assistive technology

People who most need assistive technology include:

• people with disabilities
• older people
• people with non-communicable diseases such as diabetes and stroke
• people with mental health conditions including dementia and autism
• people with gradual functional decline.

Health, well-being and socioeconomic benefits

Assistive technology can have a positive impact on the health and well-being of a person and their family, as well as broader socioeconomic benefits. For example:

• Proper use of hearing aids by young children leads to improved language skills, without which a person with hearing loss has very limited opportunities for education and employment (1).
• Manual wheelchairs increase access to education and employment while reducing healthcare costs due to a reduction in the risk of pressure sores and contractures.
• Assistive technology can enable older people to continue to live at home and delay or prevent the need for long-term care (2).
• Therapeutic footwear for diabetes reduces the incidence of foot ulcers, prevents lower limb amputations and the associated burden on health systems (3).

Challenges

policy

Very few countries have a national assistive technology policy or programme.

In many countries, access to assistive technology in the public sector is poor or non-existent. Even in high-income countries, assistive products are often rationalized or not included in health and welfare schemes, leading to high out-of-pocket payments by users and their families.

For example, it is common policy in a number of European countries for the state to provide older people with only 1 hearing aid, despite the fact that most people with age related hearing loss require 2 hearing aids to function.

Products

The assistive products industry is currently limited and specialized, primarily serving high-income markets. There is a lack of state funding, nationwide service delivery systems, user-centred research and development, procurement systems, quality and safety standards, and context-appropriate product design.

Provisions

In high-income countries, services are often stand-alone and not integrated. People are forced to attend multiple appointments at different locations, which are costly and add to the burden on users as well as caregivers, and on health and welfare budgets.

In many low- and middle-income countries, national service delivery for assistive products does not exist. Those who can afford them buy assistive products directly from a pharmacy, private clinic, or workshop.

People from the poorer sectors of society must rely on erratic donations or charity services, which often focus on delivering large quantities of low-quality or used products. These are often not appropriate for the user or the context, and lack mechanisms for repair and follow up. A similar scenario is also common in emergency response programmes.

Personnel

Trained health personnel are essential for the proper prescription, fitting, user training, and follow-up of assistive products. Without these key steps, assistive products are often of no benefit or abandoned, and they may even cause physical harm (as is the case of providing wheelchairs without pressure relief cushions for people with spinal injuries).

Assistive technology within universal health coverage

The 2030 Agenda for Sustainable Development places good health and well-being at the center of a new development vision. It emphasizes universal health coverage (UHC) to ensure a sustainable development for all, so that everyone everywhere can access the health services needed without facing financial hardships.

Universal Health Coverage can be advanced inclusively only if people are able to access quality assistive products when and where they need them.

Addressing the unmet need of assistive products is crucial to achieving the Sustainable Development Goals, to provide UHC, and to implement the UN Convention on the Rights of Persons with Disabilities, ratified by 177 countries.

‘Leaving no one behind’ means ensuring the people with disabilities, the older population and those affected by chronic diseases are included in society and enabled to live a healthy and dignified life.

WHO response

WHO is coordinating the Global Cooperation on Assistive Technology (GATE), which exists to improve access to high-quality affordable assistive technology for everyone, everywhere. The GATE initiative is developing 4 practical tools to support countries to address the challenges described above.

WHO sees the GATE initiative as a concrete step towards realizing the goals of the UN Convention on the Rights of Persons with Disabilities, universal health coverage and the Sustainable Development Goals.

The GATE initiative will reinforce WHO’s global strategy on people-centred and integrated health services across the lifespan, as well as action plans on non-communicable diseases, aging and health, disability and mental health.

(1) Global burden of childhood hearing impairment and disease control priorities for developing countries.
Olusanya BO, Newton VE. Lancet. 2007 Apr 14;369(9569):1314-7.

(2) Can adapting the homes of older people and providing assistive technology pays its way?
Lansley P, McCreadie C, Tinker A. Age Aging. 2004 Nov;33(6):571-6. Epub 2004 Sep 3.3

(3) Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.
Bus SA, van Deursen RW, Armstrong DG, Lewis J, Caravaggi CF, Cavanagh PR. International Working Group on the Diabetic Foot.