Миллионы людей с инвалидностью в Индии лишены доступа к реабилитации: нужен переход к общинным моделям

Why disability services fail to reach millions This article is authored by Prashant Agarwal, president, Narayan Seva Sansthan. Over the past three decades, India has made significant strides in education, poverty reduction, sanitation, and digital inclusion. Yet one critical challenge remains largely overlooked, millions of people with disabilities still lack access to affordable and effective rehabilitation services. According to the World Health Organization's Global Report on Health Equity for Persons with Disabilities (2023), disability continues to limit access to health care, education, employment, and economic opportunities, while increasing the risk of poverty and social exclusion. Importantly, disability is not confined to a small segment of the population. It can affect anyone at any stage of life through illness, injury, congenital conditions, ageing, or chronic disease. Closing this rehabilitation gap requires more than isolated schemes. According to the 2011 Census, about 2.21% of India's population (26.8 million) live with some form of disability. Similarly, a 2018 study by National Sample Survey Office estimated disability prevalence at around 2.2%. As a result, many researchers and disability rights activist argue that official statistics underestimate the actual scale of disability in India, highlighting the need for more inclusive definitions, improved identification mechanisms, and stronger data systems to inform policy and service delivery. Persons with psychosocial, intellectual, developmental, and other less visible disabilities are particularly likely to be overlooked. At the same time, disability should not be understood solely as a medical condition or individual impairment. A wheelchair user is disabled not by the wheelchair, but by the absence of ramps, accessible transport, inclusive schools, and supportive workplaces. The challenge for India is not only to identify people with disabilities, but also to remove the barriers that limit their opportunities and potential. As the need for rehabilitation rises, access to services remains severely limited. The gap is particularly stark in rural areas, where rehabilitation facilities and specialists are scarce. Most services are concentrated in urban hospitals and specialised centres. Compounding this challenge is a critical shortage of trained rehabilitation professionals, including physiotherapists, occupational therapists, speech and language therapists, rehabilitation psychologists, and special educators, particularly outside major cities and metropolitan areas. Delayed diagnosis and treatment often lead to worsening disability, reduced independence, lower educational attainment, lost employment opportunities, and greater financial strain on families. The rehabilitation gap is, therefore, more than a health care issue. It is a barrier to inclusion, productivity, and social mobility, one that continues to leave millions behind. One of the most widely recognised solutions to rehabilitation gap is Community-Based Rehabilitation (CBR). CBR represents a shift away from institution-heavy rehabilitation models toward community-centred systems that deliver support closer to where people live. This approach is also embedded in WHO’s CBR Guidelines (2010) and aligns with the UN Convention on the Rights of Persons with Disabilities, which emphasises inclusion, accessibility, and participation as core rights rather than optional services. In a 2021 Study by National Medicine of Health, CBR programmes can improve functional independence, increase access to assistive devices and services, enhance school participation for children with disabilities, and support better livelihood outcomes for adults. Additionally, CBR offers a practical way to address these structural constraints by decentralising service delivery and integrating rehabilitation into existing community and primary health care systems, including initiatives under India’s National Health Mission and disability inclusion programmes. Tele-rehabilitation has emerged as one of the most powerful tools for democratising access to rehabilitation services, particularly in rural and underserved regions where specialist care remains scarce. While the shortage of rehabilitation professionals and the concentration of services in urban centres remain significant challenges, digital innovations are creating new pathways to extend care beyond traditional hospital settings and bring rehabilitation closer to communities. According to a 2020 study by Journal of Telemedicine and Telecare, Tele-rehabilitation can produce clinical outcomes comparable to conventional face-to-face services for a range of conditions, including stroke recovery, musculoskeletal disorders, and chronic disease management, while reducing travel costs and improving continuity of care for patients in underserved areas. Artificial Intelligence can support early screening and detection of developmental delays, improving the speed and accuracy of referrals. Digital platforms can further strengthen care systems by tracking patient outcomes, streamlining referrals, and ensuring continuity across providers. India stands at a pivotal moment. Demographic shifts, technological progress, and sustained economic growth have created unprecedented opportunities to address long-standing social challenges. At the same time, rising rates of chronic disease, injury, and population ageing are making disability and rehabilitation increasingly central to the nation’s future. An inclusive India would be more than a fairer society. It would be a stronger, more innovative, more productive, and more resilient nation; one where every individual has the opportunity to participate, contribute, and thrive. Closing this gap requires more than incremental change. It demands a national commitment to rehabilitation as a core pillar of health, inclusion, and development. Expanding community-based services, strengthening the rehabilitation workforce, scaling assistive technologies, building accessible infrastructure, and fostering public awareness must all advance together. At its core, rehabilitation is not merely about addressing impairment. It is about enabling participation, unlocking potential, and ensuring that every individual has the opportunity to live with dignity, contribute to society, and thrive. (The views expressed are personal) This article is authored by Prashant Agarwal, president, Narayan Seva Sansthan.