World Health Organisation battles the AT deficit

08 October 2019

Some one billion people globally need at least one assistive product, according to the World Health Organisation (WHO).

But only one person in ten has access to that product due to high prices, lack of awareness and a shortage of trained staff.

There is a vast unmet need for even the most basic products, says the WHO. For example, 200 million people with poor sight have no glasses, while of the 75 million people who need a wheelchair no more than 12 million have one.

The WHO has set up a programme called Global Cooperation on Assistive Technology (GATE) to find solutions to the problem of low use of AT. GATE will be publishing a report on assistive technology in 2021 and policy makers, academics and AT users met in Geneva recently to work on its content.

Delegates heard 85 presentations during a two-day event called the Global Report on Assistive Technology (GReAT) consultation, held in Geneva. Presentations ranged from accounts of projects to bring AT to rural communities to analysis of worldwide trends in AT.

“Appropriate assistive technology provision reduces the need for formal health and support services, long-term care and the work of caregivers,” said Mariângela Simão, WHO Assistant-Director General for access to medicines and health products. “As well as improving the lives of millions it saves precious health resources.”

However, ensuring AT reached the people who need it is dogged by inefficient distribution and lack of trained staff. In Hungary, doctors prescribe AT and must chose the cheapest products. Prescriptions can only be used in medical supply shops. Users have little freedom of choice and appeals are difficult.

“Many go unhelped because the products that would help them are not available: Hungary supplies less than half the devices on the UN’s list of 50 essential AT products,” said Nora Menich of Semmelweiss University, Budapest.

“Digital technologies are very widely used especially since they can be made cheaply available on an Android phone. The distribution method bi-passes traditional distribution if you want a Google app you go to Google play nothing else is required,” pointed out David Banes of David Banes Access and Inclusion Services.

For Rosemary Joan Gowran of the University of Limerick, training was a key element in accessing appropriate wheelchairs. “If you had a bad heart you wouldn’t let someone do surgery on it if they haven’t been to college,” she said.

Many potential users of AT and their carers find it difficult to accept technology. In India a study of people with learning disabilities revealed that some people had the idea that AT would hold up their development. A project in Canada involving a group of elderly people found that having them design their own calendar and reminder system ensured they bought into AT.

“In Pakistan 23 million people need AT but the demand is not there,” said Chapal Khasnabis, GATE programme manager.

“Who can create the demand? Only user groups, their friends and their carers. The problem for user groups is that they are not aware of AT. The people in power have AT but not their followers. We need to define how we can engage family members and care givers.”

One answer may be a project called ATscale. Launched at the 2018 London Global Disability Summit by the then International Development Secretary Penny Mordaunt, ATscale is a partnership that aims to shape the market for AT products so that many more disabled people have access to AT.

“Our research found that the challenge of access to and use of AT presents a complex web of market and system failures, compounded by a lack of participation from AT users from design to selection,” said Catherine Holloway of University College London.

“This results in a supply/demand mismatch affecting almost a billion people, making AT access one of the most pressing problems facing the global health sector, development agencies, governments, communities and families.”

The partnership aims to reach 500 million people by 2030 drawing on a similar exercise to bring down the cost of pharmaceuticals for developing countries. ATscale will start with wheelchairs shaping the market will involve developing standards, arranging finance and setting up local assembly, among other things.

The need is urgent: Zoe Gray of the International Agency for the Prevention of Blindness said 90% of people who need low vision services have no access to them and were not even able to read the label on a medicine bottle.

“Procurement and financing decisions must be taken to ensure these products are affordable for all people, and appropriate to the setting,” said Gray who has worked in Hong Kong and Africa.

Christine Hemphill of Open Inclusion reported on efforts to develop a model for measuring the economic benefits of AT to persuade policymakers to invest more in the technology.

The so-called purple pound is estimated at $6 trillion globally. “A systematic approach to such a model is essential in seeking to address the need for investment in low and medium income countries,” said Hemphill.

Money is going into AT; Japan’s Nippon Foundation has invested some $40 million in prosthetics and orthotics in Far East countries since 2005. Despite success, the Foundation believes that government funding needs to be supplemented by alternatives such as insurance schemes and schemes where users pay.

The US Agency for International Development is one of the biggest backers of AT. The Agency has pumped $300 million into orthotics, prosthetics and wheelchairs over 30 years. “The gap between need and need fulfilled is growing and reducing it will depend on donors,” said Senior Advisor Michael Allen.

“In 2014 we committed $6m to GATE. We are very proud of the accomplishment of the GATE priority assistive product list.”

Research and development of new technologies was an important theme at the GReAT consultation. Delegates heard from Vicki Austin of University College London about the Global Disability Innovation (GDI) Hub. The Hub is an effort to accelerate the development of AT and has already concluded a project in India.

George Kayange of the South African Federation of the Disabled described an AT information mapping project, which has involved developing an app to enable people to find AT products in ten countries.

The AT-Info-Map, based on Google maps, shows the availability of AT in 17 different categories. It aids AT designers, producers and policymakers in making better decisions.

There was a demand for a clear distinction between medical devices and assistive technology products. “Medical devices are subjected to far more red tape and certification. They are also subject to higher tariffs,” said Clive Ondari, Coordinator of Medicines Access at the WHO. “We need to come out with a strong recommendation.”

With the number of people needing AT set to double to two billion by 2050 - according to the WHO - the need for action is urgent, most speakers agreed.  The 2030 Global Report is expected to contain the answers to many of the questions posed in Geneva.