Processes of assistive technology service delivery in Bangladesh, India and Nepal: a critical reflection

Abstract

Purpose: This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. Materials and methods: We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. Results: AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Conclusions: Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATION Although we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another. A systematic and stepwise approach to assessing current AT service delivery processes in the three countries–examining the delivery system as a whole, from initiation to repair and management–can help identify opportunities to improve the process for (prospective) AT users. A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.