Natasha Altin, Dalla Lana School of Public Health
The World Health Organization (WHO) estimates that more than one billion people worldwide require assistive products. The number of people requiring assistive products is expected to increase to over two billion by the year 2050 owing to population ageing and an increase in the prevalence of non-communicable diseases. An assistive product is any product (including devices, equipment, instruments, and software), either specially designed and produced or generally available, whose primary purpose is to maintain or improve an individual’s functioning and independence and thereby promote their wellbeing. Common examples of assistive products are glasses, hearing aids, wheelchairs, communication boards, prosthetics and therapeutic footwear. Assistive products can improve the quality of life for people living with impairments by enabling people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life. Assistive products can have a positive impact on the health and well-being of a person and their family, as well as broader socioeconomic benefits.
Only five-15% of the global population who require assistive products have access to them. However, available statistics vary between countries and types of assistive devices; for example, in the case of hearing aids, WHO estimates that only 3% of the need is being met in low-income countries. In many countries, access to assistive products in the public sector is particularly limited, or non-existent, leading to high out-of-pocket payments that manifest as a burden for both users and their families. Those from the poorer sectors of society frequently rely on donations or charitable services, which often focus on provision of large quantities of substandard, or used, products. These are often not appropriate for the user and may cause secondary health complications or premature death. This phenomenon is echoed in emergency response programmes, where the need for assistive products is high but often neglected. Without assistive products, people are often excluded, isolated, and locked into poverty, thereby increasing the impact of disease and disability on a person in addition to their family and community.
The United Nations (UN) recognizes and acknowledges that the limited access to assistive products is a critical problem that needs to be addressed. In 2013, the United Nations General Assembly on Disability and Development requested that WHO develop and lead a global initiative to realize several articles (article 32 in particular) of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) to expand the access to the assistive products worldwide. In response, WHO established the Global Cooperation on Assistive Health Technology (GATE) initiative in 2014. The GATE initiative aims to improve access to high-quality, affordable assistive technology for everyone through bringing together assistive products stakeholders representing UN Agencies, international organizations, donor agencies, professional organizations, academia and consumer groups. Further, the acronym GATE serves as a reminder that access to assistive products can open a metaphorical gate to overcoming activity limitations, facilitating inclusion and participation in a society.
The GATE initiative represents a concrete step towards realizing the goals of the key international strategies including the CRPD and Sustainable Development Goals. To achieve this, the GATE initiative seeks to facilitate a change in assistive products research, innovation and education. The GATE initiative is bringing together a range of different stakeholders to contribute to the development of five strategic priorities to improve access to assistive products globally: people (or users), personnel, policy, provision and products.
GATE released the Priority Assistive Products List (APL), which outlines a minimum list of 50 assistive products that are most widely needed, and that national governments should ensure are available to all citizens. The APL took over a year to develop and involved extensive consultation with experts, including users and caregivers. The development of the APL has involved four interlinked steps: 1) scoping review: gathering evidence on the efficacy of various assistive products in improving an individual’s functioning, independence and well-being; 2) Delphi study: consultation with more than 200 users, providers, and other stakeholders identifying key assistive products (covering a range of functioning) through an iterative process; 3) global survey: launched in 52 languages and made available online for three months; 4) consensus meetings: included 70 participants from every WHO region and included people working in service provision and at a policy level, researchers and representatives from organizations for people with disabilities, the elderly, as well as individual users of assistive products.
GATE is currently focused on addressing the remaining four strategic priorities of the initiative. Specifically, the GATE community is developing tools to support countries in developing national policy and programmes to ensure universal access to assistive products. Global stakeholders are developing an assistive technology assessment toolkit and guidelines for financing mechanisms, such as health and welfare insurance programmes, to ensure sustainability of service provision and universal access. This toolkit will include recommendations for the implementation of the Priority Assistive Products List, such as minimum standards for widely-needed assistive products, appropriate training and service provision. Further, additional priority areas include the development of innovative models of service provision, including gathering best-practice guidelines from real-world examples from across the globe. Fundamental components include the integration of assistive products service provision into the healthcare system, and a network of specialist referral centres connected to the primary health care infrastructure. This would enable most people to access assistive products for all their functional needs from a single point and would support universal access and early intervention. International stakeholders are developing provision training tool for the AT providers including assessment and prescription, fitting and user training, follow-up, maintenance and repairs. The tool will support countries in initiating capacity-building activities among their community-level workforce.
Overall, the GATE initiative is as a concrete step towards realizing the goals of the UN Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals. It reinforces the global strategy on people-centred and integrated health services across the lifespan, as well as action plans on noncommunicable diseases, ageing and disability.