30.1.1.2 Barriers in low- and middle-income countries
Disability leads to poorer health outcomes, lower education achievements, and less economic participation, which results in a perpetuating cycle of disability and poverty [6]. Despite evidence that rehabilitation is highly effective in improving clinical outcomes and quality of life, people residing in LMICs face specific barriers to accessing rehabilitation.
Barriers to the wider use of rehabilitation include inadequate policies and standards, negative attitudes toward disability, problems with service delivery, lack of accessibility, and a lack of data and evidence. Additionally, there is a lack of rehabilitation professionals to provide rehabilitation services. These professionals include physical and rehabilitation medicine doctors (physiatrists), physiotherapists, occupational therapists, speech and language pathologists, prosthetists, and orthotists. There are fewer than 10 physiotherapists per 1 million residents in many LMICs, whereas high-income countries often have several times more rehabilitation professionals [7]. Addressing these barriers to rehabilitation can provide a positive societal impact by building human capacity, improving the quality and affordability of services, and achieving the Sustainable Development Goal of ensuring healthy lives and promoting well-being for all [6].
However, most solutions are only available in high-income countries, with high costs often associated with limited market penetration of rehabilitation robotic systems. In addition to the high costs of these systems, other barriers to adoption in LMICs include a lack of training (for maintaining these systems), high duty or import taxes, and the lack of studies establishing the feasibility and cost-effectiveness of therapy in relevant settings.