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. 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.