Bridging the Assistive Technology Divide: Access, Barriers, and Pathways to Equity for Persons with Disabilities in Low- and Middle-Income Countries

Assistive technology, from wheelchairs and hearing aids to spectacles and communication devices, is a precondition for the participation, health, education, and livelihood of people with disabilities, yet its distribution is among the most unequal in global health. The WHO and UNICEF estimate that more than 2.5 billion people need one or more assistive products today and that this figure will approach 3.5 billion by mid-century, while access in some low-income settings reaches only a small fraction of need. This narrative review examines why the gap is so wide in low- and middle-income countries (LMICs) and what can close it. Organising the evidence around the World Health Organization's GATE building blocks of people, policy, products, provision, and personnel, we identify a consistent set of barriers: low demand rooted in limited awareness; products that are unaffordable or poorly suited to local environments; fragmented or absent provision systems weakly linked to health services; a scarce and under-trained workforce; and financing and social-protection systems that leave disability-related costs to fall on households already near poverty. We then synthesise the pathways that evidence and international consensus support: national assistive-technology policy, affordable and appropriately designed products, workforce capacity-building integrated with community-based rehabilitation, financing through universal health coverage and social protection, and the careful use of digital and tele-delivery. We argue that the central obstacle is no longer conceptual but a matter of political will and system-building, and that regional leadership, including Gulf models that frame disability through participation and rights, offers a template others can adapt. The review is limited by uneven and often descriptive evidence, particularly from the lowest-income and most fragile settings.