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Disability and Rehabilitation: Assistive Technology
ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20
Assistive technology policy: a position paper
from the first global research, innovation, and
education on assistive technology (GREAT) summit
Malcolm MacLachlan, David Banes, Diane Bell, Johan Borg, Brian Donnelly,
Michael Fembek, Ritu Ghosh, Rosemary Joan Gowran, Emma Hannay, Diana
Hiscock, Evert-Jan Hoogerwerf, Tracey Howe, Friedbert Kohler, Natasha
Layton, Siobhán Long, Hasheem Mannan, Gubela Mji, Thomas Odera
Ongolo, Katherine Perry, Cecilia Pettersson, Jessica Power, Vinicius Delgado
Ramos, Lenka Slepičková, Emma M. Smith, Kiu Tay-Teo, Priscille Geiser &
Hilary Hooks
To cite this article: Malcolm MacLachlan, David Banes, Diane Bell, Johan Borg, Brian Donnelly,
Michael Fembek, Ritu Ghosh, Rosemary Joan Gowran, Emma Hannay, Diana Hiscock, Evert-Jan
Hoogerwerf, Tracey Howe, Friedbert Kohler, Natasha Layton, Siobhán Long, Hasheem Mannan,
Gubela Mji, Thomas Odera Ongolo, Katherine Perry, Cecilia Pettersson, Jessica Power, Vinicius
Delgado Ramos, Lenka Slepičková, Emma M. Smith, Kiu Tay-Teo, Priscille Geiser & Hilary Hooks
(2018) Assistive technology policy: a position paper from the first global research, innovation,
and education on assistive technology (GREAT) summit, Disability and Rehabilitation: Assistive
Technology, 13:5, 454-466, DOI: 10.1080/17483107.2018.1468496
To link to this article: https://doi.org/10.1080/17483107.2018.1468496
© 2018 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group.
Published online: 23 May 2018.
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ORIGINAL RESEARCH
Assistive technology policy: a position paper from the first global research,
innovation, and education on assistive technology (GREAT) summit
Malcolm MacLachlan
a,b,c
, David Banes
d
, Diane Bell
e
, Johan Borg
f
, Brian Donnelly
g
, Michael Fembek
h
,
Ritu Ghosh
i
, Rosemary Joan Gowran
j
, Emma Hannay
k
, Diana Hiscock
l
, Evert-Jan Hoogerwerf
m
, Tracey Howe
n
,
Friedbert Kohler
o
, Natasha Layton
p
, Siobh
an Long
q
, Hasheem Mannan
r
, Gubela Mji
b
,
Thomas Odera Ongolo
s
, Katherine Perry
t
, Cecilia Pettersson
u
, Jessica Power
v
, Vinicius Delgado Ramos
w
,
Lenka Slepi
ckov
a
x
, Emma M. Smith
y
, Kiu Tay-Teo
z
, Priscille Geiser
aa
and Hilary Hooks
a
a
Assisting Living & Learning (ALL) Institute, Maynooth University, Maynooth, Ireland;
b
Centre for Rehabilitation Studies, Stellenbosch University,
Tygerburg, South Africa;
c
Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic;
d
David Banes
Access, Doha, UK;
e
Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa;
f
Lund University, Sweden;
g
CECOPS CIC,
Buckinghamshire, UK;
h
Essl Foundation, Vienna, Austria;
i
Mobility India, Bangalore, India;
j
Department of Clinical Therapies, Faculty of Education
and Health Sciences, University of Limerick, Limerick, Ireland;
k
Acasus, Hong Kong, Hong Kong;
l
Help Age International, London, UK;
m
AIAS
Bologna onlus, Bologna, Italy;
n
Glasgow Caledonian University, Glasgow, UK;
o
Hammond Care Braeside Hospital, University of New South Wales,
Sydney, Australia;
p
Department of Health Professions, Swinburne University of Technology, Hawthorn, Australia;
q
Assistive Technology and
SeatTech Services, Enable Ireland, Dublin, Ireland;
r
Health Systems Research Group, University College Dublin, Dublin, Ireland;
s
African Disability
Forum, Addis Ababa, Ethiopia;
t
Independent Consultant & Policy Advocate, Brussels, Belgium;
u
Department of Architecture and Civil
Engineering, Chalmers University of Technology, Goteborg, Sweden;
v
Centre for Global Health, Trinity College Dublin, Dublin, Ireland;
w
Faculdade de Medicina da University of S~
ao Paulo, S~
ao Paulo, Brazil;
x
Olomouc University Social Health Institute, Palacky University Olomouc,
Olomouc, Czech Republic;
y
Graduate School, University of British Columbia, Vancouver, British Columbia, Canada;
z
Melbourne School of
Population and Global Health, Melbourne University, Melbourne, Australia;
aa
International Disability Alliance, Geneva, Switzerland
ABSTRACT
Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for
many citizens to become, or continue being, meaningful participants in society. However, there is a signifi-
cant shortfall between the need for and provision of AT, and this is patterned by a range of social, demo-
graphic and structural factors. To seize the opportunity that assistive technology offers, regional, national
and sub-national assistive technology policies are urgently required. This paper was developed for and
through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT)
Summit; organized under the auspices of the World Health Organization’s Global Collaboration on
Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address
and recognizes that AT policy should be tailored to the realities of the contexts and resources available.
AT policy should be developed as a part of the evolution of related policy across a number of different
sectors and should have clear and direct links to AT as mediators and moderators for achieving the
Sustainable Development Goals. The consultation process, development and implementation of policy
should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and
imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access
to AT and are addressed systematically within this paper. We illustrate an example of good practice
through a case study of AT services in Norway, and we note the challenges experienced in less well-
resourced settings. A number of economic factors relating to AT and economic arguments for promoting
AT use are also discussed. To address policy-development the importance of active citizenship and advo-
cacy, the need to find mechanisms to scale up good community practices to a higher level, and the
importance of political engagement for the policy process, are highlighted. Policy should be evidence-
informed and allowed for evidence-making; however, it is important to account for other factors within
the given context in order for policy to be practical, authentic and actionable.
äIMPLICATIONS FOR REHABILITATION
The development of policy in the area of asssitive technology is important to provide an overarching
vision and outline resourcing priorities.
This paper identifies some of the key themes that should be addressed when developing or revising
assistive technology policy.
Each country should establish a National Assistive Technology policy and develop a theory of change
for its implementation.
ARTICLE HISTORY
Received 27 February 2018
Revised 19 April 2018
Accepted 19 April 2018
KEYWORDS
Disability; policy; assistive
technology; impairment;
ageing; economics;
accessibility
CONTACT Mac MacLachlan mac.maclachlan@mu.ie Assisting Living & Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
African Network for Evidence to Action on Disability (AfriNEAD).
ß2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
2018, VOL. 13, NO. 5, 454–466
https://doi.org/10.1080/17483107.2018.1468496
Introduction
The aim of this position paper is to outline a broad framework for
discussing the principles that should underlie assistive technology
policies for application nationally or internationally. However, we
will also consider aspects of strategy or action plans where such
aspects are relevant to policy being realistic and achievable, across
often vastly different contexts. Table 1 gives our working defini-
tions of assistive products, assistive technology systems and social
exclusion; one of the major barriers that we argue can be over-
come by assistive technology.
The difference between policy, strategy and action plans is
often not clear, and these terms are used in different and often
over-lapping ways in the literature. Table 2 summarizes how we
use these terms. Based on our engaging with the literature and
our experience of working with a range of stakeholders on these
issues, we suggest these are the most parsimonious and useful
ways of distinguishing between these terms.
It is also important to understand the role of legislation in rela-
tion to these processes. Legislation refers to statutory law; mean-
ing laws that have been approved and enacted by the governing
body of a country –the government. This may also require estab-
lishing State institutions to ensure that the law is practised in the
way intended and that it has the anticipated results. If it does not,
then it may require legislative revision. Sometimes advocacy
groups may undertake strategic litigation, where they take a spe-
cially selected case (which is often representative of the experi-
ence of many people) to court in order to show that the law is
unfair and, therefore, attempt to change the law. Alternatively, a
local authority may have established a policy concerning an
assistive technology system and citizens may have come to rely
on this service; but if it is not legislated for, there may be nothing
stopping the local authorities withdrawing the service at some
future point.
The relationship between policy, strategy and action plans
should be one of "cascading": both operationally (how things are
done), locally and regionally; ensuring that there are effective
mechanisms for national policies to successfully work in often
quite different subnational contexts. This may mean that the same
things are done in somewhat different ways and perhaps by dif-
ferent organizations, groups or individuals, in different places.
Depending on the context, the policy may need to be flexible
enough to foresee diverse ways of achieving the same ends, so
that citizens can achieve the rights legislated for in their
country’s law.
International policies, strategies and action plans on
assistive technology
Assistive technology was first introduced in international policies
through the Standard Rules on the Equalization of Opportunities
for Persons with Disabilities [3], and was further entrenched into
international policies with the advent of the Convention on the
Rights of Persons with Disabilities (CRPD) [4]. The Incheon
Strategy “Make the right real”is an example of a strategy that
includes the provision of assistive technology as an important
means to achieve disability-inclusive development [5]. The World
Report on Disability [6] has highlighted the need for action to
improve the provision of assistive technology globally, and this
has been reiterated in the Global Disability Action Plan 2014–2021
[7]. Similarly, the Global Strategy and Action Plan on Ageing and
Health 2016–2020 [8], recognizes the vital role of assist-
ive technology.
In the Standard Rules, one of the four rules on preconditions
for equal participation requires States to ensure the development
and supply of assistive products to assist people with disabilities
to increase their level of independence and to exercise their
rights. As important measures to achieve the equalization of
opportunities, States should ensure the provision of assistive prod-
ucts according to the need. Besides supporting the development,
production, distribution and servicing of assistive products, States
are to support the dissemination of knowledge about them.
States should also recognize that all who need these products
should have access to them, which includes financial accessibility.
Assistive products should be provided free of charge or at such a
low price that people requiring AT or their families can afford
them. Moreover, States should consider requirements of girls and
boys concerning the design, durability and age-appropriateness of
assistive products [3].
In contrast to the general approach of the Standard Rules, the
CRPD is more selective in mentioning assistive technology as a
measure that States should take to promote, protect and ensure
the full and equal enjoyment of all human rights and fundamental
freedoms. However, assistive technology measures are not
included –at least not explicitly –in all relevant CRPD articles.
Despite this limitation, the principles of Article 3 on non-discrimin-
ation, equality of opportunity, and equality between men and
women, as well as Article 5 on elimination of discrimination on
the basis of disability, infer that States are to ensure that all peo-
ple, irrespective of disability, gender and age, have access to
affordable assistive products [9].
It is also important to note that accessibility (of which access
to assistive technology is a part) is a precondition to the enjoy-
ment of other rights. The CRPD Committee’s second General
Table 1. Definitions of assistive products, assistive technology systems and
social exclusion.
An assistive product is “any product (including devices, equipment, instruments,
and software), either specially designed and produced or generally available,
whose primary purpose is to maintain or improve an individual’s functioning
and independence and thereby promote their wellbeing”[1]. The term
“assistive technology”is often used as a generic term.
Assistive technology systems refer to “the development and application of organ-
ized knowledge, skills, procedures, and policies relevant to the provision, use,
and assessment of assistive products”[1]. This therefore includes training in
the use of assistive technology and other infrastructure and technologies,
such as ICT, that promote the effectiveness of assistive technology.
Social exclusion is " …a complex and multi-dimensional process …[which]
involves the lack or denial of resources, rights, goods and services, and the
inability to participate in the normal relationships and activities, available to
the majority of people in a society, whether in economic, social, cultural or
political arenas. It affects both the quality of life of individuals and the equity
and cohesion of society as a whole”[2].
Table 2. Defining and differentiating policies, strategies and action plans.
Policy is a set of principles adopted or proposed by a government, party, busi-
ness, or individual. It provides the ‘What and Why’of a course of action. A
policy might for instance be based on principles of equity, social justice, or
entrepreneurship and mandate equitable access to specific services
or products.
Strategy provides a map for how policy can be enacted, a blueprint for how to
proceed –it provides the ‘How’of a course of action. This may include defin-
ing specific goals, analyzing the situation, identifying barriers, specifying
deliverables, or envisaging future scenarios.
Action Plans indicate the way in which strategy will be enacted, they zoom in
on the detail of the action –they address the “Whom, When and Where”
ASSISTIVE TECHNOLOGY POLICY: GREAT POSITION PAPER 455
Comment was on Article 9: Accessibility [10]. It stresses the inter-
relation of this right with other rights and articles (e.g., Articles 9,
19, 21, 28.2a, 26.3). The Comment asserts that “Accessibility”is
related to groups, whereas reasonable accommodation is related
to individuals. This means that the duty to provide accessibility is
an “ex-ante”duty; meaning that it must be provided before the
fact of it becoming a problem –States must ensure accessibility,
‘up front’as it were.
The recent Report of the Special Rapporteur on the rights of
persons with disabilities (2017), while broader than assistive tech-
nology, also describes how to provide rights-based support and
assistance to persons with disabilities, in consultation with them.
The CRPD also indicates that rehabilitation services (including
assistive technology) should be provided as close as possible to
where people live (Articles 26.1b, 25c). This is important for
smaller countries, particularly small island countries, which may
not have assistive technology production capacity. In such situa-
tions, other mechanisms need to ensure adequate procurement
sources. Finally, it is important to note that the responsibility of
States that have ratified the CRPD to ensure affordable provision
of assistive technology is not limited by country borders. Through
Article 32 on international cooperation, States commit to both
technical and economic cooperation on assistive technology.
Assistive technology policy and international
development
It is important to position assistive technology policy within the
broader context of international development generally as well as
more specific policy innovations, and conventions should be dir-
ectly relevant to people with a range of impairments, including
the aging population, who may benefit from the use of assistive
products. The Sustainable Development Goals [11] is a set of 17
goals, internationally agreed-upon, that will guide international
efforts across all countries to target their development efforts to
ensure that “nobody is left behind”. Recently Tebbutt et al. [12]
have illustrated how the achievement of each of these 17 goals
can be facilitated through the incorporation of assistive technol-
ogy, at the population level, when planning to reach these goals.
Assistive products can be conceived as both mediators of social
change (i.e., as a mechanism social change works through) and as
moderators of that change (as a factor that determines the extent
of the change, particularly whether it reaches the more marginal-
ized and vulnerable groups in society).
Within this context a global increase in awareness of the need
for quality, affordable, and reliable assistive products is evident.
The World Health Organization (WHO) has coordinated a collab-
orative effort through the Global Collaboration on Assistive
Technology (GATE) to maintain Assistive Technology at the fore-
front of global and sustainable developments. The remit of GATE
necessitates that it is relevant to all people who experience
impairments in whatever realm and at any age: this includes, for
example, people with non-communicable diseases, injury, visual or
hearing loss, mental health conditions including dementia and
autism, gradual functional decline, or frailty. As such, assistive
technology has an important role to play in promoting access to
education, employment, justice, health and wellbeing; as well as
to the broader cross-cutting values of promoting social inclusion
and participation, independence and autonomy (or chosen inter-
dependence) and leading a dignified and consequential life.
Assistive technology cuts across all sectors and ages, and it is
paramount that policy initiatives recognize and reflect this, rather
than seeking to silo it. This presents policy makers with the signifi-
cant challenge of providing a fully integrated system that is
capable of delivering at the population level, while at the same
time providing specific assistive technology that matches to the
particular needs of individual users (namely the Matching Person
and Technology (MPT) Model [13] or the Human Activity Assistive
Technology Model [14]).
We are living in a rapidly changing world due to the digital
revolution that is not only changing the way people live, learn,
produce and even think; but also changing decision-making proc-
esses, the way information is delivered, problems are solved and
policies are developed. This also makes the distinction between
high- and low-tech assistive products increasingly blurred, and has
the potential to reduce price barriers to high tech solutions. From
a systems perspective the digital revolution should be seen as a
resource for AT user empowerment and participation in reaching
the SDGs, whilst also being careful to avoid the risk of a wider
digital and technological divide by not incorporating these oppor-
tunities systemically [15].
Khasnabis et al. [1] have outlined some of the key components
that need to be addressed in the Assistive Technology system and
the Commentary paper in this special issue [16] describes the
principal P’s that should also be considered in policy develop-
ment. To avoid overlap, we therefore refer the reader to the
MacLachlan and Scherer paper [16] which should be read in con-
junction to this policy paper, particularly for examples of a sys-
tems thinking perspective in Assistive Technology.
Policy gaps
Different types of gaps exist in a number of areas relevant to pol-
icy development in this field. This includes, the identification of
short and long-term evidence that would be useful for policy
making, the use of existing data and information within policy,
fostering policy development in an inclusive manner, the evalu-
ation of existing policy according to human rights and social
inclusion criteria, the implementation of policy, and its monitoring
and evaluation by an appropriate range of stakeholders, especially
the consumers and users of such technology. Very often policy-
makers –including in the health and welfare sectors –are not
familiar with disability, impairment or assistive technology issues,
and are, therefore, not aware of some of the policy challenges in
this area, including the significant challenge of cross-sectoral
working [17].
In many countries, the first step in creating inclusive policy for
assistive technology will be to connect different communities with
an interest in assistive technology; to encourage sharing experien-
ces and best practices, and to simply become aware of stakehold-
ers already working in this field –from various international
organizations, governments, academics, data experts, standardiza-
tion bodies and of course civil society organizations. There are
very different ways to build this community, and the community
will be strongest if a thorough mapping process to establish exist-
ing formats, technologies and stakeholders is undertaken.
Stakeholders who are often overlooked in these processes may
include (but are not limited to), self-advocates for the independ-
ent-living movement, Indigenous peoples in countries where their
inclusion is often marginalized, rural people –especially women
and girls –in poorly resourced settings; people with intellectual
disabilities [18] for whom assistive technology may be especially
beneficial for community living [19], refugees or internally dis-
placed people.
In the APODD (African Policy on Disability and Development)
project [17], three types of policy gaps were identified: A Policy
Awareness Gap –where policy makers knew little about disability-
specific policy instruments (e.g., CRPD), and disability
456 M. MACLACHLAN ET AL.
representatives knew little about the policy instruments used in
mainstream international development. There was also a Policy
Process Gap, even where there was consultation with Disabled
Peoples Organisations (DPOs), the final version of documents
rarely reflected their primary concerns. A third gap, a Policy
Implementation-Monitoring Gap, was also noted, where there were
a lack of explicit indicators for monitoring and evaluation, that
were disaggregated by disability, or had disability specific con-
cerns. We anticipate that many of these gaps will also be appar-
ent for the users of assistive products. For instance, Gowran et al.
[20] give an example of the policy gap that exists in the provision
of wheelchair and seating assistive technology in Ireland; high-
lighting the need for greater awareness of those more distant
from service provision, for example, policy makers. They also indi-
cate the process gap across a number of facets of assistive tech-
nology systems –for example, when accessing services, assessing
and delivering services, tracking, tracing and taking care of assist-
ive technology; providing education for all and advanc-
ing research.
Figure 1 illustrates a simplified conceptualization of the primary
components involved in policy development and implementation.
While some models suggest an idealized linear sequence; again
this is rarely our experience, with the components often being
combined in non-ideal, time-limited and resource-constrained cir-
cumstances, substantially funnelled through the needs of local
contexts and settings. Each of these components should nonethe-
less be addressed through inclusive policy development and
implementation processes [21].
Engaging in policy often requires understanding the triggers
for policy change, or renewal. While the CRPD and other inter-
national policies may well set the context for a discussion on
assistive technology policy; such instruments on their own are
rarely sufficient to propel government towards policy work. So
what sort of argument may engage the attention of government
and policy makers? Evidence concerning the social, economic and
wellbeing benefits, and impact, of assistive technology, may be
especially persuasive. The widespread fragmented delivery of serv-
ices, which are often mainly reactive, with many silos, and often
with many specialists in the “supply chain”, is a very costly way to
provide a service. Thus, arguments addressing the need for
improved efficiency may be relevant. With the increasingly
emphasis on person-centeredness, on co-design and on user-led
initiatives; it may also be argued that the ethos of the assistive
technology sector, is out of kilter with government policy else-
where, and, therefore, serves to diminish its coherence and overall
effectiveness.
It is also crucial not to underestimate the challenges of produc-
ing good policy in this domain. For instance, policy has to be
across all sectors, in the same way that people live across all sec-
tors. It also needs to consider the whole-life-span approach to
people’s lives. These are both difficult for government, requiring
cross-ministerial work and for government to commit to long
term planning, which may not be expedient for shorter-term polit-
ical gain. More generally, for governments to have a policy on AT,
it has to be made clear that it is all AT i.e., everything from walk-
ing sticks to digital health; and this also fits in with holistic and
person-centred care and support. However, policy is often most
influenced by financial rewards for doing something, or financial
penalties (through prosecution or reputational damage) for not
doing something. The economic case for assistive technology,
therefore, needs to be strengthened and is perhaps one of the
most important change factors for improving assistive technology
systems. The economic case will be made most emphatically
when there is evidence of the effectiveness of assistive technology
at the individual, community and Sate/national levels; and so
research, monitoring and evaluation has to target these different
levels in ways that allows for the findings to be integrated
meaningfully.
Empowering people
While it is people who empower people, assistive technology can
contribute to creating the conditions where this is possible. The
CRPD promotes the rights and perspectives of people to be cen-
tral to policy development. A critical route to empowerment is
the establishment, by States, of mechanisms for DPO (Disabled
People’s Organisations) engagement in policy development, moni-
toring and evaluation. Articles 4–3 of the CRPD obligate State to
actively consult with DPOs in decision-making. DPOs can help ori-
ent priorities, provide inputs on what works and what does not,
and suggest and provide strategies to reach out to persons with
disabilities. This is critical to ensure the view of users is considered
and that the assistive technology policy is grounded in a rights-
based approach that truly empowers them.
Figure 1. Components of the policy process (reproduced by permission [21]).
ASSISTIVE TECHNOLOGY POLICY: GREAT POSITION PAPER 457
In addition to Articles contained within the CRPD, research sug-
gests that around a third of assistive products that are provided
may go unused; providing a powerful pragmatic and economic
argument for AT user involvement and training. In other contexts,
this perspective, most recently referred to as PPI (“public and
patient involvement”) recognizes that public participation enhan-
ces the design and delivery of better services [22]. Research also
indicates that the greater the extent to which such participation is
formalized in established structures, the more satisfactory are the
results [23].
This presents policy makers with an intriguing contradiction. If
policy development or reform is to effectively address the needs
of those who have been marginalized by mainstream society (and
previous policy), then such processes need to be explicitly disrup-
tive –meaning they need to explicitly change the structures that
oppress and marginalize. Structures in the process of policy
reform need to be established to “institutionalise disruption”(see
[21]). This may mean, for instance, re-imagining systems for the
delivery of assistive products, it may mean the development of a
new cadre working across a range of assistive products; it may
mean self-assessment for some assistive products. Stronger user
involvement in the policy process also presents the opportunity
to potentially uproot and transform prevailing power structures
that may, by design or default, be perpetuating a lack of access
to assistive products.
Our overarching schematic of the strategic issues for assistive
technology systems depicts the interlocking areas of People,
Place, Pace, Personnel, Products, Provision and Policy; it is pre-
sented in Figure 3.
Progressive bridging of the assistive technology
system gap
We base our conceptualization of access on the General Comment
of the United Nations Committee on Economic, Social and
Cultural Rights (2000), and we then apply this to the assistive
technology systems in a country. According to the General
Comment a State should have policies and programs that pro-
mote the availability (sufficient quantities), accessibility (both
physically, economically and in terms of provision of information),
acceptability (culturally, socially, gender and age appropriate),
adaptability (appropriate to local contexts) and quality (in terms
of safety, efficacy and usability and being evidence-based) of
assistive products and services. These criteria –known as the
“AAAAQ”–should also be adopted with regard to the rights of
participation, accountability and transparency, in their perform-
ance. We also supplement this with two additional, and crucial,
“A”s for assistive technology. The first additional A –Affordability
–is so crucial for this sector that it needs to be unpacked from
the concept of Accessibility more generally. Second, many people
with functional impairments, particularly (but by no means only)
in resource poor contexts, are simply not aware that many impair-
ments that may be alleviated, or overcome, by the use of assistive
technology. In fact, this applies not just to potential users but also
to health and social care personnel in resource rich and poor
areas. Thus, Awareness is the second addition, as a key moderator
of access to assistive technology.
Figure 2 illustrates our understanding of how the real gap
between the need for and provision and use of appropriate assist-
ive products should be unpacked and understood in terms
of access.
Consistent with the CRPD which promotes “progressive real-
ization”(while all rights may not be achievable immediately,
States should be able to show that they are on a path to their
realistic achievement), we recognize that policy should also adopt
this principle (re Pace, discussed in Scherer et al. [16]; along with
and recognition that “domestication”of best practice (as with the
CRPD) may play out differently, in different contexts (refer to
Place, as discussed in Scherer et al. [16]). However, it is clear that
disability and access to assistive technology is often heavily gen-
dered; with girls and women often having less opportunity to
access it; which may also reflect other inequities regarding wealth,
age, ethnicity or geography (e.g., remote and rural areas). So,
while progressive realization and domestication may result in var-
iations between countries, it is very important that these do not
reinforce general practices of discrimination, towards girls, and
women, as a particular example.
A systems-thinking perspective (see [16]) also requires taking a
long-term view of the Assistive Technology system. Responding to
the assistive technology needs of people is not a single step pro-
cess that finishes as soon as the person has an appropriate solu-
tion. Rather, delivering on Assistive Technology involves
supporting people over a longer period in their developing new
or associated technology needs. The participation of empowered
Assistive Technology users in sectors such as education and
employment is highly desirable, as well as their political and cul-
tural participation, but policy makers should be aware that those
sectors need to be prepared to welcome the participation of all.
At micro-level, this means carefully managing change. At the
macro-level, Assistive Technology provision should be seen as a
crucial part of wider efforts to build a more inclusive society.
Good practice in assistive technology systems: a
country case study of Norway
Sund [24] has described the Norwegian Assistive Technology
model, established in 1995. Its primary objectives included (1)
establishing a unified, national system for assistive technology, (2)
addressing users’practical/functional daily problems regarding the
AT they used, (3) giving the users rights in law to necessary and
appropriate assistive products, free of charge, (4) providing users
with the same level of services regardless of where they live, (5)
establishing a common ICT system for registration of purchases,
distribution, repairs, regular servicing and refurbishment of assist-
ive product, and (6) user involvement in the system and a focus
on the individual strongly emphasized. To facilitate this structur-
ally, Norway established 18 assistive technology centres (hereafter
Figure 2. A schematic representation of Assistive Technology System gaps.
1
Note
this bar chart is not to scale –globally the number of assistive products needed
far exceeds those available; sometimes by a ratio of 10 or more to one, and this
is patterned by socioeconomic factors, marginalization and so on.
458 M. MACLACHLAN ET AL.
denoted AT centres) –one in each county (administrative area) of
the country. Each AT centre coordinates assistive technology activ-
ities within their county, and cooperates closely with the local
health and rehabilitation services, in order to address the users
practical/functional daily problems (see also, Nordic Cooperation
on Disability Issues [25]).
Importantly, it is the local authorities (the municipalities) that
have the fundamental responsibility for health care, and social
and rehabilitation services; including the provision of assistive
products. Trained personnel (usually occupational therapists or
physiotherapists) are responsible for identifying and assessing the
usersneeds, recommending and providing assistive products, as
well as following up the users situation in daily life.
If appropriate rehabilitation or health care services are not
available in the local community, the individual will be referred to
the AT centre in their county. These centres are centres of excel-
lence serving as a referral system covering the whole county and
they give services and guidance within mobility, hearing, vision,
communication, cognition and the environment. The AT centres
have personnel (such as occupational therapists, physiotherapists,
technicians/engineers, speech therapists, opticians) with expert
knowledge about the application and adaptability of assistive
products. They give guidance to the local authorities and other
stakeholders in the county. More local community authorities ask
for assistance from the AT centre if the local network does not
have sufficient expertise. In some cases, the municipalities and AT
centres cooperate with retailer or suppliers of assistive products in
order to solve the users practical/functional problems. This helps
to ensure that users see professionals with the same expertise
and are given the same level of service regardless of where
they live.
Within the overall national AT system, there are also some
national competence centres with distinct areas of expertise that
also can be called upon by county AT Centres. Based on national
agreements with the retailers and/suppliers, AT centres purchase
assistive products and distribute them to the different municipal-
ities. They also repair the assistive products when needed, and do
regular servicing of electro-medical assistive devices at given inter-
vals. Interestingly, in terms of sustainability, about one-third of the
distributed assistive products are refurbished ones. These recycled
products have had worn parts replaced and the assistive products
are cleaned properly and should be “as new”before being pro-
vided to a new user. The AT centres organize and run yearly train-
ing courses on assistive technology for employees in the
municipalities and hospitals. There is a considerable emphasis on
the assistive products being be safe to use. Table 3 highlights
some relevant statistics regarding the Norwegian AT system, as
of 2016.
While Norway is a comparatively very rich country, its system-
atic-tiered approach to assistive technology is noteworthy, and its
commitment to recycling a significant proportion of its assistive
products –or their components –also demonstrates a strong
commitment to cost-saving. These and other aspects of its
Table 3. Some attributes of the Norwegian Assistive Technology System
(see [26]).
Norway has 5.2 million inhabitants, of which approximately 20% (as of 2015)
live in rural areas (see: http://www.indexmundi.com/facts/norway/
rural-population).
138,150 users received one or several assistive products from the AT centres.
They constituted 2.7% of the population
56.6% of the users were women
64.1% of the users were 67 years of age and older
11.4% of the users were 18 years of age or younger
2,240 US dollars per user or 60 US dollars per inhabitant were spent on
assistive products
37,190 ordinary repairs of the assistive products were performed. 81.0% of
these were performed by technicians at the AT centre (78.0%) or by deal-
ers (22.0%)
78.0% of the assistive products were delivered within the target of 3 weeks
of assessment.
Figure 3. The Norwegian Assistive Technology System model: 18 Assistive Technology Centres, one in each county, cooperate closely with the health care and rehabili-
tation services at the municipal level.
ASSISTIVE TECHNOLOGY POLICY: GREAT POSITION PAPER 459
geographically inclusive approach may well be relevant to many
more poorly resourced policy contexts.
Areas with different resources may be able to recycle in differ-
ent ways. So, in the case of wheelchairs, reusing a wheelchair
means that it has been cleaned with minor repairs and issued for
reuse; refurbishing means that the wheelchair has been com-
pletely revamped to “as good as new”condition, ready for reissue;
while recycling a wheelchair mean taking it out of commission
and recycling the materials and parts. Policy may indicate the
need for, and prioritize the resources for, some or all of these; and
seek to achieve them in a systemic way. Allowing them to occur
in an ad hoc manner is not likely to be the most efficient use of
resources at a national level.
Some dimensions of assistive technology policy: results
of a stakeholder consultation
Scholl and MacLachlan [27] undertook a literature review, a focus
group with WHO regional representatives, Key Informant inter-
views and three country case studies through in-country inter-
views and document analysis (in South Africa, Philippines and PDR
Laos). They sought to identify what people felt were important
elements to include in the development of a framework to sup-
port countries in developing national assistive technology policies.
Their specific aim was to explore the relevance of policy themes
used in the ground-breaking and now well established WHO
Essential Medicines List, which has the aim of making essential
medicines more accessible, globally. This aim is, therefore, cogent
to the Priority Assistive Products List (APL). The research also
addressed facilitators and barriers for the AT sector across these
different settings. Table 4 summarizes the themes that arose from
this research.
Policy in low- and middle-income countries
It is important to say that many of the critical issues for assistive
technology policy are similar in high-, middle-, and low-income
contexts; thus the challenges in Figures 1–3are common.
However, in poorly resourced contexts, there are often additional
challenges. As assistive technology presents opportunities to
address social exclusion, the allocation of resources in poorer set-
tings is crucial. Our definition of social exclusion (Table 1) stresses
the “lack or denial of resources, rights, goods and services, and
the inability to participate”and goes on to state that this lack or
denial of resources affects “equity and cohesion of society as a
whole”[2]. Generally, in low- and middle-income countries (LMIC),
the provision of assistive products is inadequate with poorly struc-
tured systems in place to aid service delivery [28,29]. We have
found that policy development in such contexts –and often in
higher-income contexts too –frequently excludes its intended
beneficiaries, and may indeed be undertaken by consultants
unfamiliar with the country in question, and with reference points
related to contexts with much greater resources. Wazakili et al.
[30] in their study of inclusion of persons with disabilities in
poverty reduction strategy processes (PRSPs) in Malawi found that
they often had limited knowledge about the PRSP process, which
partly accounted for their limited participation in policies that are
geared towards poverty alleviation.
In some countries, the situation is poor –there is a negligible
assistive technology industry and/or few professionals to provide
appropriate technologies. Where assistive products are available,
they are often unaffordable to the majority who could benefit
from them. Cheaper assistive products, when they are available,
are often of poor quality, poorly adjusted and serviced, or inad-
equately explained, and thus difficult and off-putting to use [31].
Articles 4 and 26 of the Convention make it clear that ultim-
ately, governments are responsible to ensure that appropriate
assistive technology is available and affordable and that provision
is made for users to be trained to use assistive products [29,31].
Recently both the South African National Departments of
Health and Social Development have drawn from the CRPD to
develop the white paper on disability and rehabilitation frame-
work strategy. Both documents put emphasis on the importance
of available and affordable assistive technology for persons with
disabilities [32]. Yet other research in South Africa suggests that
the failure to effectively implement the health and rehabilitation
articles of the UNCRPD is largely due not only to negative atti-
tudes in society in general [32] but also from government officials
and service providers towards people with disabilities [33] and a
rights-based approach. This certainly incorporates most people
who use assistive products. Fundamentally then, it is not only
improved “systems”but also changed organizational, societal, reli-
gious and cultural attitudes that are necessary to improve access
at the systems and policy level. However, it may be that the
actual use of assistive products can itself change attitudes in a
positive way. In Bangladesh Borg et al. [34] found that people
using assistive products were about three times more likely to
report positive attitudes from neighbours, than did people with
similar impairments who did not use assistive products.
Although stigma towards disability is a worldwide problem, it
is important to stress that in all cultural and economic contexts
there are valuable resources that can be harnessed to promote
assistive technology systems. For instance, in Africa, AfriNEAD
((the African Network for Evidence to Action on Disability) see
[35]) represents a ready vehicle to promote policy dialogue on
assistive technology. Cultural resources such as the Ubuntu phil-
osophy of collective support and harmony can be a facilitative
context in which to develop supportive and empowering services
and opportunities [36]. Of course the Ubuntu ethos can be found
in context elsewhere too: engaging key stakeholder to reflect and
work collectively; to share understanding as a community of prac-
tice for sustainable development in AT and other support serv-
ices [20,37].
The importance of assistive technology for the ageing popula-
tion is now being recognized globally and even in resource-rich
countries it is a significant challenge. For instance, a systematic
review of “intelligent assistive technology”(IAT; meaning more
technologically sophisticated) for dementias found that while the
IAT spectrum continues to expand rapidly, in volume and variety;
many structural limitations to successful adoption persist. These
include insufficient clinical validation and insufficient focus on
potential user’s needs; and this even in comparatively very weal-
thy countries. In poorer contexts, such as Puerto Rico, Hispanic
older adults with functional limitations living independently, were
found to have unmet assistive technology needs; particularly to
compensate for physical limitations and to increase safety per-
formance, mostly around instrumental activities of daily living [38].
Table 4. Possible elements of, facilitators for and barriers to, the development
of national assistive technology policies.
Elements: Affordability, Financing, Supply Systems, Regulation & Quality
Assurance, Rational Use, Research & Innovation, Human Resources,
Monitoring & Evaluation, Governance
Barriers: Conceptual, Capacity, Civil Society, Financing, Geography, Governance,
Human Resources, Rationale Use, Supply Systems
Facilitators: Civil society, Country Context, Political Will, Strong
Partner Landscapes.
460 M. MACLACHLAN ET AL.
Access to assistive technology continues to be a problem,
often especially so in rural areas. In rural China, this has also been
reported along with the barrier that “vague and complex regu-
lations”constitute their use [39]. For many countries with quite
rapidly aging populations, these challenges will have to be quickly
and systemically addressed by resources being provided on the
basis of well-articulated policy. The focus of much recent innov-
ation and developments in assistive technology has been on high
tech solutions and whilst appropriate there is probably a greater
need for more low tech affordable assistive technology products
for safety and instrumental activities of daily living. There are also
advantages of scale in addressing the accessibility of the environ-
ment in community, workplace and public settings, through
dropped curbs, ramps, lifts and handrails and communication
(e.g., hearing loops).
Assistive technology across the life course
In some countries, 46% of people with disabilities are older peo-
ple (aged 60 or over; https://www.un.org/development/desa/dis-
abilities/disability-and-ageing.html). The proportion of people with
disabilities who are in this older group is likely to increasing in
most countries, in coming years. This being the case it will be
important for assistive technology policy to adopt a life-course
perspective. This should reference to global movement for older
people and their work in advocating for better services, including
assistive technology. Older People’s Associations (OPAs) and
Disabled People’s Organisations (DPO’s) could perhaps have
greater impact on assistive technology policy and provision by
working more closely together; and this is something that can be
promoted through the process policy development [21].
From a life course perspective, we see moments along the
course of our lives where we need to access assistive technology,
not only for permanent use but also short term; and so policy
needs to cater for these different types of scenarios and needs.
The life course perspective also embraces the need for such policy
to be cross-sectoral –for instance, across education, employment
and health. Seeing the assistive technology implications of disabil-
ity, or chronic illness, along the life course, also recognizes that
assistive technology research and practise will have to develop a
much stronger population science ethos; rather than being siloed
in rehabilitation, with another silo in disability, another in educa-
tion, and so on. This surely is the crux of the policy challenge to
social inclusion at the population level.
The economic case for investing in assistive technology
Improved functioning from the use of assistive technology may
have wide ranging positive economic impacts on individuals and
society. As discussed below, the economic benefits stem from
improved health outcomes and quality of life, better education
and employment outcomes, and higher productivity. These bene-
fits could translate into a reduction in the health and social care
costs associated with impaired functioning. More broadly, the
benefits of assistive technology may also extend to a stronger
labour supply and industry development, which would benefit the
economy as a whole.
Assistive technology has been shown to improve health out-
comes and quality of life for people in need, and for care givers.
This includes comparative improvements in overall health
reported by users of wheelchairs [40], quality of life and physical
health among hearing aids users [41–43]; and better quality of life
and reduced symptoms of depression among nursing home resi-
dents who used spectacles [44]. Evidence also shows slower
functional decline and higher likelihood of maintaining independ-
ence among older people living with a disability who received
assistive products and home modification [45]; positive health and
social effects from an accessible home environment among peo-
ple with functional limitation [46]; as well as positive impacts of
assistive products on children with physical impairments and their
caregivers [47]. A systematic review by Chase and colleagues
found that AT and home modifications along with other interven-
tions prevented falls among community-dwelling older adults [48]
(see also Cho et al. [46]).
Evidence suggests that improved health outcomes could
reduce healthcare and social care costs. For example, Bensi et al.
[49] reported savings of e290,000 per person, over a 5-year period
because of increased autonomy, reduced dependence on personal
assistants and improvement in quality of life through greater con-
trol of living spaces through home adaptation, mobility and living
aids, and other AT interventions. The Disability Federation of
Ireland and Enable Ireland [50] also found comparable annual sav-
ings of e59,000 per person, following the provision of environ-
mental control technologies at home. Likewise, Barnard [51]
demonstrated that AT can result in 45% lower costs for funding
authorities in a single year.
Assistive technology also has an important role to play in keep-
ing people living in their own homes, in their own communities.
In reviewing investment to allow older people to remain living
within their own homes Snell, Fernandez and Forder [52] found
that equipment and adaptations led to reductions in the demand
for other health and social care services worth on average £579
per recipient, per annum. Such services lead to improvements in
quality of life of the person, which they estimated to be worth
£1522 per annum in reduced service requirements. Based on an
estimated average scenario and a client base of 45,000 individuals
receiving interventions at a total cost of approximately £270 mil-
lion, it is likely to generate reductions in the demand for health
and social care services worth £156 million, over the lifetime of
the equipment, and to achieve quality of life gains costed at £411
million [52].
The provision of assistive technology could confer positive
impacts on existing and future workforce. The impact could be as
direct and immediate as returning a person to work by providing
a prosthetic limb and rehabilitation; or improving the vision of
workers by providing corrective lenses. For example, workers with
poor vision in Rwanda, not wearing glasses, were three times
more likely to be asked by supervisors to repeat their work of
sorting coffee beans, than after receiving and wearing glasses
[53]. Importantly, assistive technology also helps with laying the
foundation for a stronger future workforce through increasing lev-
els of education and better education outcomes. Earlier fitting of
hearing aids contributes to better language, academic and social
outcomes in children [54]. In China, the provision of free glasses
to children with short-sightedness was found to improve their
performance on mathematics test to a statistically significant
degree [55]. These are important mediators for building skills for
the future workforce.
The cost of retaining an employee who acquires a disability is
considerably less than the cost of hiring and training new employ-
ees. Work Without Limits [56] suggest that such costs range from
$3000 to $22,000 depending on the seniority of the post, consid-
erably higher than the average $500 spent on accommodations.
Parry [57] notes “the average cost to accommodate an employee
with a disability is $500, the benefits can be substantial: employ-
ees with disabilities are five times more likely to stay on the job
than their counterparts without a disability. That translates into
less money and time spent hiring employees.”Work Without
ASSISTIVE TECHNOLOGY POLICY: GREAT POSITION PAPER 461
Limits [56] suggest that 46% of reasonable accommodations at
work cost absolutely nothing; with another 45% having a one-
time cost, typically around $500. They also assert that employees
with disabilities often exhibit high retention rates, which can
translate into financial savings for employers.
The assistive product market is set to greatly expand in the
near future, fuelled by population growth and increased longevity,
as well as advances in technology. For example, the global market
for assistive products for the elderly and people with disability
was valued at US$14.1 billion in 2015. By 2024, the market is esti-
mated to reach US$26.0 billion, corresponding to a compound
annual growth rate of 7.4% between 2016 and 2024 [58].
In many countries, domestic markets for assistive products and
related industries are relatively new and awaiting further develop-
ment. Developing local industry could not only serve to meet the
local demand at an affordable cost, but also to provide opportuni-
ties for job creation through enhancing local technical capability
and innovation. Furthermore, like other industries, the benefits
would have positive spillover effects to the broader economy
along the value chain of the primary (raw materials), secondary
(manufacturing) and tertiary (service) sectors. The potential of the
sector has been noted by some governments and has been incor-
porated into their economic development plan. For example, the
State Council of the People’s Republic of China has issued a plan
to foster “innovation capability, industry upgrade, effective market
supply and a favourable market environment, to enhance industry
development”, with a view to generating outputs of more than
¥700 billion (US$103.3 billion) from the rehabilitation and assistive
products industry [59]. Other examples include the emerging
hearing device manufacturing sector in a number of countries,
including India, Brazil and Thailand [60].
The argument for the growth of the assistive technology indus-
try within countries may be persuasive for policy-makers, and in
capturing parliamentary interest. At the First Global Assistive
Technology Conference in Beijing (2014) (http://www.ispoint.org/
events/global-conference-assistive-devices-technology-industry),
the Heads of State from China and Germany were present to test-
ify to their country’s support for and interest in assistive technol-
ogy; this was also clearly demonstrated by the strong presence of
manufactures form both countries at the accompanying EXPO
trade fair. The Second Global Assistive Technology Conference,
Beijing 2017, explicitly linked assistive technology to China’s ambi-
tious “Belt and Road”initiative; for increasing its trade and cultural
links with Asia, Africa and Europe. Such initiatives have high-
lighted the importance of policy addressing market shaping.
Market shaping in the assistive technology context refers to
engaging market factors with social equity; balancing these to
allow genuine need due to impairment to develop into reliable
demand for assistive products, and for affordable and quality sup-
ply to embrace social gain, as well as financial profitability [61].
Another relevant policy issue is that many assistive technology
products are viewed by States as medical devices and are subject
to rigorous legislative requirements or subject to particular stand-
ards (for instance, as approved by the International Standards
Organization, ISO). Whilst this may be appropriate in many circum-
stances, it can be restrictive for access in other contexts, where in
particular some lower-tech solutions may be more realistic, more
affordable and more likely to be effectively maintained. Standards
may, therefore, need to be more dimensional than absolute, with
of course minimum standards to ensure safety and the prevention
of harm to users. Onerous legislative requirements also drive up
cost, time to development and can be off putting to investment
by innovators and industry; thus reducing availability and
affordability.
A final and often neglected aspect of assistive technology eco-
nomics is that many types of assistive products can help increase
productivity for those that are not living with a disability –leading
to wider application of current technologies and, therefore,
increasing economic benefits. Indeed, mainstreaming accessibility
and various forms of assistive technology within existing products
is a key focus for many of the leading technology companies
today. So for instance Apple’s development of Siri or Microsoft’s
eye-gaze technology are examples of assistive technologies that
have gone mainstream and can contribute to everybody’s prod-
uctivity and quality of life.
The role of active citizenship
The full and active participation of civil society –in particular
DPOs as organizations representing a diversity of users of assistive
technology –is important in order to authenticate the policy pro-
cess. We highlight three issues where civil society has an espe-
cially important role. Access to relevant information for all social
actors in a timely and accurate way is crucial. In particular, with
regard to persons with disabilities, it is necessary to ensure that
information can be provided in accessible and alternative formats,
in order to promote the full and effective participation of this
group. Civil society is often the provider of accessible formats;
such as through screen readers, screen magnifiers, or text to
speech devices; but also formats not necessarily provided by tech-
nology, such as Easyread or Sign Language.
Capacity building programs in areas such as human rights
advocacy, leadership and awareness raising, designed for and usu-
ally run by civil society organizations, are critical in enabling peo-
ple with disabilities, DPOs and NGOs, to claim rights and develop
focused campaigns on achieving them. Policy needs to identify
channels for how this activity can contribute to policy develop-
ment and implementation. Without providing such channels, and
legitimizing this activity, rights claimers are placed on the
‘outside’, and can be seen as negative and critical of government,
when in fact they are advocating for internationally agreed human
rights principles. Creating a space for meaningful participation –
including DPOs and NGOs as representative organizations –is also
about ensuring the conditions for meaningful participation are
created, in terms of staff sensitized, accessibility of venues and
accessible information and communication. There is thus a corre-
sponding need to heighten awareness within policy-making
domains that those on the ‘outside’share many of the same goals
as policy makers. It may well be that important lessons can be
learned from the experience of other marginalized groups (such
as women and girls, ethnic minorities and older people) to influ-
ence mainstream policy.
Once completed, these first steps can lead to civil society rep-
resentatives being empowered; this may include forming national
coalitions, meeting government officials to review, monitor and
oversee national policies. It may also involve people with disability
securing leading roles in government, business, education, in fact,
in any area of life. An important role of civil society is also to
highlight the intersectionality of disability and assistive technology
needs. For instance, people with impairments come from all walks
of life and age; they may be men or women; members of indigen-
ous society, who may themselves be marginalized; they may live
in isolated rural areas, or urban slums. To ensure that policy
becomes fully inclusive, these intersectional forms of marginaliza-
tion have to be recognized and taken into account; preventing
different forms of marginalization multiplying disadvantage. For
instance, the use of assistive technology is associated with inclu-
sion and wellbeing even among marginalized groups in very
462 M. MACLACHLAN ET AL.
difficult circumstances; such as children with amputations in Gaza
[62]. However, we recognize that there are often greater barriers
for those with a weaker voice, such as people with intellectual dis-
ability, who also have much to benefit from initiatives such as
GATE [18] and so greater efforts need to be made to address
these barriers.
The International Disability Alliance brings together over 1100
organizations of persons with disabilities and their families; from
across eight global and six regional networks, and will continue to
advocate the global community to create the conditions for the
effective realization of the rights enshrined in the CRPD at country
level. This implies systematic and meaningful consultation with
persons with disabilities (including assistive technology users) and
their representative organizations to guide the definition, monitor-
ing and evaluation of assistive technology policies (in line with
CRPD Article 4.3). IDA and its members are an important conduit
for mobilizing the diversity of users, including most marginalized
groups such as persons with intellectual disabilities, persons with
psychosocial disabilities, persons with deaf-blindness or indigen-
ous persons with disabilities; bringing the perspective of users of
assistive technology, in all service research, procurement and
delivery. IDA, with its Members, is particularly concerned by the
need to frame assistive technology policies that truly respond to
the rights of all persons with disabilities, in particular in low and
middle income countries, to access quality assistive technology, at
an affordable cost, as close as possible to where people live. This
includes influencing assistive technology policies, public procure-
ment policies as well as ensuring that accessibility and reasonable
accommodation, including assistive technology, is included and
properly resourced in all concerned public policies [63].
While civil society has a critical representational and advocat-
ing role –and, in some cases, is a major service provider –it is
also important to ensure that policy cultivates the expectation of
civil duty being shared among all of us. It is, therefore, crucial that
such duty is not partitioned or separated; not a “them”or “us”;
but rather a shared responsibility to be addressed through
acknowledging ownership of the challenges of promoting equit-
able assistive technology systems and working through engage-
ment with people as working as a sustainable community
of practice.
Scaling good practices
National Assistive Technology policies should recognize the poten-
tial of small-scale good practices to be scaled in a variety of ways.
This is particularly important in resource poor contexts, where a
range of different service providers (including different civil soci-
ety organizations) may have developed small-scale but innovative
projects; that lack the infrastructure to be brought to the next
stage. The value of adopting a systematic approach to scaling,
such as Expandnet (http://www.expandnet.net/) (which chimes
with a human rights perspective and with the presence of civil
society actors), is a principle that should be anticipated in policy.
Such scaling may require action at the structural level (scaling-up)
as well as replication (scaling-out) of existing good practices.
Examples of structural change that promote some aspects of the
CRPD have been reported in various countries by the UNPRPD
Programme (see [11]); although none of these projects has as yet
focused on scaling assistive technology initiatives other groups
are working towards this [20].
Why policy and evidence differ
Cairney [64] cites four obstacles to evidence-based policymaking.
First, even where “the evidence”exists, it doesn’t actually tell you
what to do: This may occur because evidence points to problems,
but not solutions; it may focus more on effectiveness than appro-
priateness; scientists may exaggerate or disagree about findings,
implications or implementation methods; evidence may be patchy
because it crosses traditional disciplinary or policy boundaries; or
evidence may be presented in an unsystematic, unfamiliar, or
impenetrable format, perhaps coming from foreign countries
and contexts.
Second, the sort of evidence that is needed, is not what is avail-
able –demand for evidence does not match the supply: Research
funding may prioritize “magic bullet”interventions, that would
reduce or remove the need for political choice; the scientific
method may narrow focus on simplified and controllable variables,
while policy makers seek solution to complex problems; “the
evidence”may be interpreted selectively, or differently by policy
makers; who may need to make decisions quickly amidst uncer-
tainty; need to make decisions, the consequences of which may
take years to unfold and which are influenced by other factors.
Third, in the complexity of policymaking the role of evidence may
be unclear and contested: Many researchers do not understand the
policy process and other stakeholders may know better how to
influence it; the demand for evidence may depend on which gov-
ernment department is involved, which may favour some types or
sources of evidence over others.
Fourth, and perhaps most surprising for researchers, evidence-
based policy making and good policymaking, are not synonymous:
For instance, reducing evidence-policy gaps may mean centraliz-
ing power in the hands of just a few policymakers and ignoring
other sources of knowledge (such as personal experience and
judgement). It may mitigate against public or user involvement, it
may not value consultation with stakeholders with different per-
spectives, and thus it may undermine participatory approaches to
policy making.
We would add a fifth element: that policies should be policy-
based: By this, we mean that a National Assistive Technology
Policy should articulate with other cogent polices; be they inter-
national conventions (e.g., CRPD), best practice in relevant aspects
of regulation and law making [65], or more context-relevant
national polices (for instance, on rehabilitation or inclu-
sive education).
In our view, Assistive Technology policy must, therefore, be evi-
dence-informed, but its fundamental basis must be broader and
more inclusive than of only evidence that accords with strictly sci-
entific standards. A variety of stakeholder views, contextual, cul-
tural, resources and systems perspectives must also inform policy;
ideally with these perspectives being assessed and synthesized in
systematic and transparent ways that also further increases their
credibility. While some forms of evidence review, such as realist
synthesis, give much more emphasis to contextual and process
issues than do conventional systematic reviews (see for instance
[66,67]) for participation to be genuine, there can never, in prin-
ciple, exist a one-to-one transformation from scientific research to
policy: this is neither realistic nor desirable.
Policy needs political engagement
Many of those who are evidence-producers (researchers, practi-
tioners, users) are often unsure how, or simply unwilling, to
undertake effective political engagement. At other times, advo-
cates are frustrated by the difficulty of getting assistive technol-
ogy on the political agenda. People may talk of political
engagement wistfully; in opaque terms, as a factor outside their
control; or in negative terms, as a vaguely dirty business that is a
ASSISTIVE TECHNOLOGY POLICY: GREAT POSITION PAPER 463
necessary evil. The reality of the demands on policy makers is that
direct and persistent engagement is required to hold their atten-
tion, particularly on new ideas that may initially appear as yet
another demand.
Effective political engagement is a critical success factor in a
number of areas where assistive technology is salient –health,
education, employment. To be realistic about developing policy
on assistive technology systems, it is likely that a country will
need several assistive technology leaders, or champions, who can
understand the political landscape in which they work, translate
technical content into compelling material to engage politicians,
network and interact with key stakeholders; in short, to become
policy entrepreneurs. Some elements of this work will require
such advocates to be supported by, or undertake, a detailed polit-
ical economy analysis of factors likely to propel change in the
desired direction, and those likely to impede it.
Conclusions
This position paper demonstrates the complexity involved when
generating policy towards sustainable assistive technology provi-
sion. States that have ratified the CRPD have reporting obligations
to the CRPD Committee, to outline just how they are planning to
do this. While the general ethos of the Convention is supportive
of assistive technology, it is nonetheless rather vague (e.g., see
[9]). Currently, many States that have reported have not made ref-
erence to assistive technology within their reports [68]. We feel
the development of, and adoption of, a General Comment on
Assistive Technology (i.e., a statement additional and complimen-
tary to the CRPD) would be very helpful in both the development
of National Assistive Technology Policies, and in guiding the
Committee on how to most constructively respond to States
reports submitted to it, especially regarding those sections per-
taining to assistive technology, or indeed the absence of
such reporting.
Among other things assistive technology policy should pro-
mote ageing from a life course perspective, the need for popula-
tion level data, reducing rehabilitation silo-ing, promoting inter-
sectoralism and intersectionality, the need for more low-tech
assistive technology, universal and environmental access, the insti-
tutionalization of disruption, and the scaling of good practices. It
should also value evidence-informed as opposed to evidence-
based policy.
Work is currently underway on the development of a
Framework to guide and evaluate assistive technology policy; and
many of the ideas in this paper will inform that framework. We
need to evaluate –both quantitatively and qualitatively –the
extent to which policies, strategies and action plans related to AT,
incorporate principles of human rights and enable equitable
access in practice. This calls for analysis of policy “on the books”
where it does exist, the process of policy making, it implementa-
tion, and the documentation of the lived experiences of persons
using AT. Fundamentally, we need to make a leap forward to
user-centred systems thinking, crossing sectors, in the same way
as people’s lives cross sectors. Without this dramatic change in
approach assistive technology may become increasingly siloed,
divisive and inequitable; undermining basic principles of social
justice, on which the CRPD, as well as other human rights
Conventions and Declarations, are based.
The WHO have shown a commitment to highlighting the
importance of providing appropriate assistive technology to those
who need it, especially through GATE. While raising awareness
about assistive technology and the broad range of people it may
be crucially important for, generating an in-depth understanding
of the issues and need for context specific policy remains a huge
challenge. The identification of examples of good practice in
terms of assistive technology systems-thinking and its applications
might be useful. Borrowing from the success of Handicap
International’s“Making it Work”program (referring to good prac-
tice examples of the CRPD); good practices across very different
contexts could provide inspiring human stories –compelling nar-
ratives of success. A coordinated series of real life stories and case
studies to aid assistive technology champions engage with policy
makers might be a very useful tool for advocacy. This could fea-
ture users, carers, communities, professionals and policy makers;
describing difficulties that are able to be overcome by assistive
technology products and systems.
National assistive technology policy should aim to provide a
national system with oversight to ensure sustainable, efficient and
effective monitoring, supply and servicing of assistive technology,
which appropriately meet peoples’ever changing needs across
the life course. A National institute or committee, regulatory body,
or similar structure, should be representative of people with a var-
iety of assistive technology needs. Such a body should be charged
with specifying exactly how the State, as the primary duty bearer,
will fulfil its obligations and embrace its responsibilities from a
human rights, justice and equality of opportunity perspective.
This paper has not attempted to be either comprehensive or
exhaustive, but rather to highlight some of the key policy chal-
lenges for effective national assistive technology systems. As rec-
ognized by the GATE Research Agenda [69], this is a priority
research area; and one that requires the involvement of all stake-
holder and many different types of methodological approaches. It
is therefore crucial that policies not only reflect the outcomes of
research but also prioritize –and resource –the collection of data
that will be used to continually inform, review and
improve policy.
Acknowledgements
We very grateful to the many participants in the GREAT Summit
who provided stimulating discussion points, some of which have
also been included in this paper.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
Diane Bell https://orcid.org/0000-0003-2139-0012
Johan Borg https://orcid.org/0000-0003-4432-5256
Rosemary Joan Gowran https://orcid.org/0000-0001-8114-5815
Hasheem Mannan https://orcid.org/0000-0001-6209-2586
Gubela Mji https://orcid.org/0000-0002-6477-4123
Jessica Power https://orcid.org/0000-0001-8015-2562
Vinicius Delgado Ramos https://orcid.org/0000-0002-4566-6637
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