The article below is part of the ‘WHO-Watch’ program,which is an effort of the People’s Health Movement,aWHO-Watch programme. The programme works towards democratising global governance for healthand involving young activists in following the governing body meetings of the World Health Organisation – the Executive Board meeting in January and the World Health Assembly in May – every year.
Assistive technology (AT), a subset of health technology, embodies scientific and technological innovations. It refers to application of organised knowledge and skills related to assistive products, including systems and services. Assistive products include any external product – devices, equipment, instruments or software – especially produced to maintain or improve an individual’s functioning and independence, and thereby promote his or her well-being.
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As per WHO estimates, more than 1 billion people require assistive technology, while 90 per cent of these have no access to it. As the prevalence of non-communicable diseases increases, the need for ATs is rising. Assistive technology is not only required by people with disabilities, but by elderly, people with mental health conditions or autism and people with gradual functional decline as well.
In the 68thsession of United Nations General Assembly on ‘disability and development’ held on September 2013, country members signatory to United Nations Convention of Rights of Persons with Disabilities (UNCRPD) requested WHO to develop and coordinate a global initiative to support country members in realisng their obligations in UNCRPD.
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The convention of the Rights of Persons with Disabilities, 2007 was phenomenal shift from viewing persons with disabilities as “objects” of charity to medical treatment and social protection towards viewing persons with disabilities as “subjects” with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society. This convention was adopted on December 13, 2006 at United Nations Headquarters in New York and is ratified by 177 countries. It is legally binding on the countries who ratified this convention to bring their existing laws and rules in conformity with United Nations Convention of Rights of Persons with Disabilities (UNCRPD).
Following a consultative meeting (Geneva, July 3 and 4, 2014), the Secretariat established the Global Cooperation on Assistive Technology in partnership with international organisations, donor agencies, professional organisations, academic institutions and user groups.
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The draft resolution on this agenda was prepared by EMRO region, while Pakistan and Ecuador were the leading nations in drafting. The floor opened to discuss and consider the draft resolution on improving access to assistive technology. Pakistan started first and put forth strongly the need of affordable and quality assistive products as human rights and stated that the need is concentrated in Mediterranean region.
Most of the countries were proactive in the discussion, and endorsed the adoption of draft resolution to improve access of investing in assistive technology and priority assistive product list. As ageing population is increasing along with prevalence of NCDs, mental health issues and other disabilities, the need for ATs is even greater. Countries like Bhutan, Brazil, Sri Lanka, Ecuador, Korea, and Ghana pointed that in spite of efforts of the interagency support groups like UNCRPD, WHO, ILO, only 1 in 10 person has access to the AT, which highlights the gravity of the issue, and makes it more important to put concentrated efforts in improving access. Countries like Libya, Iraq, Thailand, Ghana, and Germany also considered access to AT as important pillar of universal health coverage, primary health care and in implementation of the 13thGeneral Programme of Work, and that access to devices requires systemic strengthening and reinforcement.
Further, USA claimed to be leader in assistive technology since 1999, and emphasised that ATs are essential to maintain and gain community-based employment and education. USA also highlighted the fact that it is the larger contributor to WHO in this sector, and has funded WHO’s work with more than $ 8 million in the last decade. USA also praised Pakistan’s effort to leverage this agenda; and extended support to other countries in sharing the best practices in this sector.
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The Republic of Korea (South Korea) raised a major concern that most of the countries have. The assistive technology/products are imported and are usually sold at very high price in developing countries, making them unaffordable to many. To mitigate this issue, South Korea requested WHO for relaxation and reduction of import and export customs on assistive products at the international level. They proposed development of standards and guidelines to prevent excessive profit taking by the sellers. South Africa also raised the need for benchmarking of rates, as is done in case of medicine and vaccine.
U.K. will be hosting the global disability summit in London in July 2018, wherein assistive technology will be discussed. U.K. is actively working with technical partners, donors, CSO’s, private bodies to build the relationship for implementation of this agenda. Japan, Malaysia, China are some of the countries actively involved in the technology development.
The non-state actors raised the concern that a corporate-controlled and patents-driven system in assistive technologies can obstruct access. Therefore, it is important to promote open design and open access innovations, copyright exemptions and mechanisms for transfer of technology. It was also advocated that the draft resolution has ignored the interlinkages between social conditions, population specificities and anthropometrics while developing standards. Failing to do so would affect the optimisation of product design as per country specific requirements.
Dr Mariângela Batista Galvão Simão, Assistant Director General for Drug Access, Vaccines and Pharmaceuticals, WHO, highlighted Secretariat’s view that this agenda is placed on the health equity agenda, and there is broad agreement around how this is related to the most vulnerable. Overwhelming support received by WHO at the discussion will generate political commitments to implement actions at country level. To the request raised on the floor to reduce costs and about WHO’s role in market analysis and prices, ADG stated that it ultimately depends on the countries how they tackle the issues of taxes, and that these products are available to people on the ground. There is dedicated program called Global Coordination on Assistive Technology (GATE) and WHO’s next steps as packages are coming as the part of this program. Dr Mariângela reiterated that it is collective responsibility to show progress in four years on this agenda.
In conclusion, WHO’s coordination and initiative in the area of access to assistive technology is welcoming, but coordinated efforts are required to handhold and support low middle income countries in developing capacities in production. Assistive technologies should be treated as a public good and thus, WHO’s intervention to ensure accessibility, effective price control policies, is imperative to realise this agenda in true spirits.
The above article is compiled with contributions from Linda Markova (UK), Kriti Shukla (India), Natasha Matthews (UK), Simrin Kafle (Nepal), Dan Owalla (Kenya), Emmanuel Tangumonkem (Cameroon), Alba Lop Girones (Spain), Matheus Falco (Brazil), Sophie Gepp (Germany/UK), Sherif Olanrewaju (Nigeria), Andrew Harmer (UK) and Ana Vračar (Croatia).