Why the Global Report on Assistive Technology (GReAT) Report matters for India?

Rajib Dasgupta, Shweta Sharma

The World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) is jointly launching the first Global Report on Assistive Technology (GReAT) on 16 May 2022. This report is the culmination of the 71 st World Health Assembly resolution in 2018 to prepare a global report on effective access to assistive technology. Despite the challenges posed by the ongoing pandemic, the editors and the contributors ensured that it was launched on schedule. The report assumes significance as 90% of those who need assistive technology do not have access to it globally, and including assistive technology into health systems is critical for progress towards the targets in the Sustainable Development Goals (SDG) relating to Universal Health Coverage (UHC). WHO, UNICEF, assistive technology, SDG, universal health coverdage, GReAT report

What is Assistive Technology?

Assistive technology (AT) is any item, piece of equipment, software program or product system that is used to increase, maintain or improve the functional capabilities of persons with disabilities. These include a very wide range of technologies and devices such as prosthetics, braces, walkers, special switches, special-purpose computers, screen readers and specialised curricular software. Universal assistive technology coverage implies that everyone, everywhere receives the AT that they need without financial or other hardships. The WHO launched the Priority Assistive Products List in 2018. These include hearing aids, wheelchairs, communication aids, spectacles, artificial limbs, pill organisers, memory aids and other essential items for the elderly and person with disabilities. Developing a national assistive products list is an important first step of an AT policy and requires knowledge of total population needs, product costs and benefits.

Magnitude of the problem in India

Subsequent to the notification of the Rights of Persons with Disabilities (RPWD) Act in 2016, the National Statistical Office (NSO) conducted the Survey of Persons with Disabilities in the National Sample Survey (NSS) 76th round (July- December 2018) and reported that the prevalence of disability was 2.2 per cent nationally. Among persons with disabilities of age 15 years and above, the Labour Force Participation Rate in usual status was 23.8 per cent. 21.8 per cent of those with disabilities reported receiving any aid/help from the government and another 1.8 per cent from organisations other than government. The rapid Assistive Technology Assessment (rATA) is a tool developed by the WHO for national representative survey to measure unmet need for assistive technology; this shall provide granular evidence of the demand-side as and when it is available for India.

The RPWD Act is committed to developing technology, assistive devices and equipment to facilitate access and inclusion for persons with disabilities in recreational activities in educational, sports and recreational activates. Disadvantaged groups and communities face hardships in their search for affordable quality healthcare in India and that for obtaining AT and associated services is no different; the estimated unmet need is about 70%. ATs handed out in camps or as a part of social service initiatives is a sporadic activity without coverage statistics as a basis for unmet needs. Products are often sub-standard and lead to poorer health outcomes.

The need for a health-industry interface

Upholding the UHC approach is necessary to ensure universal assistive technology coverage that will entail every citizen access to assistive technology they need without financial hardship. The tasks include: (i) production and provision of the entire spectrum of AT; (ii) integrating rehabilitative services as an essential strategy in long-term care; (iii) including rehabilitation at the primary health-care level; and, (iv) promoting community-based rehabilitation.

Manufacturing and provision of components of the AT system is necessary to meet the needs of a diversity of users and provide a broader range of products that match their needs. Collaboration across academia, industry and the government will help in analysing manufacturing capacity, ascertaining immediate need of specific AT and products and create a regulatory framework to provide users with products that are safe, secure and effective as per approved norms. The key to success is in increasing local innovation, design, manufacturing and repair capacities to make available locally produced affordable and contextually appropriate assistive products. Pooled procurement mechanisms to source safe and effective materials, parts and assistive products at optimal prices and stabilising the supply are critical ingredients. Developing and investing in innovative and emerging manufacturing and delivery strategies like mass production of components supplemented by additive or local parts or customisation are possible options.

Ongoing initiatives such as Make in India, Digital India along with the health insurance schemes such as Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) can cater to the AT demands of the most vulnerable 40% of the population to address their rehabilitation needs. The concept and interpretation of medical necessity in insurance regulations across the world is often fuzzy if not controversial; this holds true for statutory and regulatory limits on coverage for AT as well. The PM-JAY can be a leading light in recognising rehabilitation as a fundamental health service throug all stages of the life-course.

Key takeaways from the GReAT Report

*The obligation for WHO Member States to provide assistive technology can be traced to the Universal Declaration of Human Rights, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), and Universal health Coverage (UHC) in the 2030 Agenda for Sustainable Development.

*Measures to address barriers to universal AT coverage entails an enabling assistive technology ecosystem covering 10 Ps: People (users of AT), Policy, Products, Personnel, Provision (as strategic drivers at systems level); and Procurement, Place, Pace, Promotion and Partnership (as key situational factors for systems).

*Adopt a national essential or priority assistive products list, based on population need and available resources.

*Emerging technologies have begun to impact the field of AT: artificial intelligence, robotics and additive manufacturing. Connectivity between assistive products and the surrounding digital infrastructure is important for independence and user participation.

*Financing mechanisms are critical: loans, instalments or rebate system, including refurbishment and reuse of assistive products; reduction and, if possible, elimination of tariffs and taxes on internationally and locally produced and/or procured assistive products.

*Establish coordination systems to facilitate information, referral, procurement and delivery of assistive products in humanitarian crises, particularly for children.

Rajib Dasgupta is Chairperson at the Centre of Social Medicine & Community Health, Jawaharlal Nehru University.

Shweta Sharma is an independent public health consultant, and formerly with WHO India Country Office.

Both the authors are contributors of the GReAT report.

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