Assistive technology and support services

This CBMA policy note provides a high level overview of our understanding and policy position on relevant topics, and outlines our engagement with these areas in conjunction with our partners and other areas of the organisation.

Definitions

‘Assistive technology’ (AT) is an umbrella term that refers to ‘assistive products’ (also called assistive devices) and ‘assistive services’ that maintain or improve an individual’s functioning and independence. Assistive products allow people with disabilities to perform an activity they would otherwise be unable to do or enables them to do so with more ease and safety. The World Health Organisation (WHO) categorises AT into six groups of functioning: cognition, communication, hearing, mobility, self-care, and vision. It is fundamental to promoting dignity and wellbeing and improving the livelihoods of people with disabilities as it enables people to participate in education, the labour market, and social activities, while reducing the need for formal health services and long-term care. In turn, this has a broader impact on the individual’s family and community, as well as the healthcare system.

The scope of assistive products is wide ranging and includes hearing aids, wheelchairs, prostheses, spectacles, and communication aids. In addition to products, assistive services are also a necessary element of AT and are essential in ensuring products are functional and effective. WHO recommends four types of services – assessment, fitting, user training, and follow up – to ensure that products are beneficial for individuals’ needs.

‘Support services’ do not fall under the umbrella of AT. Support services are intended to facilitate community inclusion and enable people with disabilities to live independently and with autonomy. They can include personal assistance, living arrangement services, and person-to-person mobility and communication support. Similarly, ‘rehabilitation’ sits alongside AT with the purpose of optimising functioning in individuals with health conditions to support their interaction with their environment. This involves interventions that build muscle strength and skill-building to support eating, socialising, and self-care. While these concepts do not fall within the scope of AT, they work together to facilitate inclusion and equity for people with disabilities.

Assistive technology

WHO estimates that 1 billion people need AT, with this number set to rise to more than 2 billion by 2050 in line with the aging of the global population and an increase in non-communicable diseases. Access to AT and support services is limited in developing countries, with only 1 in 10 people in need having access to AT at a global level. Access to AT is recognised as a human right in Article 20 of the Convention on the Rights of Persons with Disabilities (CRPD) and Article 16 recognises the importance of rehabilitation for people with disabilities to support meaningful participation in society. Universal access to high-quality AT is necessary to the fulfilment of the United Nations Sustainable Development Goals (SDGs) through its cross-cutting impacts in:

Goal 3 – Ensure healthy lives and promote well-being for all at all ages.
Goal 4 – Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.
Goal 10 – Reduce inequality within and among countries.

There are numerous barriers to AT that prevent its uptake and efficacy. Prominent barriers include but are not limited to lack of awareness, high costs, limited physical and geographical access, inadequate product range and quality, and procurement and delivery challenges. For assistive products to be effective, they must be combined with assistive services for individual assessment, fitting, training, and repair. WHO suggests that services for AT products be integrated into health, education, and social services, as opposed to being a standalone service.

Support services

Support services are often coupled with AT, and although they serve similar end goals, they operate separately. In line with the CRPD which foregrounds personhood, autonomy, and community inclusion, support services are intended to enable community living. Article 19b of the CRPD requires States to ensure that people with disabilities have access to required in-home, residential, or other community support services to support living and inclusion in the community and to prevent segregation.

The disability rights movement has proposed that human support be organised through multiple approaches, such as one-to-one support (personal assistance) and community-based support (peer support, supported decision-making circles). As such, support services are among the suite of preconditions to inclusion alongside AT, accessibility, social protection, non-discrimination, and community-based inclusive development. Barriers that might prevent people from accessing support services include lack of geographical access, services being inadequate for the individuals’ needs, lack of financial capacity, discrimination, and past negative experiences with health care and other providers.

CBM Australia’s position on assistive technology and support services

CBM Australia (CBMA) outlined its position on AT and support services in its submission to the International Disability Equity and Rights Strategy (IDEARS) to be released in 2024. In the submission, CBMA recognises AT as a necessary precondition for disability equity and inclusion and as integral to quality and accessible healthcare. CBMA calls on the Australian government to understand AT as being part of a holistic model of care that includes support services.

As such, emphasis is placed on support services involving the leadership of people with disabilities in their design as well as service redesign for different cohorts, such as people with psychosocial disabilities and young people with disabilities. CBMA echoes the calls of the Special Rapporteur on the rights of persons with disabilities and the Pacific Disability Forum for greater investment by states in support services.

CBMA’s recommendation to the Australian government is that Australia plays a leadership role in ensuring the provision of appropriate, quality and affordable AT and support services across the Indo-Pacific by:

Working with partners to establish a Pacific regional procurement facility for quality and affordable AT by 2025.
Providing funding for regular training of multi-disciplinary personnel in the maintenance of AT.

Funding pilots and scale ups of effective, contextualised rights-based support services.

CBMA’s support for AT and support services is informed by the positions of partner countries and its necessity in the Indo-Pacific region. Regional development frameworks that prioritise the right to AT and support services include:

Pacific Framework for the Rights of Persons with Disabilities 2016-2025
Western Pacific Regional Framework on Rehabilitation

CBM Australia’s engagement

In an advocacy capacity, CBMA is supporting regional stakeholders calls for regional procurement facilities for AT and improved support services, including necessary training around AT to ensure that it can be maintained and fitted for individual needs.

In a program capacity, CBMA is supporting local partners and country offices to provide wider coverage of high-quality AT and their associated support services. As of the end of 2023, CBMA has programs focusing on strengthening physical rehabilitation in Nepal and Papua New Guinea.