Assistive devices in low-income countries

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One of the major hurdles that impede widespread access to the robotic rehabilitation technology is its cost. Despite the appearance of some cheaper models in 2017-2018, the recent Coronavirus Covid-19 Pandemic will cause production delays and potential closures that might result in supply shocks, favoring the survival of companies with a larger moat. It is perhaps too early to speculate on the exact price-effect of the pandemic, but most experts agree that a price increase tendency seems probable. The most widely used robots in rehabilitation clinics within the US are highly priced (to the tune of $70,000 for the lower range and up to 360,000 USD on the higher end). Adding the hidden costs like taxes, shipping and maintenance, as well as installation and training expenses, the real price is even higher.

While investments in hardware are somewhat easier secure in developed economies, in low and middle-income countries there are additional considerations that prohibit this kind of long-term investment. More generally, low-income countries face limitations in delivering assistive technology due to cost, availability, and infrastructure problems. More than 80% of all stroke deaths occur in these lower-income economies. Stroke survivors (approximately 3/4rths of the afflicted) suffer long-term impairment, severe disability, and reduced participation or handicap. Moreover, within lower-income countries, assistive devices are accessible only through expensive private services, inaccessible to the majority of patients. According to the WHO a mere 5% of the population in need within low-income countries have access to essential rehabilitation services. Looking beyond the statistics, the long-term burden of stroke has severe consequences for individuals, families and societies.

With the relentless aging of the population and increased risk factors for cardiovascular disease on a global scale, the economic burden of stroke is expected to increase despite advances in preventive care. In order to account for this rise in the population at risk, efforts to address and reduce disability must be undertaken. The health sector in developing economies suffers through budget constraints and insufficient resources to implement a wide usage of clinic-based rehabilitation robots, even thought the long-term societal cost (including human cost) outweighs the initial investment. The use of robotic devices has the potential to reduce hospital stays, lessen the burden on therapists and doctors while increasing the effectiveness and efficiency of treatments. Assistance programs and development subsidies are insufficient to address the rising need of financing, but there are other more sustainable ways to facilitate the adoption of assistive technologies. Policies and measures that facilitate the production of these devices (exception to patent rights, charitable donations, debt alleviation strategies among others).   

Creating sustainable strategies for the production of assistive devices is in itself problematic. Policies to recommended for implementation on a national level include the training of local professionals for quality production. Educational facilities that encourage specific training while enlisting the help of national associations and professional groups will further encourage the creation of a nascent community centered on rehabilitation. Training a professional workforce would not only facilitate local production; it would enable the provision of the technology within the country for the population in need at a much lower cost, but also to other developing nations that might not have the means to import the technology. The locally trained staff would increase access to services that would ensure a chance for a higher quality of life, a chance to participate in community life and be a productive member within that community for the victims of stroke and other disabling maladies. In order to make assistive technology more affordable and accessible, community-based rehabilitation programs could be designed.

The development of appropriate and sustainable technologies that can respond to the needs of patients may be produced and offered for an affordable price. Governments should encourage local production of components and the usage of locally sourced materials, further adding to sustainable economic development within the nation or region. To improve access for other developing nations the development of these technologies should be documented and made available where needed.
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While poverty is the most significant constraint influencing rehabilitation outcomes in low-income countries, higher health costs, insurance limitations, insufficient staffing and time to provide more services are limiting the administration of quality care in middle-income countries as well. Even in developed nations, like the USA, rehabilitation outcomes are rendered inferior as a disproportionately large number of the population is without access to rehabilitation technologies and has no recourse to services and skilled clinicians. While assistive technologies are not a panacea for all the issues that plague low-income societies, the integration of lower-cost robotic technologies would improve accessibility and opportunity, alleviating poverty and facilitating the functional independence of stroke survivors by improving access to rehabilitation services for poverty-stricken communities worldwide.

If you found this engaging, here are some additional articles that might be of interest:

• Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym, Michelle Jillian Johnson, Roshan Rai, Sarath Barathi et al. Journal of Rehabilitation and Assistive Technologies Engineering 
• World Report on Disability
• Rehabilitation Robotics: Cost Effectiveness Issue, Viroj Wiwanitkit 
• Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art