To conduct disability research in low-income countries: human rights, culture, and some experience of use of ICF

It was estimated that about 0.5% of the world’s population is in need of assistive devices; in 2013, the number of people who required such aid was estimated at 25 million in Africa and Asia. The majority of these people could have increased their participation within society by receiving an assistive device to facilitate mobilisation, recognised as a step in accessing basic human rights such as food, housing, education, income, healthcare, and social inclusion. Assistive technology is required to implement the Convention of Rights of Persons with Disabilities (CRPD). The CRPD asserts that persons with disabilities have the right to personal mobility, so as to ensure independence, and rehabilitation services, including provision of prosthetic and orthotic devices and training. It further indicates that states must make quality mobility aids such as prosthetic and orthotic devices accessible and affordable (Articles 20 and 26). Prosthetic and orthotic services are limited in developing countries and need to be scaled up, as they have the potential to improve mobility and facilitate increased inclusion in society for amputees and persons with physical impairments. Service provision is affected by policy, poverty, and attitudes within cultures. Human rights and the CRPD are seen as being universal, designed to be culturally neutral, and applicable in cross-cultural settings. However cultures are varied, and this affects how disability is viewed. Consequently, it is vital to consider this fact when implementing rehabilitation services. Peoples’ understanding of disease and disability and its causes are dynamic and sometimes incoherent. Discussion in speech and writing in society about illness, disease and disability, cultural resources and beliefs, as well as expert discourses including biomedicine and traditional medicine, all affect how a person with a disability is viewed in society. The World report on disability, suggest that the CRPD and The International Classification of Functioning, Disability and Health (ICF) biopsychosocial concept of disability are aligned. The ICF is a model of functioning and a classification for various aspects of health. According to the ICF classification, products and technology such as prosthetic and orthotic devices are environmental factors. Other environmental factors are natural environment, support and relationships, attitudes, and service systems and policies. The CRPD requires states that have ratified the convention to also implement monitoring mechanisms for the CRPD. However, creating indicators to monitor the CRPD is a challenge. An attempt to develop indicators for monitoring Article 26 of the CRPD, covering rehabilitation, suggested that the ICF framework can be used. However it is a challenge to apply to prosthetic and orthotic services. Further development of the ICF for groups of users of orthoses and prostheses and/or more detailed outcome measures are required if the ICF is to be used to investigate the functioning of prosthetic and orthotic devices for these purposes. References: Magnusson L. Prosthetic and Orthotic Services in Developing Countries. Doctoral Thesis. School of Health Sciences, Jönköping University Dissertation Series No 56. 2014. ISBN 978-91 Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-2497