AT2030: Assistive Technology Scoping Exercise

Funded by UK Aid this focused on mapping and analysis of the innovation landscape around Assistive Technology globally with a focus on low and middle-income countries to highlight potential market failures and to scope out possible solutions.

Partners:

• World Health Organisation (WHO)
• Clinton Health Access Initiative (CHAI)
• Leonard Cheshire and Motivation

Executive Summary

Over one billion people – largely disabled people and older people – are currently in need of Assistive Technology (AT). By 2050, this number is predicted to double.

Assistive Technology can make the impossible possible for people living with a wide range of impairments, but a lack of access to basic Assistive Technology – such as eyeglasses, hearing aids, wheelchairs or, increasingly, mobile applications – excludes individuals and reduces their ability to live full, enjoyable, and independent lives. Despite the proven advantages of Assistive Technology for disabled and older people, their families, and society, there is still a vast and stubborn gap between the need and the supply; currently only 10% of those who need Assistive Technology currently have access to it.

Used appropriately and delivered with the right services and education in the context of an accessible environment, Assistive Technology is empowering, cost effective, and vital to meet the growing needs of 21st century populations.

The report

This Scoping Research Report on Assistive Technology seeks to unpick and understand the multi-layered and multifaceted ways in which economic, social, and political factors interplay and interact to create barriers to Assistive Technology for those who need it the most.

Through primary and secondary research, we explore the current landscape, the limitations, and current initiatives, ultimately answering the question: “How best should a target intervention around the Assistive Technology sphere affect positive change for poor, disabled and older people in Global South priority countries?”.

To understand this question, the research team asked two specific questions:

1. What are the barriers which prevent access to Assistive Technology for the people that need it, with a focus on those living in low resource settings within the UK government priority Global South countries?
2. How should the UK government, in partnership with others best direct its intervention toward overcoming these barriers?

Findings

Our work reveals that, while levels of Assistive Technology market development vary across countries, key barriers are common. These barriers can be classified into five main categories related to both supply and demand factors and across the 5Ps of People, Products, Provision, Personnel, and Policy.

People

Need to measure impact
Evidence is a key tool to promote investment, as well as to prioritise interventions.

Stigma and discrimination
Although discrimination and stigma are worse for some types of disabilities, they pervade all sectors of the disability community.

User-centred design
Products designed with the participation of users are ultimately much better in meeting users’ needs; they are used more and abandoned less.

Products

Affordability, availability, and quality
Affordability, both in terms of the full cost of the product as well as service delivery, was mentioned by all stakeholders as critical to success.

Standards needed
The lack of globally accepted specification and standards for Assistive Technology is a significant barrier to the access of effective and appropriate Assistive Technology .

Need for a critical mass of innovation
There is a need to open channels for collaborative innovation, as most Assistive Technology is designed, developed, and sold by large, private companies.

Provision

Need for a sustainable approach
Providing a person with an Assistive Technology is not a “one-off” occurrence; rather, it is an end-to-end process, beginning with screening activities and encompassing assessment, selection, fitting, user training, follow-up, and maintenance. A sustainable systems approach is therefore essential.

Fragmented services
Fragmented, geographically distant service delivery may discourage and even prevent users from accessing services.

Donor dependent supply
Donor-dependent supply chains can have a detrimental effect on the continuity and effectiveness of Assistive Technology provision.

Low demand, high cost
Low demand for Assistive Technology and materials results in much higher cost-per-unit. A globally coordinated effort to bulk purchase, combined with regional distribution hubs, may mitigate the problem.

Personnel

Expanding current Assistive Technology workforce
Assistive Technology service delivery models are dependent on the availability of highly qualified professional staff. Task shifting might be a potential solution.

Harnessing the power of technology
Mobile technology is a powerful tool in improving the capacity of personnel involved in Assistive Technology development and provision, as well as being a mode of new Assistive Technology delivery.

Continued development of workforce
There is need for continued training. One-off training provides little opportunity for follow-up or to further expand knowledge.

Policy

Lack of coordination
Lack of coordination between parties responsible for the development and delivery of Assistive Technology results in decreased efficiency of many programmes, with increased cost and an uneven distribution of the Assistive Technology network across the territory.

Policies without implementation
Policies must be implemented and reviewed periodically.

Legislation to facilitate rather than to hinder
Excessive bureaucracy can become a significant barrier to the development and delivery of Assistive Technology.

Funding clarity
A more effectively managed funding system, which is clear and transparent for all parties involved, is essential.

Other

Need for an accessible environment
Access to Assistive Technology is not a sufficient condition for independence. An inaccessible environment can prevent or limit the use of Assistive Technology.

Recommendations for
intervention

There is a real opportunity to show leadership on the Assistive Technology agenda, but a global approach is needed to deliver genuinely revolutionary change. The way in which this is done matters. The approach to Assistive Technology provision requires an explicit normative framework; this report suggests this be framed around the following principles:

A Social Development approach and political leadership

The priorities for intervention should lead to better outcomes for Assistive Technology users.

A global, mission-led partnership

This partnership should go beyond a donor-led approach, with targets well understood by stakeholders, measurable outcomes, and clarity of how to return on investment.

Testing and piloting market shaping as a methodology

The opportunity to back this approach at scale is still some way off. Global leaders beyond the disability sector should spearhead this work, developing, trialling, and refining a research base.

Backing market shaping with work on systemic interventions

Work done to reduce the cost of Assistive Technology must be carried out in conjunction with national governments, with clear routes for the provision of Assistive Technology within healthcare, education, and other nationally delivered systems.

Harnessing innovation

With a focus on leapfrog technology, looking beyond the traditional understanding of products or services, and bringing in fresh players and approaches.

Community participation and capacity building

The exclusion of Assistive Technology users from programme design, policy and decision-making leads to less good outcomes, continued power imbalance and political exclusion. An Assistive Technology ‘solution’ must be designed to counter this, through building on community-led solutions with Assistive Technology users involved at every level of the process.

Conclusions

The challenge of Assistive Technology is a complex web of market and system failure, compounded by a lack of participation from those that have the best knowledge of the issues (users themselves). This results in a supply/demand mismatch affecting almost a billion people, making Assistive Technology access one of the most pressing issues facing those that wish to see implementation of the SDGs by 2030.

Any intervention that is to be successful must go hand in hand with policies and practices to remove stigma and discrimination and empower Assistive Technology users to take part at all levels of society. If the global community can get behind a single mission, enabling an environment where the holistic nature of the problem is acknowledged, innovation can thrive, and there is a willingness to fund large-scale strategic interventions based on what is shown to work, then there is much hope for success.

The risk is that the challenge of Assistive Technology is complex and multi-faceted and has been largely obscured from view. The expertise needed to tackle the problem from its multiple angles is not held in one place; rather, it lies between the traditional boundaries of innovation, development, disability, and market leaders. Creative partnerships of emerging and established actors, involving Assistive Technology users and those running the systems that serve them at all levels, will be critical for success.

Foreword

This report seeks to contribute to a better understanding of the issues around access to assistive technology in a global context. Utilising both primary and secondary research, various barriers to assistive technology have been identified and explored. Building on this work and developing opportunities and ways to overcome those barriers is a key part of this project.

The ultimate goal must be ensuring that nobody is denied access to potentially life changing products and services.

Assistive technology covers a vast range of tools and products including (but not limited to): walking sticks, wheelchairs, hearing aids, eyeglasses and, increasingly, mobile, and digital applications; essentially, anything that enables people to participate fully and lead more productive and enjoyable lives. I am a proud user of several assistive technologies and am genuinely excited by the mainstreaming of accessibility features in modern technology that is doing so much to bring assistive technology to increasingly large numbers of people.

The fact remains however, that in the global south – where it is estimated that 80% of disabled people live – being able to access appropriate, safe and affordable assistive technology can literally make the difference between life and death. Often simple and relatively cheap products are simply not available. This mismatch in demand and supply suggests that the markets for assistive technology are not operating effectively, which has resulted in assistive products being either too expensive or simply unavailable. Coordinated market shaping activities have worked well for other areas of lifesaving healthcare commodities, for instance, bed nets for Malaria, vaccines, and medicines for conditions such as HIV, and contraception. Such activities have not yet been tested for assistive technology.

GDI Hub has produced this report with support from leading market shaping experts at the Clinton Health Access Initiative (CHAI) as well as specialist input from Leonard Cheshire and ‘deep-dive’ support from Motivation in the UK and Kenya. We would like to thank all these contributors. We would also like to thank the team at the Boston Consulting Group (BCG) who led an aligned piece of work with a focus on wheelchairs and hearing aids over a similar timescale.

The figures are staggering: it is estimated that by 2050 two billion people would benefit from assistive technology, yet 90% will not have access. Assistive technology has the potential to enable and empower and can be a key part of delivering on the United Nations General Assembly’s 17 global Sustainable Development Goals. The challenge is huge but the prize, should we succeed, is far more so and we hope this report will provide a comprehensive starting point from which to achieve universal access to assistive technology globally.