Chapter 1 Introduction

A girl is walking with two prosthetic legs while holding the hands of another girl on each side.Photo credit: @CDPF

Assistive technology (AT) can improve the daily lives of hundreds of millions of people around the world. AT is an umbrella-term for devices and associated services that help users live with greater autonomy and choice by facilitating daily activities they would otherwise be unable to do well, or at all. Assistive devices include a range of products, from wheelchairs, walkers, and crutches, to hearing aids, electronic reading devices, and braille displays. There are many groups who can benefit from AT. These include people with chronic health conditions or physical impairments, temporary injuries and diseases, older people, and people with disabilities.

The world so far has failed to meet the global need for AT. Well over one billion people today would benefit from at least one form of AT. This need is estimated to double by 2050 due to ageing global populations, increased prevalence of non-communicable diseases, and other factors. 3 Much of this need falls across four products and related services: hearing aids, prostheses, eyeglasses, and wheelchairs. Based on current estimates, nearly one billion people living in low-and middle-income countries (LMICs) require one or more of just these four devices, although the overall need could potentially be significantly greater. Yet only 5–15% of this population have access to AT. 4 This gap is a product of insufficient political will, lack of investment, and numerous systemic supply- and demand-side barriers. Despite efforts to overcome these challenges, access to AT continues to fall short of what is needed—and these essential technologies continue to receive little attention on the global agenda.

Figure 2: Number of people in need of the priority assistive devices*

This figure shows people in need of at least one of the indicated ATs; some overlap exists between users of each type. Nevertheless, this infographic demonstrates the scale of people touched by the four focussed AT devices and associated services. Each icon represents 10 million individuals. The numbers for different devices are as follows: Eyeglasses (reading) : 720 million Hearing aids : 54 million Prostheses : 35 million Wheel Chairs : 60 million Eyeglasses (prescription) :130 million

The significant unmet global need for AT is concentrated in LMICs. While access to AT is limited globally, the unmet AT need is disproportionately high in LMICs. For example:

Only 3% of the LMIC need for hearing aids is being met. 5
Only 5% of individuals in need in LMICs have a wheelchair compared to 90% of those in high-income countries. 6

Assistive technology can contribute to achieving global development targets

In order to meet the goals outlined in the 2030 Agenda for Sustainable Development—and live up to our commitment to ‘leave no one behind’—the global community needs to accelerate access to high-quality, affordable, appropriate AT. Guided by human rights instruments—including the UN Convention on the Rights of Persons with Disabilities (CRPD)—the 2030 Agenda for Sustainable Development heralds a global commitment to reducing inequality in the pursuit of sustainable development worldwide. The 2030 Agenda and its 17 Sustainable Development Goals (SDGs) pledge to ‘reach the furthest behind first,’ including people with disabilities and other disadvantaged groups. While disability is recognised as a cross-cutting issue for the implementation of all the goals, eight SDG targets and 11 indicators explicitly reference disability.

‘As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the goals and targets met for all nations and peoples t for all segments of society. And we will endeavour to reach the furthest behind first.’

2030 Agenda for Sustainable Development

small graph with the icons of the 7 SDGs linked to assistive technology

Greater access to AT has a direct link to accelerating progress on SDG 1 (No Poverty), SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), SDG 8 (Decent Work and Economic Growth), SDG 9 (Industry, Innovation and Infrastructure), SDG 10 (Reduced Inequality), and SDG 17 (Partnerships to achieve the Goal).

A host of other global agreements have also recognised commitments to the rights and inclusion of people with disabilities—these include The Sendai Framework for Disaster Risk Reduction (2015); The Addis Ababa Action Agenda (2015); Habitat III and the commitment to a disability- inclusive New Urban Agenda (2016); and, within the World Humanitarian Summit 2016, the resulting Charter and Interagency Standing Committee Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action (2016, 2019).

SPOTLIGHT:

The Convention on the Rights of Persons with Disabilities

The Convention on the Rights of Persons with Disabilities (CRPD) is the highest international standard that articulates the right to AT for people with disabilities. The CRPD reinforces that all people with disabilities should enjoy all human rights and clarifies and qualifies how all categories of human rights apply to people with disabilities. It outlines where adaptations should be made for people with disabilities to exercise their rights, where violations often occur, and where protections should be reinforced.

AT can mitigate institutional and physical barriers and help people contribute to, and benefit from, society on an equal basis with others. People with disabilities make up a large user group of AT. Within the global disability community, AT is recognised as a basic right, and is specifically referenced within the Convention on the Rights of Persons with Disabilities. The Convention states that people with disabilities ‘include those who have long-term physical, mental, intellectual, or sensory impairments, which in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others.’ 7 The importance of AT in helping to overcome some physical, communication, and information barriers is specifically noted and referenced throughout the Convention. It is a critical component of support, which, alongside non-discrimination and accessibility, is a precondition for inclusion and participation in society.

International legal obligations for AT have thus far not been translated into sufficient action and investment. While international pledges to these agendas and movements are an important step, action and investments will be required to ensure that commitments are met. For example, ‘The UN Flagship Report on Disability and Development’ (2018) showed that despite recent progress, people with disabilities, among other AT users, continue to be at a considerable disadvantage regarding the implementation of the SDGs. This disadvantage stems from numerous barriers that limit people with disabilities from participating fully in their communities, including lack of access to AT, essential services and support; stigma and discrimination; and inaccessible physical and virtual environments. Significant progress in funding and implementing AT-supportive programmes will be critical to the full and inclusive achievement of the SDG Agenda.

Photo of a training session in Africa. A man in a wheelchair demonstrates how to manoeuvre obstacles placed on the ground in front of a group of wheelchair users. Photo credit: ©David Constantine, Motivation

This report presents the case for investing in AT and an assessment of the rate of Return on Investment (ROI). It is meant to inform those who have not previously considered its role in transforming the lives of users. As this report will demonstrate, investing in AT both has a transformative impact on people’s wellbeing and makes sound economic sense for funders and governments. It is both the right thing to do and a smart thing to do.