Assistive technology as a pillar of universal health coverage: qualitative analysis of stakeholder responses to the world health assembly resolution on assistive technology

Figures & data

Figure 1. Three dimensions to consider when moving towards universal coverage [8].

Table 1. Key Components of the WHA resolution on improving access to assistive technology.

The need for and the impact of AT. Relevant mandates such as UN CRPD and UN SDG’s, and WHO Global Action Plan, WHO mental health action plan and AT’s role in ameliorating contributors to the global burden of disease, such as road traffic injuries and poliomyelitis. Challenges in access including needed research and development; standards and regulation; manufacturing; selection, pricing and reimbursement; procurement and supply; managing health emergencies; and service provision. Four interlinked components within the framework of UHC: policy, products, personnel, and provision. Calls for member states’ action to improve access to high quality and affordable assistive products for those who need them.

Table 2. Key statements related to challenges.

While we commend the WHO for compiling the APL, we still do not see assistive products enjoy the same intense and comprehensive attention given to medicines, for example. (Israel) Australia commends WHO on the GATE Initiative and looks forward to seeing continued progress in accessibility, affordability of AT, especially in the Western Pacific region. Noting this region has specific challenges, and remains one of the least resourced regions globally, with regards to AT. (Australia) The South East Asia (SEARO) region has the 2nd highest prevalence of moderate disability, 3rd highest of severe disability amongst the WHO region. We are deeply concerned of the rising rates of disability due to aging population, and the rising trend of NCDs. (Bhutan) We agree on the list of challenges highlighted in the report, but wish to add cost and affordability of AT, especially in LMIC. (South Africa) We call upon the secretariat to also consider the additional vulnerabilities in the situations of conflict and instability. Improving access to AT in areas of conflict must be an inherent component of global and country integrated health preparedness and response to humanitarian and emergency context. (Qatar on behalf of MS of the (Eastern Mediterranean Region (EMRO))

Table 3. Key statements related to desired outcomes and goals.

Access to AT is the key precondition for social inclusion. (Germany) Access to AT is needed to ensure that some of the most vulnerable people in our societies, such as the disabled, elderly and mentally ill, and those suffering from injury from road traffic accidents, can lead economically productive lives. (Zimbabwe) This [AT] is a top priority for my country, given that it will enable a person with functional disabilities to lead a healthy dignified, and autonomous life, to participate in society effectively. (Columbia) AT are a substantive tool to healthcare system, in particularly because they increase the functionality of the person with a disability. They also improve the quality of life, enabling one to be more productive and independent. We agree that AT has repercussions that goes beyond the health benefit of the persons and their families, including socio-economics benefits. Through an active and productive population, we can encourage economic growth and improve health care system because of the reduce burden on healthcare system. (Mexico)

Table 4. Key Statements related to recommended strategies.

This is why we need to promote appropriate funding and research, as well as ongoing training for people providing AT. Some of the challenges identified in the report are important, but we believe there is also a need to develop specific plans to promote partnership, to reduce cost of these technologies, to promote technology transfer as well as to incentivise R&D. (Mexico) The UK is working with technical partners, donors, civil society and the private sector, to build a relationship, to support the implementation of this agenda. The UK sees a clear opportunity to deploy the market shaping approaches, that has proven so successful in increasing access for life saving commodities, such as vaccines, anti-retroviral, bednets and contraceptives. This includes pooling and coordinating procurement and bringing new, low cost, high quality suppliers into the market. (UK) We recommend the community-based approach to remote areas. (Colombia) Support should be extended to LMIC in manufacturing, supply chain management, and usage of assistive products. AT should be treated as a public good. A corporate control, patent-driven system in AT can obstruct access. We urge Member States and WHO to promote open access innovations, open design and copyright exemption mechanisms for transfer of technology. (Medicus Mundi International) Vietnam…should develop long-term planning for national procurement system. We should integrate provision of AT into emergency response planning and programme to facilitate early hospital discharge and a programme to assess mobility. We should develop strong guidelines and mechanisms to post marketing control for assessing the product quality and safety for end users. (Vietnam)

Table 5. Key Statements revealing connections to international agendas.

In the framework of the UN CRPD, states have undertaken to promote, protect and guarantee the full realisation of all human rights of PWD. That is why we support the promotion of access to AT, in order that people can live a dignified, healthy, full and autonomous lives. (Peru) HelpAge welcomes the focus on the draft resolution on the APL and the alignment with the Global Strategy and Action Plan on ageing and health, for which the priority list is an indicator. (HelpAge International) Humanitarian Inclusion (HI) is in official collaboration with WHO in implementing the Call for Action, Rehabilitation 2030, and witnesses daily the lack of AT services. Based on this experience, I affirm that access to rehabilitation as well as quality and affordable assistive products, is key in achieving inclusive health. (Handicap International Federation/Humanitarian Inclusion)

Table 6. Key Statements exemplifying the inter-play between health, human rights and sustainable development.

The provision of affordable, quality AT is an equity and human rights issue, and it is an essential enabler in achieving the SDG’s. (Australia) We would like to underscore in the documents, the inter-sectoral nature of providing AT, and the role the Ministry of Health plays in rehabilitation. It is also important to point out, one of the main goals of AT, is to achieve the social inclusion of persons with disabilities, the elderly, and persons with difficulties in movement. Therefore, it is a multi-sectoral responsibility. (Colombia) Ensuring effective access to AT is more than just achieving SDG 3, implementing obligation to the UN CRPD or promoting ILO’s goal of descent work for all. It is above all, a matter of guaranteeing equal opportunities for all, and improving the quality of life for those most in need. (Brazil) Equitable access to affordable, quality and safe Assistive products to those who need them, is a human right. Without such access, it would not be possible to achieve the SDG targets and UHC. (Qatar on behalf of Member States of the EMR) We think that this is one of the pillars of UHC. This is the one of the essential human rights. (Libya)

Table 7. Key Statements relating to international collaboration – support required or on offer.

So that no one is left behind, we need the support of the organisation [WHO] to continue to improve access and overcome existing barriers related to [lack of] R&D, standards and regulation, financing options, production, purchasing and delivery of AT. (Dominican Republic) We look …[to] …the Secretariat for the technical assistance in developing tools and national AT programmes and policies and strategic plans. (Tanzania) Throughout the years, Vietnam has received a lot of support from foreign organisations and we hope that in future international organisations will continue their support in helping us improving access to necessary AT. (Vietnam) Support should be extended to LMIC in manufacturing, supply chain management, and usage of assistive products. (Medicus Mundi International) ….strengthen international communication and cooperation, in particular the implementation of WHO GATE Plan, to establish a universal and global AT standards, to share our experiences in R&D and manufacturing. (China)

Figure 2. The intersection of the WHA Calls, Key Statements and Themes.

World Health Organization. World health report. Health Systems Financing. The path to universal coverage. 2010. Available from: https://www.who.int/whr/2010/en/

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