Access to assistive technology for persons with disabilities: a critical review from Nepal, India and Bangladesh

PURPOSE

The purpose of this paper is to analyse and critically reflect on access to Assistive Technology (AT) for persons with disabilities (PWD) in Nepal, India and Bangladesh. This analysis aims to guide the development of a contextualised generic AT service delivery model suitable for these countries, based on the best practices identified.

MATERIALS AND METHODS

This paper is based on a comprehensive study conducted in Nepal, India and Bangladesh, observing mobility and hearing-related AT service delivery centres run by the government, as well as private and nongovernmental organisations, and interviews with key informants: policymakers (5), AT service providers (20) and AT service users (20) between December 2019 to February 2020. A descriptive, qualitative exploratory study design was followed. A quality assessment framework was used to structure the analysis and interpret the findings.

RESULTS

AT service provisions are poorly developed in all three countries. On all quality indicators assessed, the systems show major weaknesses. AT users have very limited awareness about their rights to these services and the availability of AT services, the range of services available is very limited, and eligibility is dependent on medical criteria related to visible and severe disabilities.

CONCLUSIONS

Lack of accessibility, eligibility, reachability and affordability are the main barriers to access AT services for PWD in Nepal, India and Bangladesh. Increased community level awareness, increased Government funding and a community based, medically informed flexible social model of AT services is a way forward to ensure access to AT services for PWD in these countries.IMPLICATIONS FOR REHABILITATIONIncreased community awareness is necessary to increase access to Assistive Technology Services for Persons with Disabilities.Increased and flexible funding from the Government and philanthropists will improve rehabilitation.Establishment of community based Assistive Technology Services centres will increase access and improve rehabilitation.

Abandonment of assistive products: assessing abandonment levels and factors that impact on it

PURPOSE

To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center.

METHODS

This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.

RESULTS

The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.

CONCLUSION

The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery. Implications for Rehabilitation Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings. The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users. The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels. As assistive products users' perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.