A Country Report on Measuring access to Assistive technology (AT) in Nepal

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Background

Evidence based research findings on the use, need and unmet need is a key metric for planning and improving access to Assistive Products (AP). It is estimated that only 5-15% of people in low- and middle-income countries (LMICs) who need assistive technology (AT) have access to them with few availabilities, affordability and trained personnel. In Nepal, accurate data on the needs of AP is still not yet known. With a growing population of older age, increasing prevalence of non-communicable diseases in Nepal, the number of people needing AT is certain to rise. Therefore, the study aims to measure access to AT in Nepal.

Methods

A nationwide population-based household survey was conducted from 7 December 2021 to 27 December 2021 using the WHO rapid Assistive Technology Assessment (rATA) questionnaire. Two-stage cluster sampling technique process was used to select 2970 households and the total number of participants interviewed was 11, 230. Participants included all the family members of the selected household. Complex survey analysis was performed using SPSS version 21 and the data was presented using frequency and percentage (weighted).

Key Findings

• The mean age of the total participants was 34±21.5 year. More than half of the participants (52.6%) were female. Majority of the sampled population (55.3%) were from rural areas.
• Majority of the participants (57.9%) had no difficulty followed by 28.4% of the participants who had some level of difficulty in doing certain activities because of a health condition. At least some level of difficulty was seen highest in seeing/vision domain (32%) followed by mobility (16.9%). Overall functional difficulties increased with increase in age. Almost half of the participants (46.4%) aged >65 years had some level of difficulty. Participants living in urban areas had more difficulty level (42.4%) as compared to the ones living in rural areas (34.8%). Majority of the participants living in Bagmati province (42.8%) had at least some level of difficulty as compared to other provinces.
• The prevalence of use of any AP currently was found to be 27.7%. Among the participants who could not do any activities without assistance, more than half of them (51.6%) used any AP. Use of AP increased with increase in age: half of the participants aged >65 years (50.6%) used any AP. The use of AP was seen higher in urban areas (28.2%) as compared to rural areas (15.1%). The use of AP was seen highest in Bagmati province (28.9%) as compared to other provinces.
• The prevalence of unmet need was reported to be 19.7%. Unmet need increased with increase in level of functional difficulties: 70.9% of the participants who could not do any activities without assistance had unmet needs of AP. Almost eighteen percent (17.6%) of the male participants and more than one-fifth (21.4%) of the female participants had unmet needs of AP. Unmet needs also increased with increase in age: more than half of the participants aged >65 years (51.7%) had unmet needs of AP.
• Participants living in rural areas have more unmet needs of AP (21.3%) as compared to participants living in rural areas (19.6%). The prevalence of unmet needs was seen highest in Madhesh province (21%) followed by Sudurpaschim province (20.1%) and Province 1 (20%).
• The prevalence of use of spectacles was seen highest (22.3%) among the total sampled population followed by canes/sticks (3.3%) and spinal orthoses (1.8%). In all seven provinces, the most commonly used assistive product was spectacles.
• Among the total sampled population, the unmet need of AP was seen highest in spectacles (10.1%) followed by spinal orthoses (4.8%) and hearing aids (3.4%). In all seven provinces, the unmet need of AP was highest for spectacles.
• Among the participants who use any AP, the AP were predominantly sourced from private sector (64.3%) followed by public sector (22.0%).
• More than half of the participants (57.1%) obtained their AP through out-of-pocket expenditure followed by friends/family (38.9%) who paid for their AP.
• Among the participants who use any AP, most of them (62.8%) travelled <5km followed by one-fifth of the participants (24.7%) who travelled 6-25km to get their AP.
• Nearly two-third (63.6%) of the participants living in urban areas had to travel <5km to obtain their AP whereas majority of the participants living in rural areas (32.4%) had to travel 6-25km.
• Among the participants who had unmet needs of AP, majority of them reported that they did not have enough support (41.5%) followed by unaffordability (39.2%) and lack of time (36.2%) for not having the product needed.
• Majority of the participants living in urban areas reported lack of support (42.1%) as the reasons for not having AP whereas participants living in rural areas reported unaffordability (59.3%) as the reasons for not having AP.
• Among the participants who use any AP, more than ninety percent (91.2%) reported that they are satisfied with respect to the products they use, nearly three-fourth (70.6%) reported that they are satisfied with the assessment and training they had received, and more than three-fourth (78.1%) reported that they are satisfied with respect to repair, maintenance, and follow-up services.
• Nearly two-fifth (39.3%) of the participants who use any AP reported that the AP was mostly suitable for their home and surroundings. Majority of the participants (34.9%) reported that the AP completely helped individuals to do what they want (usability).
• Among the participants who use any AP, majority of them (42.4%) reported that the AP could be completely used as much as they wanted in places; they needed to visit such as schools, workplaces, and public spaces.

Conclusion

The nationwide rATA survey has demonstrated clear gaps in access to assistive products in Nepal with high prevalence of use and unmet needs. It is transparent from the findings of the survey that functional difficulties, use and unmet needs of AP is seen higher in older age group. Functional difficulties and use of AP is seen higher in participants living in urban areas, however, the unmet need of AP is seen higher in rural areas. Lack of support, unaffordability and lack of time remains the main barrier to access AP. Therefore, the survey calls for creative solutions to improve access to assistive products that can be easily sourced, is accessible and affordable and suitable to be used.

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Paudel KP, Gyanwali P, Dahal S, Bista B, Baskota R, Das CL, Marasini RP, Baral RP, Napit P, Shrestha N, Aryal UR, Koirala P, Marahatta K, Pokhrel S, Shrestha A, Dhimal M (2023). Measuring access to Assistive Technology in Nepal: A Country Report. Kathmandu: Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Nepal Health Research Council and World Health Organization, Nepal.

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