Project

AT2030 - Life Changing Assistive Technology for All

Goal: Over five years, AT2030 will test ‘what works’ to improve access to AT and will invest in and support solutions to scale with a focus on innovative products, new service models, and global capacity support. The programme will reach 9 million directly and 6 million more people indirectly to enable a lifetime of potential through life-changing Assistive Technology.

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Dorothy Boggs
added a research item
The supply of and market demand for assistive products (APs) are complex and influenced by diverse stakeholders. The methods used to collect AP population-level market data are similarly varied. In this paper, we review current population-level AP supply and demand estimation methods for five priority APs and provide recommendations for improving national and global AP market evaluation. Abstracts resulting from a systematic search were double-screened. Extracted data include WHO world region, publication year, age-groups, AP domain(s), study method, and individual assessment approach. 497 records were identified. Vision-related APs comprised 65% (n = 321 studies) of the body of literature; hearing (n = 59), mobility (n = 24), cognitive (n = 2), and studies measuring multiple domains (n = 92) were proportionately underrepresented. To assess individual AP need, 4 unique approaches were identified among 392 abstracts; 45% (n = 177) used self-report and 84% (n = 334) used clinical evaluation. Study methods were categorized among 431 abstracts; Cross-sectional studies (n = 312, 72%) and secondary analyses of cross-sectional data (n = 61, 14%) were most common. Case studies illustrating all methods are provided. Employing approaches and methods in the contexts where they are most well-suited to generate standardized AP indicators will be critical to further develop comparable population-level research informing supply and demand, ultimately expanding sustainable access to APs.
Jamie Leigh Danemayer
added a research item
In this chapter we explore the setting of health, this covers healthcare as well as illness which can affect the health of an individual. We start the chapter by exploring the value of health within society, to understand how its conceptualization might affect the development and diffusion of technology to support the health of people with disabilities. We then take a quick look at digital health interventions and move onto unpack some of the arguments about healthy aging, assisted living and the overlaps and contrast between aging and disability. Afterward, we look more closely at the links between mental health, disability, and the role of technology in supporting psychological wellbeing. We then move to understand some of the nuances and interactions between assistive products and the provision of healthcare services by exploring the definition of AT as formulated by the World Health Organization. Finally, we bring an example of how the DIX framework can be applied to research in health and healthcare services by analyzing the role of data population level screening to connect functional assessment to the estimation of AT need and support provision.
Mikaela Patrick
added a research item
This case study presents insights on the current state of accessibility and inclusion of the built environment in Varanasi, India. Part of the AT2030 programme which is improving access to life changing assistive technology, these case studies are building knowledge on how the built environment can support access to assistive technology by providing an enabling and inclusive environment for people with disabilities. Drawing on 4 months of research with government, built environment industry and community stakeholders such as people with disabilities and Disabled Persons' Organisations, the case study offers challenges and opportunities for what an inclusive environment might look like in Varanasi, India.
Dorothy Boggs
added 2 research items
If Sustainable Developmental Goal 3 and Universal Health Coverage are to be achieved, functioning is a third health indicator which must be assessed and integrated into global health population-based metrics alongside mortality and morbidity. In this paper, we define functioning according to the International Classification of Functioning, Disability and Health (ICF) and present why functioning is important to measure, especially when considering the need for, and outcome of, rehabilitation and assistive technology. We discuss examples of tools that measure components of functioning through clinical assessment and self-report methodologies, and present the development of a comprehensive population level tool which aligns with the ICF and combines self-report and clinical measurement methods to measure functioning and the need for rehabilitation and AT. Throughout the paper a survivor of Coronavirus 2019 (COVID-19) is given as an example to illustrate functioning according to the ICF and how access to the interventions of rehabilitation and assistive technology might be of benefit to improve and optimise his/her functioning. We argue that the Global Health community must take action and ensure that the measurement of functioning is well established, accepted and integrated as the third health indicator following the COVID-19 pandemic.
Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the relationship between the two methods. The Gambia 2019 National Eye Health Survey is a nationally representative population-based sample of 9188 adults aged 35+ years. Participants underwent standardised clinical vision assessments including the need for glasses (distance and near). Approximately 25% of the sample underwent clinical assessment of hearing and hearing aid need. Data were also collected on self-reported awareness, need and access barriers to vision and hearing ADs. Overall, 5.6% of the study population needed distance glasses (95% CI 5.0–6.3), 45.9% (95% CI 44.2–47.5) needed near glasses and 25.5% (95% CI 22.2–29.2) needed hearing aids. Coverage for each AD was very low (<4%). The agreement between self-report and clinical impairment assessment for AD need was poor. In conclusion, there is high prevalence and very low coverage for distance glasses, near glasses and hearing aids in The Gambia. Self-report measures alone will not provide an accurate estimate of AD need.
Dorothy Boggs
added a research item
Background Epidemiological data on musculoskeletal impairment (MSI) and related service and assistive product (AP) needs for displaced populations are lacking. This study aimed to estimate the prevalence, aetiology, and specific MSI diagnosis and the need for related services and APs among Syrian refugees living in Sultanbeyli, a district in Istanbul, Turkey. Methods A population-based survey used probability proportionate to size and compact segment sampling to select 80 clusters (‘street’) of 50 individuals (aged 2+), for total sample size of approximately 4000 participants. An updated version of the Rapid Assessment of MSI tool (RAM) was used to screen all participants using six questions. Any participant who screened positive underwent a standardised examination by a physiotherapist to assess the presence, aetiology, severity and specific diagnosis of MSI and an assessment of need for related services and APs. Results The all-age prevalence of MSI was 12.2% (95% CI 10.8–13.7) and this increased significantly with age to 43.8% in people 50 and older. Over half (51%) of MSI was classified as moderate, 30% as mild and 19% as severe. The war in Syria was identified as the direct cause for 8% of people with MSI. The majority (56%) of MSI diagnoses were acquired non-traumatic causes. There was high unmet need for rehabilitation services; for example, 83% of people with MSI could benefit from physiotherapy but were not receiving this service. Overall, 19% of people with MSI had an unmet need for at least one AP. Apart from availability of walking sticks/canes, coverage was low with less than half the people with MSI who needed APs and services had received them. The most common reasons for not seeking services and APs were ‘need not felt’, lack of service availability and of awareness of services, and financial barriers. Conclusions MSI is common among the Syrian refugee population living in Sultanbeyli District, particularly older adults, however less than half have been able to access relevant services and APs. These findings can inform the planning of health services for migrant populations, including the essential integration of rehabilitation and APs, and increase access to these vital services.
Dorothy Boggs
added a research item
OBJECTIVES: To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self-report and clinical impairment assessment. METHODS: Population-based surveys of approximately 4000 people each were conducted in Mahabubnagar district, India and Fundong district, Cameroon. Participants underwent standardised vision, hearing and musculoskeletal impairment assessment to assess need for distance glasses, hearing aids, wheelchairs. Participants with moderate or worse impairment and/or self-reported difficulties in functioning were also asked about their self-reported AP need. RESULTS: 6.5% (95% CI 5.4-7.9) in India and 1.9% (95% CI 1.5-2.4) in Cameroon of the population needed at least one of the three APs based on moderate or worse impairments. Total need was highest for distance glasses [3.7% (95% CI 2.8-4.7) India; 0.8% (95% CI 0.5-1.1), Cameroon] and lowest for wheelchairs (0.1% both settings; 95% CI 0.03-0.3 India, 95% CI 0.04-0.3 Cameroon). Coverage for each AP was below 40%, except for distance glasses in India, where it was 87% (95% CI 77.1-93.0). The agreement between self-report and clinical impairment assessment of AP need was poor. For instance, in India, 60% of people identified through clinical assessment as needing distance glasses did not self-report a need. Conversely, in India, 75% of people who self-reported needing distance glasses did not require one based on clinical impairment assessment. CONCLUSIONS: There is high need and low coverage of three APs in two low-and middle-income settings. Methodological shortcomings highlight the need for improved survey methods compatible with the international classification of functioning, disability and health to estimate population-level need for AP and related services to inform advocacy and planning.
Giulia Barbareschi
added 2 research items
Living have a mobility impairment. Traditional assistive products such a wheelchairs are essential to enable people to travel. Wheelchairs are considered a Human Right. However, they are difcult to access. On the other hand, mobile phones are becoming ubiquitous and are increasingly seen as an assistive technology. Should therefore a mobile phone be considered a Human Right? To help understand the role of the mobile phone in contrast of a more traditional assistive technology-the wheelchair, we conducted contextual interviews with eight mobility impaired people who live in Kibera, a large informal settlement in Nairobi. Our fndings show mobile phones act as an accessibility bridge when physical accessibility becomes too challenging. We explore our fndings from two perspective-human infrastructure and interdependence, contributing an understanding of the role supported interactions play in enabling both the wheelchair and the mobile phone to be used. This further demonstrates the critical nature of designing for context and understanding the social fabric that characterizes informal settlements. It is this social fabric which enables the technology to be useable. in informality is challenging. It is even harder when you-loway. 2020. Bridging the Divide: Exploring the use of digital and physical technology to aid mobility impaired people living in an informal settlement.
Innovations in the feld of assistive technology are usually evaluated based on practical considerations related to their ability to perform certain functions. However, social and emotional aspects play a huge role in how people with disabilities interact with assistive products and services. Over a fve months period, we tested an innovative wheelchair service provision model that leverages 3D printing and Computer Aided Design to provide bespoke wheelchairs in Kenya. The study involved eight expert wheelchair users and fve healthcare professionals who routinely provide wheelchair services in their community. Results from the study show that both users and providers attributed great value to both the novel service delivery model and the wheelchairs produced as part of the study. The reasons for their appreciation went far beyond the practical considerations and were rooted in the fact that the service delivery model and the wheelchairs promoted core values of agency, empowerment and self-expression.
Mikaela Patrick
added a research item
This case study presents insights on the current state of accessibility and inclusion of the built environment in Ulaanbaatar, Mongolia. Part of the AT2030 programme which is improving access to life changing assistive technology, these case studies are building knowledge on how the built environment can support access to assistive technology by providing an enabling and inclusive environment for people with disabilities. Drawing on 4 months of research with government, built environment industry and community stakeholders such as people with disabilities and Disabled Persons' Organisations, the case study offers ideas for what an inclusive environment might look like in Ulaanbaatar, Mongolia. Mongolia has been making progress in the domains of accessibility and inclusion since ratifying the UNCRPD in 2009, including establishing accessibility standards in 2009 and a law to 'Protect the Rights of Persons with Disabilities' in 2016. Current barriers to an accessible and inclusive built environment in Mongolia include: an implementation gap from policy initiatives and lack of clarity on responsibility or accountability, a lack of mandatory accessibility standards, limited understanding of inclusive design beyond physical accessibility interventions, limited space to build in accessibility due to urban planning constraints, a perception that inclusive design is expensive and limited awareness among stakeholders and the general population on the needs of people with disabilities. Suggested actions towards a more inclusive environment include: establishing a shared vision and ambition for an inclusive city among city stakeholders, education and awareness initiatives to support a culture of inclusion, developing examples of good practice to show how inclusive design can benefit everyone, develop an inclusive design approach that responds to Ulaanbaatar's unique geography, climate and culture and its resource constraints, and embed inclusive design and accessibility from the beginning of built environment interventions.
Giulia Barbareschi
added a research item
Globally, mobile technology plays a significant role connecting and supporting people with disabilities. However, there has been limited research focused on understanding the impact of mobile technology in the lives of persons with disabilities in low or middle- income countries. This paper presents the findings of a participatory photovoice study looking at the role that mobile phones play in the daily lives of 16 persons with disabilities in Kenya and Bangladesh. Participants used a combination of pictures and voice recordings to capture their own stories and illustrate the impact that mobile phone use has on their lives. Through thematic analysis, we categorized the benefits of mobile captured by participants as 1) Improved social connection; 2) Increased independence and 3) Access to opportunities. While mobile phones are ubiquitously used for communication, for persons with disabilities they become essential assistive technologies that bridge barriers to opportunities which are not accessible otherwise. Our paper adds evidence to the need for mobile phones for persons with disabilities to enable communication and connectivity in Support of Development.
Giulia Barbareschi
added a research item
To address issues around the provision of appropriate wheelchairs in low-and-middle income countries Motivation developed a new method for producing customized wheelchairs leveraging technologies such as Computer Aided Design and 3D printing. To test the feasibility and acceptability of this new provision system alongside the quality of the wheelchair manufactured, a 5-month study was carried out in Kenya. Five local members of staff and 8 expert wheelchair users were recruited as participants. The results of the study show that in general both the local members of staff and the wheelchair users had extremely positive opinions concerning this new delivery system. However, technical and logistic challenges will have to be taken into account in future wider implementations. Beyond the measurable outcomes recorded as part of the study, the project had a considerable impact on participants. The inclusive assessment process made wheelchair users feel empowered and increasing both their confidence and their knowledge about appropriate wheelchairs. Similarly, the staff at Bethany Kids reported that their involvement in the study changed the way they approach their clinical practice, making them more prone to listen and proactively involve users when prescribing a new wheelchair or adapting an old one.
Ben Oldfrey
added 2 research items
At least 1 billion people have a vision impairment that is uncorrected or could have been prevented. Refractive error is the most common cause and can easily be corrected with eyeglasses. The unmet need (at least 826 million) is concentrated in lower-and middle-income countries. Key market barriers include: low levels of investment by governments; high costs to the end-users; complex in-country supply chains; a service delivery model that requires high levels of resources in terms of personnel and infrastructure; limited number of points of services and sales; and low awareness and acceptance of eyeglasses. Innovations in the identification of refractive errors, refraction devices, service delivery, and eyeglasses themselves may provide opportunities to address some of these barriers. Increasing access to eyeglasses to eliminate the burden of uncorrected refractive errors in LMICs will require a multisectoral approach that brings together the public and the private sector, multilateral organisations, and donors. This will require an approach that increases the demand for eyeglasses, raises the number of access points for screening and provision, and accelerates the availability of affordable products. To achieve this, we propose five strategic objectives that can strengthen the market in both the short and longer-term: • Mobilise key stakeholders, including donors, multilaterals, NGO implementers, and the private sector, around reliable data and scalable proven models to accelerate efforts against vision impairment caused by refractive errors. • Strengthen global policy guidance around service delivery standards for low-resource settings to accelerate the adoption of innovative models, devices, and products that support a simplified service delivery. • Support governments to develop comprehensive eye care plans integrating validated models of vision screening and provision within the public health system, and facilitate scale-up of those models. • Engage the private sector to expand delivery of affordable, quality eyeglasses and related services in LMICs. • Build and drive awareness and consumer demand for eyeglasses. Full text available at: https://www.at2030.org/product-narrative:-eyeglasses/
TO ACCELERATE ACCESS TO ASSISTIVE TECHNOLOGY (AT), it is critical to leverage the capabilities and resources of the public, private, and non-profit sectors to harness innovation and break down barriers to affordability and availability. Market-shaping interventions can play a role in enhancing market efficiencies, as well as coordinating and incentivising stakeholders involved in demand- and supply-side activities. This document will address the key barriers and opportunities to increase access to prostheses services. Since there is a significant overlap in prosthetic and orthotic service delivery, access to orthotic services will also benefit from the proposed interventions. Full text available at: https://www.at2030.org/product-narrative-prostheses/
Catherine Holloway
added 3 research items
This report seeks to contribute to a better understanding of the issues around access to assistive technology in a global context. Utilising both primary and secondary research, various barriers to assistive technology have been identified and explored. Building on this work and developing opportunities and ways to overcome those barriers is a key part of this project.
The Sustainable Development Goals (SDGs) aspire to “leave no-one behind”. Universal access to assistive products is a critical link between the realization of the SDGs and those most likely to be left behind. However, assistive technology provision in many countries, particularly low- and middle-income countries, has traditionally been conducted through small-scale local providers, manufacturing products of varying degrees of quality at a limited price range. An effective way to scale these production and provision enterprises to the required level is needed to close the gap between available and required assistive technology. We argue that better access to assistive technology will only be realized through the adoption of a far stronger systems thinking and market shaping approach. We undertook a rapid literature review to explore the relationship between market shaping and assistive technology. Based on our review, we present an emergent framework for conceptualizing intersections between systems thinking and market shaping for assistive technology—the SMART (Systems-Market for Assistive and Related Technologies) Thinking Matrix.
Emma Tebbutt
added a research item
Technical Report from a pilot of a new WHO training resource - Training in Assistive Products (TAP). Training in assistive products (TAP) is an open access online learning platform, developed in response to the widespread shortage of personnel trained to provide assistive products (AP). TAP intends to equip primary/community health and other community-level personnel to provide a range of simple AP, selected from the World Health Organization’s (WHO) Priority Assistive Products List (APL) 1. The training modules teach a ‘four step’ approach for the safe and appropriate provision of these selected AP. During the development of TAP, modules are being piloted in different contexts around the world. The Papua New Guinea (PNG) pilot was carried out in June 2019, in collaboration with the National Department of Health (NDOH) Health Facilities Standards Branch, National Capital District Community (NCDC) Health Services, Port Moresby General Hospital (PMGH) Eye Clinic and the National Orthotics and Prosthetics Service (NOPS).
Emma Maria Smith
added 4 research items
To accelerate access to assistive technology (AT), we need to leverage the capabilities and resources of the public, private, and non-profit sectors to harness innovation and break down barriers to access. Market shaping interventions can play a role in enhancing market efficiencies, coordinating and incentivizing the number of stakeholders involved in demand and supply-side activities. Across health sectors, market shaping has demonstrated its potential to enhance national governments’ or donors’ value-for-money, diversify the supply base, and increase reliability – ultimately increasing product and service delivery access for end users. These market shaping successes in other health areas have led practitioners to hypothesize that market shaping could also be applied to assistive technology markets. ATscale, the Global Partnership for AT, aims to mobilise global stakeholders to shape markets in line with a unified strategy. To inform this strategy, it is critical to identify specific interventions required to shape markets and overcome barriers. The first product undergoing analysis by ATscale is wheelchairs. The market for appropriate wheelchairs in low-and middle income countries (LMICs) is highly fragmented and characterized by limited government interest, investment, and a low willingness-to-pay. Moreover, the market is dominated by cheaper, low quality wheelchairs which fail to meet the needs of end-users. Non-profit organizations have attempted to fill the need for context-appropriate wheelchairs, but market uptake is limited. These initial findings led ATscale to believe that market shaping could support increased access to appropriate wheelchairs. This paper outlines what market shaping is, and how it can be applied to assistive technology at large -- using the aforementioned wheelchair product narrative as an illustrative case study and presents the proposed market shaping strategy for wheelchairs. ATscale will develop a framework to evaluate short-term interventions identified to achieve a healthy market and increase access. This paper provides an opportunity to obtain feedback from interested stakeholders on the market shaping strategy for wheelchairs, as well as the product narrative process to be undertaken for other priority AT.
In the last decade, mobile phones have become invaluable allays in the everyday lives of people with disabilities. Even in low and middle income countries mobile phones are highly popular and the penetration rate of mobile technology is almost three times higher than for desktop computers and broadband lines. Despite their diffusion and their importance, large datasets on how people with disabilities in lower resourced settings use mobile phones, the services they access and the barriers they encounter when interacting with mobile technology, are scarce. This article presents data from a survey with 1000 participants that explored how people with disabilities use mobile phones and the impact that mobile technology has on their daily lives. Findings highlight the presence of a mobile gap with many people with disability struggling to acquire and operate mobile phones independently. Most respondents had only access to basic or feature phones that lacked appropriate accessibility features and offered limited functionality. However, participants still described mobile phones as invaluable tools that could increase access to basic services and offer support in many important activities in their daily lives.
Innovations within the AT space frequently fail to get to market and therefore to the people who could benefit from the products. The Scoping Report which underpins the AT2030 programme identified the need to test and develop “what works” for AT innovation to ensure new products, services and approaches are able to scale and reach people, especially people living in low- and middle-income countries. This paper sets out the initial thinking for an East Africa Innovation Ecosystem. We present the emerging thinking from initial scoping exercises and product trials which have helped to shape the newly launched Innovate Now ecosystem. We outline the ecosystem including the core elements – the accelerator programmes and Live Labs. Live labs will allow for rapid innovation testing and user feedback. Thus, increasing user-involvement in the design and development process, and reducing the time to market. The Innovate Now ecosystem is growing and is being led by AMREF. Successful graduates of innovate Now will be connected into the Innovation Scale Fund which will be launched by AT2030 next year (2020).
Giulia Barbareschi
added a research item
Living in an informal settlement with a visual impairment can be very challenging resulting in social exclusion. Mobile phones have been shown to be hugely beneficial to people with sight loss in formal and high-income settings. However, little is known about whether these results hold true for people with visual impairment (VIPs) in informal settlements. We present the findings of a case study of mobile technology use by VIPs in Kibera, an informal settlement in Nairobi. We used contextual interviews, ethnographic observations and a co-design workshop to explore how VIPs use mobile phones in their daily lives, and how this use influences the social infrastructure of VIPs. Our findings suggest that mobile technology supports and shapes the creation of social infrastructure. However, this is only made possible through the existing support networks of the VIPs, which are mediated through four types of interaction: direct, supported, dependent and restricted.
Emma Maria Smith
added a project goal
Over five years, AT2030 will test ‘what works’ to improve access to AT and will invest in and support solutions to scale with a focus on innovative products, new service models, and global capacity support. The programme will reach 9 million directly and 6 million more people indirectly to enable a lifetime of potential through life-changing Assistive Technology.