National priority assistive product list development in low resource countries: lessons learned from Tajikistan

Michael Allen, Satish Mishra, Chapal Khasnabis, Manfred Huber, Andrea Pupulin, Björn Ekman
April 2, 2020
Tajikistan
Academic Research Publications
Publisher Link

Introduction

Developing a national assistive products list is an important part of an assistive technology policy and requires knowledge of total population need, and product costs and benefits; information is not always readily available in low-income countries. Our experience in Tajikistan of developing a national assistive products list provides guidance for others.

Methods

Two hundred people with disabilities participated in a survey on self-reported need for assistive products, user experiences and barriers to access; 12 focus groups, of over 100 people with disabilities and older adults, conducted discussions on assistive technology. Major providers of assistive technology (government, nongovernmental organizations, local producers) were interviewed.

Results

These results were presented at a meeting with government and other stakeholders, which led to a consensus on 30 assistive products for the national assistive products list.

Conclusion

We identified the essential stakeholders responsible for developing the assistive products list, and discussed the data needed (total need, cost-effectiveness, unmet need, resources, barriers, system analysis) to make an informed decision on which products to include. This work can be used as a case study for developing an assistive products list quickly on a small budget without compromising on a user-centred approach or active participation of stakeholders.

  • Implications for Rehabilitation

  • Incorporating rehabilitation and assistive technology in universal health coverage.

  • Establishing and strengthening networks and partnerships in rehabilitation and building on existing resources (stakeholders, knowledge, government policy documents) to strengthen rehabilitation and assistive technology particularly in low- and middle-income countries.

  • Developing a national assistive products list is an important part of an assistive technology policy.

  • Creating a national assistive products list requires knowledge of population need, and product costs and benefits; information that is not always readily available in low-income countries.

  • In this article, we identify the essential stakeholders responsible for developing the assistive products list and the data needed for informed decisions.

  • We demonstrate that developing an assistive products list can be carried out quickly and on a small budget.

In most low-income countries, the assistive technology sector is underdeveloped and only a small percentage of people in need have access to assistive products [Citation1]. Over the last 30 years, and currently, nongovernmental organizations (NGOs) and development agencies have played a crucial role in supporting rehabilitation centres and in providing assistive technology [Citation2]. However, reliance on external donors is not a sustainable long-term strategy and governments are starting to take increased control and responsibility for the development of the sector. As government involvement rises, policies and programmes need to keep up with the changes. Effective policies and programmes that aim to make the most efficient use of limited funding and resources need to be developed. A phased approach with realistic objectives and timelines is in most contexts the most favourable strategy for low-income countries to move towards the goal of universal health coverage.

Developing a national assistive products list (APL) is an important part of assistive technology policy [Citation3]. The APL represents the formal set of assistive technology products that are of highest priority and which should be accessible to everyone in the country. The list enables a country to focus on the procurement and provision of the most needed products; thus, optimizing the use of resources [Citation3]. A national APL is neither exclusive nor unalterable. In other words, it does not necessarily restrict provision to listed products, and as the country makes progress the list can be revised and expanded to include more devices [Citation3]. Importantly, a national APL implies that the government is committed to providing at least all the APL products to all people in need; therefore, the list should not be so extensive as to exceed the country’s provision capacity, as this would be counterproductive to the growth of the sector.

Two fundamental questions that need to be answered when developing a national APL are: who is in charge of selecting the assistive products, and how are they selected. Making an informed decision on which assistive products have higher priority requires relevant data from the country, such as total need and impact of different devices. In many low-income countries, this information is often missing, and even related data on disability may be inaccurate or incomplete [Citation4–7]. Often, it is difficult to justify a large investment in research or an extensive process of product screening through clinical processes exclusively for developing an APL. This often leaves APL selection committees or policy-makers and service providers with limited information on which to base their conclusions.

This paper aims to be used as a practical guide on how an APL can be developed on a relatively small budget and short timeline. In the first part, we discuss the “who” (stakeholders responsible) and “how” (selection criteria) of national APL development. In the second part, we discuss the process of APL development in Tajikistan, which consisted of a preliminary research and a stakeholder consensus meeting. In conclusion, we reflect on the advantages of this method and how the process can be replicated and potentially improved.