprises products like wheelchairs, hearing aids, and prosthetic limbs. These are crucial for improving the independence and functioning of individuals with disabilities, the ageing population or those affected by diseases. The ongoing conflicts and natural disasters have increased the demand for AT while simultaneously disrupting their supply. According to the World Health Organization’s (WHO) data portal on AT, it is estimated that more than 2.5 billion people require assistive products globally, which is expected to grow to 3.5 billion by 2050. Access to AT is considered a human right due to its role in enabling individuals to engage themselves actively in education, work, family and society; however, close to one billion people, especially from low- and middle-income countries, lack access to it. According to the 2022 WHO and UNICEF Global Report on Assistive Technology, the inequality is incredibly considerable in the case of low-income countries (LICs), where only 3 percent of the population had access to assistive products against 90 percent in high-income countries (HICs). While mechanisms like the AT10 Project have been initiated to enhance access to AT, the application of innovative instruments such as sovereign funds and artificial intelligence (AI) could be instrumental in bridging the gap and improving access to AT.
While mechanisms like the AT10 Project have been initiated to enhance access to AT, the application of innovative instruments such as sovereign funds and artificial intelligence (AI) could be instrumental in bridging the gap and improving access to AT.
Assistive technologies are integral to Universal Health Coverage and essential for realising Sustainable Development Goals (especially Goals 3 and 10). The timely provision of AT has a positive socio-economic impact as it improves individuals' independence and safety. However, there is an unmet global need for various reasons, such as high costs, lack of sufficient financing, awareness, and availability. For instance, despite wheelchairs being critical for enhancing mobility, only 35 percent of the 80 million people who need them have access. Another example is hearing aids; while it is estimated that 1.5 billion people face the issue, the production of hearing aids currently meets only around 10 percent of the global demand. This unaddressed hearing loss is found to incur an annual cost of US$ 980 billion globally. Figure 1 depicts the major barriers to accessing assistive products according to the WHO Assistive Technology Data Portal.
Assistive technologies are integral to Universal Health Coverage and essential for realising Sustainable Development Goals
While obtaining access to AT can be difficult in many states, macro-level factors such as political unrest, socioeconomic instability, structural inequalities, and conflicts make it even more difficult in LICs, particularly in Fragile and Conflict-Affected Situations (FCAS). The humanitarian crisis in these areas might need unique and specific assistive products to cater for people who acquire injuries or disability and those who lose or damage their AT during the conflict in addition to the people who needed AT even before the crisis but have not been provided. Thus, the situation places more pressure on the existing provision mechanisms. Among the people living with disabilities, around 16 percent of them are attributed to armed conflicts. The duration, frequency, and severity of the conflicts directly impact the living conditions, making it challenging to meet essential needs, especially for those with disabilities. The challenges to the provision and access of AT in FCAS can be divided into pre-existing challenges and challenges caused by the conflict.
Figure 1: Global Average of Barriers to Accessing Assistive Products
Source: Assistive technology population access indicators
The existing health infrastructure in many FCAS might lack facilities and have limited personnel trained to deliver the required services. Additionally, crucial rehabilitation services in conflict settings have remained a low priority for governments, highlighted by the absence of senior officials/leaders who oversee these services. Another pre-existing challenge is the limited production of AT, which widens the gap of unmet demands. The crisis/conflict, on the other hand, could deepen the barriers to access by placing pressure on the already weaker systems. The conflicts cause infrastructural damage to the health systems which support and provide AT services. Furthermore, concerns like travelling to healthcare facilities and forced migration of healthcare professionals limit the provision and service of AT. The conflict also leads to economic downturns, restricting the ability of public finance to provide critical AT services. The issue of the displaced population also challenges the accessibility to AT, especially those living in refugee camps, due to associated administrative barriers.
The existing health infrastructure in many FCAS might lack facilities and have limited personnel trained to deliver the required services.
Realising the need to overcome the disparity in access to AT, the international community has formulated global measures such as the IASC Guidelines on the inclusion of persons with disability in humanitarian action (2019), the United Nations Convention on the Rights of Persons with Disabilities (CRPD), WHO Resolution Improving Access to AT (2018) to improve access to AT. Through its resolution, it also calls for developing a Global report on Assistive Technology, which, while communicating the progress made towards improving access, also presents a comprehensive dataset based on the best available evidence and global experiences. Despite such measures, the inequality in access to AT, especially among the FCAS, persists, which calls for enhancing international cooperation. Taking the imperative from the Global Cooperation on Assistive Technology (GATE) 5P framework (People, Policy, Products, service Provision and Personnel), which aims to build a people-centric AT ecosystem, diverse stakeholders must be needed to strengthen access to assistive technology in all contexts. For instance, WHO and the GATE Community work across regions including Kenya, Tanzania, Syria, and Egypt to integrate AT throughout healthcare systems, building capacity and developing mobility services. Such examples of cooperation among government ministries, professional and civilian groups, NGOs, and the private sector could help include AT within the scope of UHC, which can help strengthen their provision through primary healthcare. It further helps create an integrated approach with sectors such as education, labour, services, and health to ensure the domestic provision of AT.
International cooperation becomes imperative in increasing the range of geographical coverage of AT technology sufficiently and efficiently. Initial steps can start with promoting a provision and coordination framework for AT in the FCAS. The current WHO data portal has data from around 70 member states, which needs to be expanded to the FCAS as a priority to gather information on the need and unmet demand for AT in these settings. This data availability will boost the identification of barriers hampering the provision of AT and help develop effective enablers. Further, emergency preparedness and humanitarian responses need to incorporate the AT component. Realising these strategies demands a multistakeholder approach, which can be extended by international cooperation. While these are some of the immediate measures, in the long run, there is a need to develop the capacities of the FCAS with better mechanisms for procuring, supplying, and distributing AT effectively. This can be enabled by promoting research and donor-recipient engagement as it provides an opportunity for evaluation, leading to the development of tailored responses to cater to the demand of the FCAS. Thus, international cooperation is critical for developing an overarching policy to ensure equitable access to assistive technology.
Kiran Bhatt is a Research Fellow at the Centre for Health Diplomacy Department of Global Health Prasanna School of Public Health Manipal Academy of Higher Education.
Sanjay M Pattanshetty is Head of the Department of Global Health Governance at Prasanna School of Public Health Manipal Academy of Higher Education (MAHE) Manipal Karnataka India.
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Kiran Bhatt is a Research Fellow at the Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of ...
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Dr. Sanjay M Pattanshetty is Head of theDepartment of Global Health Governance Prasanna School of Public Health Manipal Academy of Higher Education (MAHE) Manipal Karnataka ...
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