Enabling local provision of assistive products in rural South India: an organisational survey of needs, barriers, and facilitators

Abstract

Objective: Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals’ perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge.Methods: A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO’s multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO’s Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training.Impact: Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context.

IMPLICATIONS FOR REHABILITATION

• Identified barriers to assistive product (AP) provision in rural South India include poor acceptance by clients/families due to stigma, high AP costs, limited AP availability, and rehabilitation capacity gaps.

• Suggested facilitators to AP provision in rural South India include improving AP acceptability, affordability, and accessibility through community awareness, client/family education, AP funding and supply, and assistive technology (AT) service provision capacity building.

• An organisational-level survey based on the WHO’s Priority Assistive Products List and the Principles of AT Access can identify local needs, barriers and facilitators.

• An AT access strategies in resource-limited areas may be developed based on barriers and facilitators identified by local/regional rehabilitation professionals.

Keywords:

• Assistive technology
• AT access
• rehabilitation
• disability inclusion
• LMIC
• capacity building
• service providers

Acknowledgements

The authors thank the Amar Seva Sangam rehabilitation specialists who participated in the study. We also thank the leadership of Amar Seva Sangam’s Centre of Excellence in Rehabilitation and Development for Children with Disabilities for their support of this project.

Disclosure statement

The authors report that there are no competing interests to declare.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.