India has made major advances in healthcare, education, sanitation and digital inclusion over recent decades, yet access to rehabilitation remains deeply uneven for millions of people living with disabilities.
Writing in the Hindustan Times, Prashant Agarwal, President of Narayan Seva Sansthan, argues that rehabilitation remains one of the country’s most significant but insufficiently addressed healthcare and inclusion challenges.
For India’s prosthetics and orthotics community, the issue goes directly to the heart of service delivery.
India does not simply need more prosthetic limbs, orthoses, wheelchairs and assistive technologies. It needs systems capable of identifying people who need them, connecting them with qualified professionals and maintaining those services over the long term.
At least 26.8 million Indians officially live with disability
India’s 2011 Census recorded around 26.8 million people with disabilities, representing approximately 2.21% of the population. The National Sample Survey Office later estimated a similar prevalence of around 2.2% in 2018.
However, disability organisations and researchers have long argued that official figures may underestimate the true scale of disability in India.
People with intellectual, psychosocial, developmental and less visible disabilities can be particularly difficult to capture through traditional identification systems.
For rehabilitation planners, that creates a fundamental problem.
Services cannot be planned effectively without understanding how many people require them, what type of interventions they need and where they live.
Better disability data therefore has direct implications for everything from workforce planning to the number of prosthetic and orthotic clinics required across different states.
Rehabilitation remains concentrated in cities
One of the biggest barriers is geography.
Specialist rehabilitation services remain heavily concentrated in major cities and tertiary hospitals, while people living in rural and underserved areas may have limited access to rehabilitation professionals.
For a person requiring a prosthesis or orthosis, this can mean travelling considerable distances simply for an initial assessment.
The challenge becomes even greater when multiple appointments are necessary.
A lower-limb amputee may require assessment, casting or scanning, fitting, alignment, gait training and later socket adjustments. A child receiving an AFO may need regular review as they grow.
A service that exists hundreds of kilometres away may technically be “available”, yet still remain practically inaccessible.
This distinction between having rehabilitation services and being able to reach them is central to India’s disability challenge.
Workforce shortages limit capacity
Infrastructure is only part of the problem.
India also needs sufficient numbers of qualified rehabilitation professionals distributed across the country.
The Hindustan Times article highlights shortages of physiotherapists, occupational therapists, speech and language therapists, rehabilitation psychologists and special educators, particularly outside metropolitan areas.
The same broader workforce challenge is highly relevant to prosthetists and orthotists.
Supplying a prosthetic limb is not simply a manufacturing task. Clinical assessment, prescription, socket design, alignment, gait assessment, follow-up and patient education all require professional expertise.
Orthotic care is similarly dependent on appropriate clinical assessment and prescription.
Expanding device production without simultaneously strengthening the professional workforce risks creating a system focused on distributing products rather than delivering rehabilitation outcomes.
Delayed rehabilitation has consequences
The consequences of inaccessible rehabilitation extend well beyond healthcare.
Delayed diagnosis and treatment can contribute to reduced independence, poorer educational opportunities, difficulty entering or returning to employment and increased financial pressure on families.
For an amputee, delayed prosthetic rehabilitation may mean spending months with severely restricted mobility.
For someone with diabetes, delayed foot assessment can allow a manageable problem to progress towards ulceration or more severe complications.
For a child requiring orthotic intervention, delays during important periods of growth and development can affect mobility and participation.
Rehabilitation should therefore be considered part of a wider economic and social inclusion strategy rather than an optional service delivered after acute medical treatment.
Community-based rehabilitation offers another model
One of the solutions highlighted by Agarwal is Community-Based Rehabilitation (CBR).
Rather than requiring everyone to travel to large specialist institutions, community-based models seek to bring elements of rehabilitation closer to where people live.
The approach can include local screening, referral, assistive technology provision, rehabilitation support and links with education and employment services.
India’s geography and population make such models particularly relevant.
For prosthetics and orthotics, this does not necessarily mean attempting to deliver every specialist service in every village.
A more realistic model could involve regional specialist P&O hubs supported by community screening, mobile assessment clinics and structured referral networks.
Digital tools could strengthen that approach further.
Tele-rehabilitation could extend specialist reach
Tele-rehabilitation is increasingly being considered as one way to reduce the effects of distance.
The Hindustan Times article notes that digital rehabilitation platforms can help connect specialists with patients in areas where conventional services are scarce, while potentially reducing travel and improving continuity of care.
Some aspects of P&O care will always require physical interaction with the patient.
A prosthetic socket cannot be properly assessed entirely through a video call.
However, digital systems could still support:
- Initial screening
- Follow-up consultations
- Gait review
- Device troubleshooting
- Appointment triage
- Patient education
- Outcome monitoring
- Communication between local clinicians and specialist CPOs
This hybrid approach could allow limited specialist resources to cover larger geographical areas.
Digital technology can help connect the pathway
Artificial intelligence and digital healthcare systems could also play an increasing role in identifying patients earlier and improving referrals.
Agarwal points to AI-assisted screening and digital platforms capable of tracking outcomes and improving continuity between healthcare providers.
For P&O services, one of the most valuable applications may simply be better coordination.
Patients are frequently seen by multiple professionals before reaching a prosthetist or orthotist.
An amputee may pass through surgery, wound care, physiotherapy and rehabilitation before receiving a prosthesis.
A child requiring an orthosis may move between paediatrics, neurology, physiotherapy and orthopaedics.
Better digital referral systems could reduce the number of patients lost between those stages.
Assistive technology must be part of mainstream healthcare
India already has numerous government, charitable and private programmes supplying assistive devices.
But the long-term challenge is moving from individual distribution initiatives towards a coherent national rehabilitation pathway.
That means considering assistive technology alongside workforce development, clinical assessment, maintenance and follow-up.
A prosthesis that cannot be repaired locally can quickly become unusable.
An orthosis that is never reviewed may stop fitting correctly.
A wheelchair without an appropriate seating assessment may fail to deliver the intended benefit.
Access therefore needs to be measured not simply by the number of devices distributed, but by whether people continue using them successfully.
A major opportunity for India’s CPO profession
India’s rehabilitation gap also represents one of the greatest opportunities for the country’s prosthetics and orthotics profession.
Demand exists far beyond the patients currently attending established clinics.
Community outreach, mobile services, digital workflows and decentralised fabrication all have the potential to help CPOs reach more patients while maintaining professional oversight.
The challenge is to expand without lowering clinical standards.
India needs scale, but it also needs quality.
That means investing in CPO education, professional development, digital infrastructure, regional rehabilitation centres and closer collaboration between government, hospitals, NGOs and private providers.
Agarwal’s central argument is that rehabilitation must increasingly be treated as a core component of health, inclusion and national development, rather than an isolated disability service.
For Bharat CPO, that message is particularly relevant.
India’s future prosthetics and orthotics system cannot be judged solely by how sophisticated its technology becomes.
Its success will ultimately depend on whether a person who needs a prosthesis, orthosis or other assistive technology — regardless of where they live or what they earn — can actually reach a qualified professional and continue receiving appropriate care.
- Hindustan Times – Why disability services fail to reach millions
- Narayan Seva Sansthan
- Department of Empowerment of Persons with Disabilities
- Rehabilitation Council of India
- World Health Organization – Rehabilitation
- Bharat CPO