国际辅助技术服务的政策架构、核心内容和发展研究

Framework and Core Content of International Policy on Service of Assistive Technology

目的研究联合国和世界卫生组织(WHO)辅助技术服务的政策架构与核心内容,比较不同经济发展水平国家辅助技术发展现状,探讨未来辅助技术政策与服务发展。方法基于联合国和WHO辅助技术的相关政策与理论架构,运用WHO健康服务体系构成要素的理论,分析国际辅助技术服务的政策架构与主要内容,比较全球不同经济发展水平国家辅助技术服务政策、辅助产品和服务发展,探讨国际辅助技术的政策与创新技术发展热点。结果辅助技术服务是康复服务的重要组成部分,发展辅助技术服务是实现联合国可持续发展目标三“确保健康的生活方式,促进各年龄段人群的福祉”的关键步骤。联合国和WHO发布的辅助技术服务相关指南提供了辅助技术服务政策,其核心架构是基于联合国《残疾人权利公约》有关辅助技术内容,并具体表现在WHO《世界残疾报告》《全球残疾行动计划》《健康服务体系中的康复》和《健康服务体系中的康复:行动指南》以及WHA 71.8号有关辅助技术的决议《改善获得辅助技术的机会》等核心文件中。国际辅助技术政策核心内容旨在构建以人为本的综合保健服务,强调将辅助技术纳入公共卫生医疗体系和康复服务范畴,根据WHO健康服务的六大核心构成要素建立和发展辅助技术服务,从而提高获取优质辅助技术机会,以实现全民健康覆盖,并且在辅助产品和辅助技术服务领域,倡导技术和服务创新,形成5P辅助技术模式。高收入国家和中低收入国家在辅助技术服务政策、辅助技术产品提供以及服务覆盖率方面都面临诸多困难,存在着较大差异。未来各国辅助技术发展热点主要是采用WHO提出的5P模式进行政策和服务提供以及技术变革,辅助技术产品开发、辅助技术服务模式的创新将是未来发展的热点。结论国际社会有关辅助技术的政策是以联合国《残疾人权利公约》为核心,并以联合国及WHO发表的辅助技术服务的相关政策文件为基础形成的,其主旨在于发展辅助技术服务,为残疾人、老年人和其他功能障碍者提供及时、适当和可负担的辅助技术服务,改善他们的健康并提升生活质量和福祉。要将辅助技术纳入全民健康覆盖,并通过初级卫生保健加强服务提供,以实现联合国可持续发展目标三全民健康覆盖的目标,实现辅助技术服务全覆盖。发展辅助技术,要将辅助技术纳入康复服务的范畴,在WHO健康服务体系的六大构成要素架构下,完善辅助技术服务的治理,通过多种机制为辅助技术服务进行筹资,培训康复人才从事辅助技术工作,改善辅助技术的服务提供,提升服务的质量,将辅助技术纳入基本医药技术,建立适应辅助技术发展的健康信息系统并对辅助技术服务提供监测。在世界不同地区,由于经济和社会发展水平的差异,辅助产品和技术服务的发展水平存在着很大差异,在获得辅助技术服务时遇到很大挑战。需要制定相关的政策、规划,并进行技术和服务创新。未来辅助技术发展将围绕辅助技术的5P模式进行产品和服务提供领域的改革以及技术创新,以提升辅助技术服务的覆盖率、有效性、可及性和可负担性,在全民健康覆盖架构下,将辅助技术服务融入健康服务体系,实现全民辅助技术服务全覆盖,提升辅助技术服务的质量和辅助技术消费者的福祉。

Objective To study the policy framework and core content of assistive technology(AT)services,compare the current sta‐tus of AT in countries with different levels of development,and discuss the future development of international policies and services of AT.Methods Based on the policy and theoretical framework of AT of the United Nations(UN)and World Health Organiza‐tion(WHO),the policy framework and main contents of international AT services were analyzed;the policies,as‐sistive products and service development of AT services in countries with different levels of development world‐wide were compared;and the policy and innovative technology development hotspots of international AT were explored.Results AT service is an important component of rehabilitation services,and the development of AT services is a key step toward achieving the UN Sustainable Development Goal 3,"Ensure healthy lifestyles and promote the well being of people of all ages".UN and WHO advocated AT services policy.The framework is based on the UN Convention on the Rights of Persons with Disabilities(CRPD)on articles related to AT,and WHO documents of AT and rehabilitation,such as World Report on Disability,the Global Plan of Action on Disability,Rehabilitation in the Health System,and Rehabilitation in the Health System:A Guide to Action,as well as WHA 71.8 on Assis‐tive Technology,Improving Access to Assistive Technology.The core elements of the international AT policy aim to build integrated,people-centered health services,emphasize the integration of AT into the health system and re‐habilitation services,establish and develop AT services in six building blocks of WHO health system,thereby im‐proving access to quality AT to achieve universal health coverage.Further in the fields of technology and service innovation,it proposed to establish a 5P model.High-income countries and low-and middle-income countries are facing many difficulties and large differences in AT service policies,assistive product provision,and service coverage.In the future,adoption of the 5P model proposed by WHO for policy and service delivery and techno‐logical changes,and the innovation of assistive product development and AT service models will be the hot spots of AT development.Conclusion The policy on AT at international level is centered on the concept of UN CRPD and is based on prospect of policy documents issued by the UN and WHO on AT services,with the core objective of developing AT services to provide timely,appropriate,and affordable to persons with disabilities,aging,and people needed to improve their health,quality of life and well-being.It proposes to integrate AT into universal health coverage and to deliv‐er AT service through primary health care in order to achieve the UN SDG 3 goal with full coverage of AT.It pro‐poses to integrate AT into rehabilitation services,i.e.leadership and governance,financing,AT professionals,AT delivery,medicine and technology,and health information system monitoring AT services.There are differneces in AT products and AT delivery due to the globel differneces in economic and social development levels and chal‐lenges in access to AT services.It is necessary to develop relevant policies,planning and innovations in assistive products and AT services.AT development in the future will focus on the 5P model of AT to implement reforms in the field of product and service delivery as well as technological innovation in order to improve the coverage,availability,accessibility and affordability,integrate AT into the health system within the framework of universal health coverage,achieve full coverage of universal AT services,and enhance the quality of AT and improve con‐sumers'well-being.