Interview | Rajib Dasgupta
The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) jointly launched the first Global Report on Assistive Technology (GReAT) on May 16. A billion people globally are currently estimated to be in need of assistive technology (AT). This is projected to double by 2050, with an aging population and increasing prevalence of non-communicable diseases. Rajib Dasgupta , Chairperson at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, and a contributor to Chapter 3 of the GReAT report, in his interview to The Hindu’s Bindu Shajan Perappadan , explains the key points of the report and the related conditions in India.
What does GReAT report released in Geneva today highlight and what is the current status of access as far as India is concerned?
With AT and in the context of prevailing disabilities, the core concern is that 90% of those who need assistive technology globally do not have access to it. AT is an umbrella term for assistive products and related systems and services.
This report was developed as a joint initiative of WHO and UNICEF and draws upon surveys conducted in 20 countries that indicate that the proportion of the population currently using at least one assistive product ranges from less than 3% to about 70%.
In India, disadvantaged groups and communities face hardships in their search for affordable quality healthcare, and that for obtaining ATs and associated services is perhaps more so; 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.
Given the enormity of challenges, how is India planning to move forward?
The 2011 Indian Census put the national estimate of the disabled at 2.21% of the total population (26.8 million persons), including persons with visual, hearing, speech, locomotor and mental disabilities with the majority in the 19-59 years [age].
The rural populace has a higher percentage of disabled (75%), with only 49% being literate and less than half (34%) employed. The Indian situation is marked by a high percentage decadal change in disabled population (22.4%) during 2001-11 as compared to that for the total population (17.7%).
The 76th round (July-December 2018) of the National Sample Survey (NSS) reported that among persons with disabilities, 21.8% reported receiving any aid/help from the government and another 1.8% cent from other organisations.
Indian government agencies are dedicated towards the cause of improving access to ATs. The planning efforts will be supplemented by the recommendations from the global report.
In your view, are there any missing links?
Three key challenges confront us — financing, designing and incorporating ATs into health systems. As with any healthcare intervention, ATs require continuous innovation to meet the needs of patients and providers. Despite an emerging concern for policies and strategies, a plethora of structural barriers abound. These include social and economic discrimination; inaccessible built environments; expensive, socially isolating and often counterproductive disability policies and institutions; insufficient information; inadequate data and limited coordination of disability policies, strategies and activities. Policymakers need an estimate of the unmet need of ATs for India’s population.
What are the barriers to accessing the assistive products?
Barriers to access and coverage, in the context of AT, is best understood as the 5Ps:
People: Related to age, gender, type of functional difficulty, location and socioeconomic status of those in need of AT.
Products: Range, quality, affordability and supply of assistive products continue to be enormous challenges. Quality and standards issues such as safety, performance and durability are key concerns.
Provision: Information and referral systems remain complex and services are not available across all geographies and populations.
Personnel: Significant workforce gaps are not just about numbers but adequate training and education too.
Policy: A survey of more than 60 countries reported at least one government Ministry or authority responsible for access to AT with almost 90% having at least one piece of legislation on access to AT; however, current levels of access imply a long road to universal AT access.
How crucial is the need for ATs for the vulnerable sections of society (children, women)?
It is estimated that approximately one in every 10 children in the world has a disability and less than 10% of children with disabilities in low-income countries go to school. Around the world, an estimated 93 million children under the age of 15 are living with some kind of disability.
Besides poverty and prejudice, the lack of access to assistive technology, as well as inaccessible transport and school environments are major barriers, which restrict children with disabilities to access education and to participate in the community. The report also puts great emphasis on approaches to reducing barriers to assistive technology in humanitarian crisis settings, and includes designing and producing appropriate assistive products. Together the WHO-UNICEF collaboration and technical support to the country can help in addressing these challenges.
