## Health benefits

Access to assistive technology increases the wellbeing of people who need it. Providing the four focus assistive devices and services to people in need across LMICs will lead to over one billion additional quality-adjusted life years (QALYs) over the lifetime of the people in need today.

Table 2: Breakdown of health benefits from AT access

| HEARING AIDS | PROSTHESES | EYEGLASSES | WHEELCHAIRS
| CHILDREN | ADULTS | CHILDREN | ADULTS | CHILDREN | ADULTS | CHILDREN | ADULTS
Total QALYs | ~3 million | ~20 million | ~40 million | ~170 million | ~40 million | ~950 million | ~30 million | ~90 million
Total QALYs across products | ~ 1.3 billion
Cohort size | 4 million | 50 million | 5 million | 30 million | 20 million | 830 million | 10 million | 50 million
Avg. QALYs / user | ~0.6 | ~0.4 | ~8.9 | ~5.2 | ~1.8 | ~1.1 | ~2.7 | ~1.8
Avg. QALYs / user across products | ~1.3

User

Filling the unmet need for AT leads to improved health outcomes and greater access to health care for users, resulting in over one billion additional QALYs over the users’ lifetimes.

Based on the experiences of AT users, providing the four products to those who need them in LMICs would produce an average of 1.3 ‘quality-adjusted life years’ per person. A quality-adjusted life year (QALYs) provides a ‘common currency’ to assess the benefits of health-related interventions on a person’s quality of life. They measure ‘lives improved’ One QALY represents a year of life with ‘perfect health.’ It expresses how much an individual’s ability to, for example, conduct day-to-day activities free of pain and mental distress, incorporating such factors as mobility restrictions, ability to independently self-care, and engagement with work and leisure, changes before and after the intervention.28 For example, a child who continues to receive the prosthetic device needed over their lifetime will on average see an improvement worth 8.9 QALYs – the equivalent of 8.9 years of ‘perfect health.’ Providing the four products to the 900 million people in LMICs who need them would collectively produce the equivalent of over one billion years of perfect health. 32

These benefits come from a combination of improved physical and mental health and increasing access to existing health services. Although AT alone does not constitute a complete solution and systems and societies still need to become more inclusive and accessible, 33 WHO has noted improved health outcomes among users after receiving AT. 11, 11 The primary driver of these gains is greater access to, and utilisation of, health services. While current evidence is inconsistent, lived experience speaks to reductions in secondary conditions, such as pressure sores amongst wheelchair users, and increased ability to engage in healthy personal habits following uptake of properly fitted AT. Many users are also better able to avoid accidents and identify and respond to threats to personal safety.

I. Improved user outcomes

Increased use of AT is directly linked to improved physical and mental health by preventing or reducing the impact of secondary conditions. Both the US Center for Disease Control and Prevention (CDC) and WHO report that people with disabilities, as a subset of AT users, are often at a higher risk of experiencing from secondary conditions related and unrelated to their disability, such as obesity, diabetes, and chronic fatigue. 11, 34 Research on AT and the reduction of pressure sores has so far been mixed, but hearing aids have been shown to reduce incidence and severity of dementia as well as improving balance and reducing falls. 35, 36, 37 At a basic level, access to AT is likely to improve health outcomes simply through facilitating increased mobility and physical activity.

No less critically, AT can have a profound effect on the mental health of users. Dealing with barriers (including stigma) and feelings of isolation, among other daily challenges for those in need of AT, can increase stress and contribute to negative mental health outcomes. Data show that people with physical disabilities, among other AT users, are three times more likely than the general population to experience depression. 38, 39 AT can be an important tool for helping users overcome some of these barriers and better engage with those around them.

II. Greater access to care services

AT can help people overcome widespread barriers to accessing healthcare services. Many people in need of AT must overcome physical barriers—such as lack of accessible and affordable transportation—in order to access health services. For example, across lower-income countries, a reported 30% of people with disabilities (compared with less than 20% of those without disabilities) could not access healthcare due to transportation costs—such as the added expense of taxis or ride-shares when public transit is inaccessible. 11 People who need AT often also contend with communication barriers, attitudinal barriers within health facilities, lack of services, and inappropriate treatment options—all of which contribute to the fact that individuals with disabilities in lower-income countries are three times more likely to be denied treatment than those without disabilities. 11 While AT cannot address all of these barriers, it plays an important role in helping users overcome some of them.

For women, in particular, greater access to health facilities and better communication with health staff allow users greater access to sexual and reproductive health services and with support in addressing violence and abuse. For example, increased access to care has shown to improve rates of cervical cancer screening. Women can also better communicate with their care providers, which improves understanding and uptake of offerings such as family planning tools.

Family

Meeting the unmet need for AT not only improves users’ health outcomes; it also provides increased economic opportunities for those supporting users.

Access to AT can improve the mental and physical health of supporting family members by reducing their fatigue and anxiety and freeing up more time for other activities. Family members of those needing AT have been shown to face significantly greater risk of mental distress, including elevated rates of depression, anxiety, and suicide. 40 Further, data have shown that the leading reason parents of people with disabilities fail to seek out mental health services is a lack of time amidst existing support-giving responsibilities. 40 Just as AT use alleviates users’ needs for some forms of support and can free up time for family members to engage in paid work, it can also mitigate the levels of stress and fear that family supporters experience and enable them to seek out formal health services. Thus, the family and community members who support AT users often see improvements in their own wellbeing.

SPOTLIGHT:

How a wheelchair benefits a whole family

Renu lives in New Delhi with six members of her family, including her 11-year-old daughter Jiya. When Jiya was born, the doctors told Renu that she had cerebral palsy, which would cause some delay in her development. The family believed it could manage.

Jiya started in a special school with the help of her mother and grandmother. The school provides physiotherapy with special education and teaches Jiya about supporting herself.

But the school is 40 minutes by train from home. Before she had a wheelchair, Renu and Jiya’s grandmother had to transport Jiya in a child’s pram. Renu suffers from back pain, which made the journey even more difficult.

Now, the family has a wheelchair that is comfortable for Jiya to sit in. Jiya has better posture in the chair, improved neck control, and can sit for a much longer time. In fact, she often chooses to remain in it after she has come home from school.

For Renu and her mother, the new wheelchair is manageable on the trains and can be carried up and down steps with two people. Now it is possible for Jiya’s grandmother to stay with Jiya at school on her own—two people are not needed. Renu can receive treatment on her back while Jiya is in class.

Society

Meeting the unmet need for AT not only improves users’ health and economic outcomes; it also provides increased economic opportunities for those supporting users.

I. Health system savings

Greater access to preventive care can reduce total longer-term health system expenditures. Primary and preventive healthcare is significantly cheaper and more cost-effective than curative tertiary and referral-based care. 41 By facilitating greater utilisation of preventive services, and thereby preventing the development of more serious comorbidities, AT can contribute to savings across national-level health systems. At the same time, data also suggest that in some cases these savings may be offset by the significant increase in total healthcare consumption among AT users as they overcome some of the barriers they currently face to accessing all care. However, even if overall health spending may go up, improved access to health services for more people is fundamentally a good thing, contributing to a healthier workforce, which is a more productive workforce. This further contributes to the economic gains discussed above and more than offsets any increase in health expenditure.

II. Universal health coverage

Investing in increased AT provision ultimately represents an important step for countries towards the achievement of universal health coverage. One of the targets of the SDGs, universal health coverage (UHC), is a commitment to ensuring that ‘all individuals and communities receive the health services they need without suffering financial hardship.’ UHC includes ‘the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care’. 42 Given the range of health and other benefits AT facilitates for users, AT must be a critical part of UHC packages.

Furthermore, AT’s potential to expand users’ access to other health services makes it an even more important part of guaranteeing affordable and effective care and promoting more equitable outcomes for all.

III. Safety

AT can help users more safely navigate their environment and engage with one another. Hearing aids, wheelchairs, prostheses, and eyeglasses improve users’ safety when navigating outside the home by helping them avoid accidents and identify and respond to threats to personal safety. Eyeglasses, for example, contribute to greatly reducing traffic fatalities for drivers. 43

Figure 5: Social benefits of AT provision