Prosthetic and Orthotic Service Gaps in India: Implications for Rehabilitation Access and Policy Reform

Background: Access to prosthetic, orthotic and related assistive services remains uneven globally; this manuscript examines the systemic causes and rehabilitation consequences within the context of India. We frame service gaps as health-systems failures with measurable workforce, supply-chain, financing and data components. Methods: A narrative policy review was undertaken using targeted searches of peer-reviewed literature, government reports, professional body publications, and NGO datasets. Key themes were synthesized across governance, workforce, supply chain, financing, and monitoring domains to derive pragmatic policy interventions. (Authors should replace or update search dates and data sources as required prior to submission.) Findings/Observations: Four structural deficits drive undercoverage: (1) insufficient trained P&O workforce and uneven geographic distribution; (2) fragmented manufacturing and procurement with limited quality control; (3) inadequate public financing and poor insurance/benefits coverage for device services; and (4) absence of routine service and outcome surveillance. These deficits produce preventable functional dependency, increased caregiver burden, and inequitable access—most pronounced among rural, low-income, and disabled populations. Conclusions: Closing P&O service gaps requires integrated health-systems actions: workforce scale-up and credentialing, pooled procurement and quality standards, explicit public financing pathways, and routine service/outcome monitoring. Policy recommendations (summary): Five priority actions are proposed: national workforce strategy, accreditation and CE frameworks; standardized device procurement and quality assurance; finance and benefit design for assistive services; decentralized service hubs with tele-rehabilitation links; and a national monitoring dashboard tied to performance indicators.