Assistive technology (AT) has immense potential to improve independence, participation, and productivity, facilitate access to education, employment, and family life. However, the Global report on AT published by the World Health Organization revealed that one billion potential users are denied access to AT. In low- and middle-income countries (LMICs), only 3% percent of those who need such life-changing products have access to them.
This article reflects on key barriers to assistive technology in LMICs. These reflections are from IDA’s Assistive Technology User Fellows from Africa (Uganda), Asia-Pacific (Bangladesh and Pakistan), Middle East and North Africa (Sudan) and Latin America (Peru), as well as from participants of assistive technology workshops from amongst Organizations of Persons with Disabilities (-OPDs) in Kenya and Rwanda held in November-December 2023.
Barriers across Borders
AT devices are not widely available, particularly in the rural areas of all seven countries. The distribution chain of assistive products and provision in most countries including Bangladesh, Pakistan, Sudan, and Uganda is not balanced. The availability and distribution in Kenya isbetter due to better cross- sectoral efforts. Across nations, AT is concentrated in the cities,leading to the forced migration of the families of children with disabilities to access educational settings that offer AT. The assistive products available may be rendered unusable due to the difficult and unpaved terrain, for example in hilly areas of Rwanda and Bangladesh, as these products have not been developed with these considerations in mind. It was observed in all countries that mobile phone applications and other technology-based solutions for communication, transportation, and access to information are often unavailable or inaccessible due to limited internet connectivity, the lack of digital literacy and financial insolvency insufficiencies. Specialized devices and training on those for deafblind individuals are practically non-existent in remote areas of Bangladesh and Uganda. There is also a lack of qualified personnel to maintain assistive technology, which means that when an assistive product such as a wheelchair breaks down, it cannot be repaired in the places where the user resides.
A lack of awareness about the potential of assistive technology is another major barrier that limits the access to AT. This was reported by the participants of AT workshops in Kenya and Rwanda. Participants also shared that the pathway to access assistive technology is not smooth, due to limited access to information about assistive products and services. Most persons with disabilities and their families are unaware of their right to access and potentials of AT. None of the countries have systematic dissemination of information related to AT in accessible formats.
A system driven by the medical model of disability another significant barrier to accessing AT. In Kenya, assistive products need to be prescribed by doctors in Kenya. In Bangladesh, Pakistan and Uganda, persons with disabilities need to be registered and clear medical examinations if they want to access subsidized products. Many countries including Sudan produce prosthetic legs and arms which are medically functional, but are socially and culturally unacceptable as the colors of the products do not match with the skin color of the users. Screen reader software does not consider diverse accents, which affects the usability of the technology in different country contexts.
Stigma and attitudinal barriers and negative beliefs about disabilities exist in all seven countries. Participants in Rwanda reflected that persons with disabilities who use AT may experience more stigma. In some countries, such as Sudan, assistive products are associatedwith negative stereotypes. For example, a common stereotype is that the white cane is used for begging. In many contexts, persons with disabilities are not allowed entry into religious spaces with their assistive devices.
Due to the low availability, persons also have their right to choose assistive products restricted. Participants from Rwanda shared that most products imported from other countries do not consider the socio-cultural norms and beliefs of the potential end users. In Bangladesh, Pakistan, Peru and Rwanda, people do not have the opportunity to choose products and services when they are delivered by charity organizations or donors.
A lack of adaptability of AT causes it to not be usable. Devices often cannot be customized based on users’ size, weight, environment, tasks, or be sensitive to users’ age, gender, or other personal aspects.
Concern about the quality of assistive technology prevails in every country. In Bangladesh, for instance, there is no dedicated body to monitor and certify quality of the assistive products and services, while there is reportedly a shortage of skilled personnel who can provide AT services, including assessment, fitting, maintenance, and training of users in all countries.
Financing assistive technology
AT devices are often expensive and unaffordable for many persons with disabilities, especially those from low-income families. High and mid- tech devices
remain out of reach due to financial constraints and the lack of innovation. The inadequacy of financial support in terms of disability inclusive social protection exacerbates this situation. The efforts made by the administration to share information about these initiatives are not adequate. For instance, participants in Peru shared that the government has budgets that are allocated to local and regional governments for the distribution of assistive devices and improving access to AT, but due to a lack of awareness, these budgets are not adequately used. Most other countries, including Bangladesh, Kenya, Pakistan, Rwanda, and Uganda have neither a dedicated department for AT nor any specific fund allocation for assistive devices in their national budget. Instead, there are social protection programmes aimed at covering disability costs, which are often too meagre to purchase assistive devices. Most need is met out-of-pocket, or with the help of charitable organizations. Kenya provides a tax exemption for the purchase of AT products. Government subsidies for assistive devices exist in Bangladesh, Pakistan, Sudan, Rwanda, and Uganda but are found to be insufficient.
Governance and policy framework
In most of the seven countries, different departments and ministries including the Ministry of Health and the Ministry of Social Welfare deal with assistive technologies. Participants and fellows shared that ministries and departments that would have roles and responsibilities around AT including certification, social protection, tax exemptions etc. have little to no coordination between themselves. This results in poor management in this sector. Bangladesh, Kenya, Pakistan, Peru, and Uganda have disability laws, but none of them have explicit and comprehensive policies to facilitate access to assistive technology for all persons with disabilities. There is still a need for improvement in the implementation of these regulations in all countries in discussion.
Conclusions
The overall availability, accessibility, adaptability, acceptability, and quality of the assistive technology in Bangladesh, Kenya, Pakistan, Peru, Rwanda, Sudan, and Uganda is low. The situation is worse for those from underrepresented groups including women and children with disabilities, persons with intellectual disabilities, persons with psychosocial disabilities and persons who are deafblind. Cross-sectoral efforts around products and services, provision, personnel, and policy are critical for improving access to AT for all. All AT actors including the government, non-governmental organizations, manufacturers, the international community, and users must work together to develop and implement a comprehensive AT strategy that includes a strong policy framework in compliance with international human rights instruments including Convention on the Rights of Persons with Disabilities, adequate funding, effective information dissemination in accessible formats, and improved access to products and services.
