Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals (Van Niekerk, Dada and Tönsing)

Van Niekerk, Dada and Tönsing address an important and intriguing topic in their paper [1]. Based on a thorough qualitative study among assistive technology professionals working in South Africa, they describe the factors influencing the choice of assistive technology solutions for young children. The results show that the selection process is complex and influenced by many factors that have to be considered and negotiated. Their findings are very well aligned with earlier publications about assistive technology selection but they add to the debate on the relation between the characteristics of the technology and the environment (e.g., the need for electricity in relation to the availability of charging facilities). They propose that such factors should be added to the widely recognized assistive technology device (ATD) selection model [2]. This would indeed be important to make this ATD selection model suitable for use in any setting.

While appreciating the tone and contribution of the paper, I was left with a basic question, that is to what extent the findings reported are indeed applicable to AT provision in low resource settings. The study approached the AT selection process from the perspective of professionals who are working in established facilities for rehabilitation and AT service delivery, but how does it look from the perspective of a child with a disability and its parents? It is well known that only a small percentage of people with disabilities have access to AT. The absence of targeted policies, easily accessible organizations, sufficient numbers of professionals and procedures that can provide AT, and lack of expertise among professionals are among the causes of that. Other important factors are lack of awareness about the possibility of AT as a solution and cultural acceptance of AT. From research in rural areas in India, we know for example that people with severe disabilities, including children, often never get connected to any rehabilitation or AT service, that they are not aware of such services, and that they seem to accept their disability as a fact of “karma” [3]. In a study looking at child health in a large slum in Bangalore, India, we recently conducted a community meeting with a group of around 30 women who had about 100 children, some of whom displayed obvious disabilities. Asking why they were not at school it appeared that only three of the children of these women regularly went to school, and none of the children with a disability [personal experience, not published]! They will probably never receive proper care or support, let alone AT.

I think the aforementioned situation is the major challenge for many low resource settings: how to make sure that people with disabilities get access to solutions that might fundamentally improve their lives? That is in a way the backside of the problem Van Niekerk, Dada and Tönsing discuss. Of course, it is important to work on models, methods and tools that support professionals to do the best possible job, and of course these need to be embedded in well designed and efficient processes. But, what is the meaning of all that when people with disabilities don’t “find” these professionals and services? There is an urgent need for approaches that link these two sides of the AT provision challenge: making sure that professionals are well trained and use well founded models and procedures, and making sure that people with disabilities have access to those professionals. That might be a relevant area to expand the ATD selection model, or maybe better to develop a complementary model to help analyse the broader context of AT provision in low resource settings.

Disclosure statement

No potential conflict of interest was reported by the author.