Healthcare Infrastructure Crisis: Status of Disability Health Services in India

India is home to over 26 million people with disabilities, according to the 2011 Census – and that figure is widely considered an undercount. What is far clearer, however, is that when persons with disabilities need healthcare, the system often fails them at multiple levels. From a hospital entrance that a wheelchair cannot navigate, to a village that simply has no health centre, the barriers are structural, financial, geographic, and deeply systemic. Understanding the full picture of disability healthcare access in India is not just an academic exercise – it is a matter of basic rights.

Multiple barriers to healthcare access
Physical barriers in healthcare facilities
Provider awareness and attitudinal barriers
Financial and geographic constraints
Inactive health facilities: a data crisis
Rural healthcare system shortfalls
Bihar and Uttar Pradesh: the deepest gaps
Workforce gaps compound the infrastructure crisis
The rights framework and the implementation gap

Multiple barriers to healthcare access

Persons with disabilities in India face a layered set of challenges that go well beyond any single problem. Research published in the Asian Bioethics Review identifies these as falling into several overlapping categories: physical, attitudinal, financial, and geographic – all of which compound each other and push people further away from the care they need.

Physical barriers in healthcare facilities

Walk into most government hospitals in India and the infrastructure tells a story. Accessibility audits of healthcare institutions have found widespread non-compliance with the standards set by the Central Public Works Department for barrier-free environments. Ramps are missing or poorly designed, doorways are too narrow for wheelchairs, accessible toilets are absent, and examination tables cannot accommodate people with mobility limitations. The 2023 Accessibility Standards for Healthcare, issued by the Ministry of Health and Family Welfare under the Rights of Persons with Disabilities (RPwD) Act, 2016, now specify detailed requirements for everything from adjustable examination chairs to wheelchair-accessible diagnostic equipment – but the gap between what is mandated and what exists on the ground remains vast.

Provider awareness and attitudinal barriers

Physical design is only part of the problem. A study in the Indian Journal of Public Health found that compared to persons without disabilities, those with disabilities were significantly more likely to report barriers including lack of awareness of services (13.3% vs. 2%), poor fit of hospital equipment (13.2% vs. 2.1%), and inaccessible physical buildings (12.7% vs. 2.3%). Beyond these numbers, persons with disabilities regularly encounter discrimination and stigmatisation from healthcare staff, which leads to inadequate treatment, misdiagnosis, or complete neglect of health concerns. Research on healthcare providers has also confirmed that awareness of the provisions under the RPwD Act, 2016 remains low even among health professionals who work directly with persons with disabilities – a gap that directly translates into worse care.

Financial and geographic constraints

Even when a person with a disability manages to reach a healthcare facility, the cost of doing so is disproportionately high. Disability is strongly associated with higher out-of-pocket health expenditure, and since public facilities frequently lack accessible infrastructure, persons with disabilities are often forced into the private sector – which is far more expensive. The WHO has estimated that around 53% of persons with disabilities cannot afford healthcare costs, compared to 32% among persons without disabilities. Vulnerable groups with disabilities are also less likely to be enrolled in health insurance schemes, further pushing them toward catastrophic health spending.

The geographic dimension adds another layer. In the South India Disability Evidence (SIDE) study, 13% of persons with disabilities identified the cost of transportation as a direct barrier to accessing healthcare. Public transport in most Indian cities is not equipped for wheelchairs, and in rural areas, the journey to the nearest healthcare facility can be long, arduous, and inaccessible – particularly for those with locomotor disabilities. Assistive technology, medical consultations, and diagnostic tests also carry significant costs that many households simply cannot absorb, especially in low-income rural communities.

Inactive health facilities: a data crisis

One of the most telling indicators of India’s healthcare infrastructure challenge is not the number of facilities that exist, but how many of them are not functioning. Data from the National Health Mission and Ministry of Health reveals a troubling trend across multiple states: health facilities that exist on paper but have become inactive over time. States such as Chhattisgarh, Gujarat, and Uttar Pradesh have shown particularly high numbers of non-operational facilities. By 2019-20, Uttar Pradesh alone recorded over 2,000 inactive health facilities – a figure that reflects deepening systemic failure rather than an isolated administrative lapse. For persons with disabilities, who already face greater difficulty travelling to seek care, the closure or inactivation of even a nearby centre can mean the complete removal of accessible healthcare from their lives.

This pattern of facility inactivity is not confined to one region. It reflects a national pattern of infrastructure that has been built without the accompanying investment in staffing, supplies, maintenance, and management needed to keep it operational. For a person with a visual, locomotor, or hearing impairment living in a district where the local sub-centre is inactive, the only option becomes a longer, more expensive, and often inaccessible journey to a higher-level facility.

Rural healthcare system shortfalls

India’s rural healthcare system is structured as a three-tier hierarchy: Sub Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs). Each level is meant to serve a defined population. In practice, the shortfall between what is required and what exists is severe – and has been widening relative to population growth.

The Rural Health Statistics 2019-20, published by the Ministry of Health and Family Welfare, recorded 155,404 sub centres, 24,918 PHCs, and 5,183 CHCs functioning in rural areas as of March 2020. On the surface, these appear to be significant numbers. But when measured against the actual population they must serve, critical gaps emerge. As of 2018, shortfalls stood at 18% at the sub-centre level, 22% at the PHC level, and 30% at the CHC level – and these figures have continued to deteriorate as population growth outpaces facility expansion.

Bihar and Uttar Pradesh: the deepest gaps

Among all Indian states, Bihar and Uttar Pradesh consistently show the most severe shortfalls in health infrastructure. Bihar has the highest percentage shortfall in sub-centres nationally. Data shows that more than half of Bihar’s population does not have access to even a midwife through the sub-centre network. The state is officially reported to be short of over 11,000 sub-centres relative to its population requirement – meaning that the foundational tier of rural healthcare is simply absent for millions of people.

In Uttar Pradesh, the picture is equally stark. The state requires over 13,000 additional sub-centres to meet the population norm. Analysis of Rural Health Statistics data shows that Uttar Pradesh needed 2,844 specialist doctors at its Community Health Centres but had only 816 in place – a deficit that directly affects referral care, surgical capacity, and specialised treatment. For a person with a spinal cord injury in rural Uttar Pradesh, or a child with cerebral palsy in a remote district of Bihar, this is not a policy statistic – it is the daily reality of having nowhere to go.

Workforce gaps compound the infrastructure crisis

Research on India’s primary care system highlights that even the health facilities that do exist are severely understaffed. Only about 13% of PHCs across the country meet the basic staffing standards set by the Indian Public Health Standards. As of 2020, there was a 24% vacancy rate for medical officers in rural PHCs – meaning nearly one in four posts was unfilled. By 2021-22, Community Health Centres were operating with a shortfall of nearly 80% of the required specialist doctors – including surgeons, physicians, obstetricians, and paediatricians. These vacancies hit rural and tribal communities hardest, and for persons with disabilities who already require more frequent and more specialised care, the impact is disproportionate.

The distribution of health workers also skews heavily urban. Data shows that about 67% of health workers serve urban areas, which hold only a third of India’s population – while rural areas, home to two-thirds of Indians, have access to just 33% of the health workforce. This urban concentration of medical professionals leaves rural persons with disabilities with limited options for any kind of disability-responsive healthcare, let alone the specialised rehabilitation services they often need.

The rights framework and the implementation gap

India has a reasonably robust legal framework on paper. The Rights of Persons with Disabilities Act, 2016 mandates barrier-free access to healthcare institutions and places responsibility on facility owners to ensure accessible environments. India has also ratified the UN Convention on the Rights of Persons with Disabilities and is a signatory to the Biwako Millennium Framework for an inclusive Asia-Pacific region. The Accessible India Campaign (Sugamya Bharat Abhiyan), launched in 2015, was designed to make the built environment, transport, and information systems more accessible.

Yet, as civil society analysis has consistently found, schemes like the Accessible India Campaign see chronic underuse, and fund allocations for disability-related health and rehabilitation services remain inadequate. The treatment gap for mental health conditions alone – a category covered under the RPwD Act – ranges from 76% to 85%, meaning the vast majority of people with mental health disabilities receive no treatment at all. The gap between what the law requires and what the healthcare system delivers is not marginal – it is systemic.

Closing that gap will require more than policy declarations. It demands sustained investment in rural health infrastructure, targeted training of healthcare providers on disability-responsive care, genuine enforcement of accessibility standards in existing and new facilities, and meaningful inclusion of persons with disabilities in healthcare planning at every level. Until then, the healthcare crisis for disabled persons in India will remain not just a health issue, but an ethical one.

What do you think? Given the severe infrastructure shortfalls in states like Bihar and Uttar Pradesh, where should India’s healthcare investment be prioritised first – expanding the number of facilities or ensuring that existing ones are fully staffed and made accessible? And how much responsibility should individual healthcare providers carry for improving disability awareness within their own institutions?

References

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Table of Contents

Multiple barriers to healthcare access 🔗

Physical barriers in healthcare facilities 🔗

Provider awareness and attitudinal barriers 🔗

Financial and geographic constraints 🔗

Inactive health facilities: a data crisis 🔗

Rural healthcare system shortfalls 🔗

Bihar and Uttar Pradesh: the deepest gaps 🔗

Workforce gaps compound the infrastructure crisis 🔗

The rights framework and the implementation gap 🔗