🟠 Moderate Evidence
A mixed-methods study published in The Lancet Regional Asia (2024) has documented significant barriers to assistive technology (AT) access in Sri Lanka, with disparities systematically linked to age, biological sex, and urban-rural location. The research underscores that these factors do not act in isolation but interact in complex ways, creating compounding barriers that policy frameworks have largely overlooked.
Key takeaways
- Age, sex, and geographic setting independently predict AT access disparities in Sri Lanka
- Interaction between demographic and systemic barriers creates multiplicative disadvantage for some populations
- Population ageing combined with inequitable AT policies threatens health equity across the region
- Current policy frameworks do not account for intersectional barriers to device provision and maintenance
Study at a Glance
| Source | The Lancet Regional Asia |
| Study type | Mixed-methods (quantitative and qualitative) |
| Population | Individuals requiring assistive technology in Sri Lanka |
| Country | Sri Lanka |
| Focus | Barriers to AT access; disparities by age, sex, and setting |
Assistive Technology Access Barriers in Sri Lanka: Key Dimensions
Disparities by demographic and geographic factors, 2024
Source: The Lancet Regional Asia (2024) | Georgian Medical Journal News
Disparities Compound Across Demographic Lines
The research documented that disparities in assistive technology access are not uniformly distributed across Sri Lanka’s population. Age emerged as a significant predictor of access difficulty, with older adults facing greater challenges in obtaining and maintaining AT devices such as mobility aids, hearing aids, and vision correction devices. According to The Lancet Regional Asia study, biological sex also independently predicted access disparities, with women reporting greater barriers to device acquisition and use—a pattern consistent with broader health equity findings across the region.
Geographic location further stratified access. Residents of rural areas faced substantially fewer options for AT provision, assessment, and maintenance compared to their urban counterparts. This urban-rural divide reflects both infrastructure gaps and distribution challenges endemic to many South Asian health systems. The interaction of these factors meant that, for example, older women in rural areas faced compounded disadvantage—not simply the additive effect of three separate barriers, but a multiplicative effect where each barrier amplified the others. Global health equity frameworks increasingly recognize such intersectional disadvantage, yet Sri Lankan AT policy had not explicitly addressed it.
Systemic Barriers Beneath Demographic Disparities
The mixed-methods design allowed researchers to move beyond describing who lacked AT access and examine why. Qualitative interviews revealed that systemic barriers—operating across the entire health system—created the foundation upon which demographic disparities were layered. These barriers included limited government funding for AT provision, lack of trained professionals to assess and fit devices, absence of AT services in rural areas, and inadequate supply chains for device maintenance and replacement.
Cost emerged as a dominant barrier across all demographic groups. Many Sri Lankan households cannot afford out-of-pocket AT purchases, yet publicly funded programs remain underfunded and geographically concentrated. Awareness gaps compounded cost barriers: individuals who might qualify for government-subsidized devices often did not know such programs existed or how to access them. Professional capacity constraints further limited access—Sri Lanka lacks sufficient AT specialists, particularly outside major urban centers. The World Health Organization estimates that globally, one billion people require assistive technology, yet less than 10 percent have adequate access, suggesting Sri Lanka’s challenges reflect a region-wide crisis.
Population Ageing Intensifies the Urgency
Sri Lanka’s demographic trajectory makes these access disparities increasingly urgent. The country is experiencing rapid population ageing—a trend documented across South Asia as fertility rates decline and life expectancy extends. An ageing population will dramatically increase demand for mobility aids, hearing aids, vision correction, and other AT devices. Without simultaneous expansion of AT policy frameworks and service infrastructure, current disparities will deepen, affecting millions of additional older adults.
The intersection of ageing and AT access inequality represents a public health imperative that extends beyond individual disability support. Lack of appropriate AT accelerates functional decline, increases fall risk and injury, reduces independence, and intensifies caregiver burden—all drivers of healthcare costs and system strain. For policymakers, this suggests that AT investment is not a discretionary social program but a core health system function necessary to manage an ageing population equitably.
Policy Implications and Intersectional Solutions
The study’s authors and the broader health policy community emphasize that addressing AT disparities requires multi-level intervention. First, governments must recognize AT access as a health equity and human rights issue—not merely a disability accommodation. Second, funding mechanisms must explicitly target underserved populations (rural residents, older adults, women) and measure equity outcomes, not just total devices distributed. Third, professional capacity building is essential—training programs must expand to produce AT specialists in rural and remote areas.
Fourth, supply chain and distribution networks must be redesigned to serve dispersed populations. Fifth, awareness campaigns must reach communities most affected by disparities. Sixth, policy must explicitly acknowledge intersectional disadvantage: a woman over 75 living in a rural district does not face three separate problems requiring three separate solutions, but rather a convergent ecosystem of barriers requiring integrated solutions. The research demonstrates that incremental improvements within existing systems will be insufficient; comprehensive AT policy reform is needed.
Age, sex, and setting were independently associated with assistive technology access disparities in Sri Lanka, with their interaction and relationship to systemic barriers requiring urgent policy attention alongside projections of population ageing to create equitable AT provision frameworks.
— The Lancet Regional Asia (2024)
What this means
Individuals requiring assistive technology—particularly older adults, women, and rural residents—should advocate for equitable access through patient organizations, engage with public health authorities, and support policy campaigns for expanded AT funding and service availability. Awareness of disparities can prompt individuals to seek alternative funding sources and to document access barriers for advocacy purposes.
Healthcare providers must screen all patients for AT needs regardless of demographic group, recognize that barriers differ by age, sex, and location, and actively refer patients to available services. Training in AT assessment and familiarity with public funding schemes is essential. Clinicians should document unmet AT needs and contribute to data that drive policy change.
AT policy must move beyond demographic targeting to explicit intersectional analysis. Budget allocations should map to both current unmet need and projected ageing-driven demand. Rural service expansion, professional training capacity, supply chain strengthening, and public awareness campaigns are simultaneous imperatives. Health system reform should recognize AT as core infrastructure, not peripheral service.
Frequently asked questions
Why does assistive technology access matter for public health?
Assistive technology enables functional independence, reduces fall risk and injury, delays institutional care placement, and improves quality of life for people with disabilities and chronic conditions. Lack of appropriate AT accelerates disability trajectories and increases system-wide healthcare costs. As populations age, AT provision becomes a foundational element of preventive and geriatric care.
What is meant by ‘intersectional’ barriers in AT access?
Intersectionality recognizes that individuals have multiple overlapping identities (age, sex, geography) that interact to create unique patterns of advantage and disadvantage. An older rural woman does not face independent barriers that simply add together; rather, being older, female, and rural simultaneously creates compounded disadvantage that requires integrated solutions rather than separate interventions for each characteristic.
What can other countries learn from Sri Lanka’s experience?
Many middle-income countries face similar AT access disparities rooted in underfunding, geographic concentration of services, and lack of trained professionals. Sri Lanka’s documented barriers and demographic projections serve as an early warning for neighboring countries experiencing rapid ageing. Proactive policy investment in AT infrastructure now—before demand surges—is more cost-effective than reactive crisis response later.
As Sri Lanka’s population ages and global awareness of assistive technology as a health determinant grows, the findings from this Lancet Regional Asia study provide an urgent evidence base for policy action. The interaction of age, sex, geographic, and systemic barriers suggests that fragmented, categorical responses will fail. Instead, governments must develop comprehensive, equity-centered AT policies that simultaneously address funding, professional capacity, geographic distribution, and intersectional disadvantage. The window for proactive policy reform—ahead of the full force of demographic ageing—remains open but is closing rapidly.
Source: Assistive technology unmet need and barriers to access in Sri Lanka: a mixed-methods study, The Lancet Regional Asia (2024)
Was this article helpful?
Disclaimer. This article is health journalism intended for general information and education. It is not medical advice and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your individual circumstances. Full disclaimer →
Related Coverage
Editorial standards. This article was produced under the GMJ News editorial process, with oversight by the GMJ Editorial Board. Our editorial process. Spotted an error? Contact the editorial team.
