Chapter 41 Appropriate technologies for assistive devices in low-income countries
These are the first sentences of the United Nations (UN) Standard Rules on the Equalization of Opportunities for Persons with Disabilities, which were adopted by the UN General Assembly in 1993.7 Disabilities may affect all of us if we live long enough, no matter where we live. We all may need some assistive devices, depending on different life situations. There will always be a need for professionals for the production and provision of assistive technology all over the world, especially in low-income countries that do not have the means and resources to import expensive assistive technology for its population in need.
According to Rule 4 on support services and assistive technology of the UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities: “States should ensure that development and supply of support services, including assistive devices for persons with disabilities, to assist them to increase their level of independence in their daily living and to exercise their rights.”7 The rule does not say how this should be done, but the rule clearly indicates it is the responsibility of each government. Even though many national and international nongovernmental organizations perform much of this work, it is essential to remember the responsibility and coordination of the national government.
Assistive technology is a term that is more extensive than the previous term technical aids. Assistive devices are the specific products used by individuals. As such, these terms are used when describing this field of work. The term technical aids should not be used because of confusion with the illness AIDS/HIV (acquired immunodeficiency syndrome/human immunodeficiency virus).
The human rights issue for people with disabilities has been discussed more during recent years. As a result of the UN’s work on the International Convention on the Rights of Persons with Disabilities, the convention was adopted by the UN General Assembly in 2006.8 It stresses the importance of assistive technology, including assistive devices, for people with disabilities as well as information and communication technologies, giving priority to technologies available at an affordable cost.
Access to devices is important for people with all types of disabilities. The ultimate aim of services in society should be to ensure that every person in need has access to assistive technology in order to have a better quality of life. For many persons with disabilities, assistive technology is a prerequisite for participation in the community. It is a tool in a process leading to equalization, participation, and independence, enabling individuals to participate in education and/or work, move between different places, dress and eat by themselves, communicate with other people, express their own thoughts and wishes, and otherwise enjoy life.15
Assistive devices give a freedom that we all would like to have, the freedom and the control over our lives. Assistive technology can provide a way to live independently and actively as well as to live safely and securely.
The term appropriate technology is more difficult to define. Should not all kinds of technology for people with disabilities be appropriate? Appropriate technology normally means that assistive devices should be produced locally by locally available material and tools. However, socioeconomic and cultural aspects also are involved.
The product must be affordable to most people and thus be appropriate to the people concerned. The cost for the country is another essential financial aspect. An imported product is costly for the country, and the money spent then cannot be used within the country. In addition, importing a product does not provide job opportunities in the country.
The cultural aspect is important so that the product is convenient to the people’s traditions. A wheelchair is not always suitable for indoor use in Asia, where everyone usually sits on the floor or squats when performing household work and during family talks. A low trolley may be better in these situations.
The International Society for Prosthetics and Orthotics (ISPO) held a Consensus Conference on Appropriate Prosthetic Technology for Developing Countries in Phnom Penh, Cambodia, in 1995 and later declared the following at a meeting in Wuhan, China, in 19964:
The UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities also states in Rule 4 on support services that “States should recognize that all persons with disabilities who need assistive devices should have access to them as appropriate, including financial accessibility. This may mean that assistive devices and equipment should be provided free of charge or at such a low price that persons with disabilities or their families can afford to buy them.”7
Approximately 600 million people worldwide experience some form of disability. Eighty percent live in low-income countries; most of them are poor and do not have access to basic health services, including rehabilitation facilities.11 The number of people with disabilities is increasing. War injuries, land mines, HIV/AIDS, malnutrition, chronic diseases, substance abuse, accidents, environmental damage, population growth, and medical advances that preserve and prolong life all have contributed to this increase. These trends are creating a great demand for rehabilitation services, including assistive technology, and improved accessibility in society.
In low-income countries, only 2% to 5% of the population in need can access the necessary rehabilitation services. One of the most neglected areas in rehabilitation is access to, and provision of, assistive devices to disabled and elderly people. In many low-income countries, assistive devices are accessible only through private services, which are inaccessible to the majority of people with disabilities because of high costs. The World Health Organization (WHO) estimates that only 5% to 15% of persons needing assistive devices have access to them.11
People with disabilities who have access to appropriate rehabilitation services can rise out of poverty and meet their basic needs, but the absence of such services contributes to a larger impoverished group. People with disabilities often belong to the poorest of the poor because they have no salary from employment and often do not have families to use as a protective net. Poverty-related illnesses, such as polio, leprosy, and lack of iodine, lead to disabilities such as mobility and intellectual impairments. Blindness is caused by a lack of vitamin A. Loss of hearing acuity and deafness are caused by chronic ear infections that are not treated properly.
Assistive devices play an important role in enhancing mobility and functionality and reducing dependency. Most people with disabilities and older people need assistive devices, particularly for mobility, hearing, and low vision. By 2020, more than one billion people 60 years and older will be living in the world; 700 million will be living in developing countries.
Elderly people face the risk of being affected by different age-related diseases. They will need assistive devices for dementia; impaired mobility, vision, or hearing; or general frailness. Elderly people often have several impairments at the same time, which make both the life situation and the care more difficult. Combinations of problems with mobility, sight, hearing, and cognition, that is, learning and understanding, result in more people with multiple disabilities. Elderly persons need more time to learn how to use assistive devices and learn how to take care of themselves in a new way.
The number of facilities that produce assistive devices in low-income countries is far from satisfactory. Where available, services are centralized, production is low, device quality is poor, and the number of trained personnel is insufficient.
If money is available to buy assistive devices, there are no problems. However, if money is lacking, there are problems with the production of devices and the distribution of devices to individuals. No firm can afford to produce many devices that are not sold.
Assistive devices alone cannot solve all problems. Other issues exist, such as accessibility, equal opportunities and human rights, and poverty alleviation, but assistive devices can result in change. Assistive technology will make people with disabilities visible and active contributors to society.