When the Accessible India Campaign (Sugamya Bharat Abhiyan) was launched in 2015, it set out a framework for progressive improvements across public infrastructure, transport systems, and information services for persons with disabilities.
A recent study evaluates the ongoing operational progress and practical implementation of these standards on the ground.
The audit examined 35 government hospitals across Madhya Pradesh and Goa to assess how accessibility standards translate into daily utility. The findings point to structural and operational gaps in how accessibility guidelines are executed across healthcare facilities.
The study, titled ‘Participatory accessibility audits as a tool for disability-inclusive health systems: Findings from two Indian states,’ published in Dialogues in Health, found that while many hospitals have incorporated basic physical infrastructure, significant implementation gaps remain, particularly for individuals with visual, hearing, cognitive, and sensory disabilities.
The overall accessibility score across the hospitals was just 32.6%. What made the study particularly significant is not merely the deficiencies it documented, but who was asked to identify them.
Instead of treating persons with disabilities as beneficiaries waiting for accessible infrastructure, researchers trained them to become field investigators and auditors. Their lived experience became an essential part of assessing whether hospitals were genuinely usable.
“Until persons with disabilities are involved in planning, designing, auditing and monitoring, many practical barriers will remain invisible,” said one of the authors, Dr Satendra Singh, Professor at University College of Medical Sciences, Delhi, and founder of Doctors With Disabilities: Agents of Change.
The other researchers were Harikeerthan Raghuram, Shilpee Verma, Eesha Lavalekar, Anoushka Virk and Anant Bhan, all from Initiative for Health Equity Advocacy and Research, Sangath, Bhopal.
The 180-point checklist examined almost every stage of a patient's journey through a hospital, including external pathways, parking, reception counters, ramps, stairs, lifts, waiting areas, wards, toilets, emergency exits, information and way-finding, equipment and digital accessibility.
The outcome was not very encouraging. Ramps were among the most visible interventions, but their presence often created an illusion of accessibility, the study said, noting that only 57.1% of the hospitals had ramps with the recommended gradient of 1:12 or less. Nearly 70% lacked handrails on both sides, and 94% did not have dual-height handrails. Several ramps were steep, obstructed or slippery and lacked adequate colour contrast.
“A ramp is not accessible merely because it exists. Its gradient, width, handrails, surface and approach all matter,” Dr Singh pointed out.
The same problem was evident with lifts. About 63% of the hospitals had lifts connecting different floors. Yet among hospitals with lifts, 91% did not have controls at an accessible height, 64% lacked Braille-enabled controls and 77% did not provide audio announcements indicating the floor.
Nearly 95% did not have a rear-wall mirror. “A mirror inside a lift is also important because a wheelchair user may need to reverse out and should be able to see what is behind them,” Dr Singh said.
The study found that accessibility measures were often concentrated around the main entrance rather than integrated into the entire hospital.
The sharpest gaps emerged in sensory accessibility, with just 5.7% of hospitals having tactile ground surface indicators to guide people with visual impairment. None had signage supplemented with embossed letters or Braille, and only one hospital had a tactile map.
Not a single hospital had a sign-language interpreter.
While 85.7% used high-contrast and readable visual signs, only 31.4% used appropriate pictograms.
“The absence of Braille signage, tactile pathways, sign-language interpreters and accessible communication systems shows that accessibility cannot be reduced to construction,” Dr Singh said.
Similarly, toilets recorded the lowest score in the audit, at just 4%. Several toilets designated for persons with disabilities were found to be locked, non-functional, undersized or being used for storage. In 94% of cases, doors opened inwards, making wheelchair access difficult. Emergency bells, suitable handrails, adequate turning space and accessible signage were largely missing.
The findings exposed the gap between an accessibility feature existing on paper and being usable in real life.
Parking and registration counters too posed similar problems. Although external pathways were adequately wide in 85.7% of hospitals, only 60% were free from obstructions. Reserved accessible parking was available at just 25.7% of hospitals, and only one had a marked drop-off zone.
None of the hospitals had a lowered reception counter suitable for wheelchair users. Only 17.1% had a dedicated counter or helpdesk for persons with disabilities.
Emergency preparedness was another weak area. Although emergency exits existed, only 40% had clearly visible and understandable directional signs. Emergency lighting was available in just 34.3% and functioning fire alarms in 45.7%, as per the study.
There were also no specific evacuation plans addressing the needs of persons with disabilities, including tactile or Braille exit maps and specialised evacuation equipment or protocols.
Dr Singh noted that these findings suggest a need to re-evaluate how accessibility campaigns are scaled.
“The Campaign was a welcome and necessary initiative, but much of its implementation has focused on selected buildings and urban centres. This is particularly significant because nearly 70% of persons with disabilities in India live in rural areas,” Dr Singh said, noting that expanding focus beyond prominent metropolitan facilities is essential for broader impact.
“The biggest weakness has been the limited involvement of the very people for whom the campaign was designed,” Dr Singh said, stressing that awareness among engineers and planners matters as much as construction itself.
Accessibility standards may exist, but unless those designing and building public facilities understand why each feature matters, compliance can become a box-ticking exercise.
The researchers also emphasised that the answer lies in making accessibility participatory and adopting universal design rather than treating disability access as a special requirement for a small section of society.
Universal design benefits not only persons with disabilities but also older people, pregnant women, people recovering from injuries and anyone who may temporarily have difficulty walking, seeing, hearing or navigating a public facility, they said.
After all, pointed out Dr Singh, a hospital, or for that matter a bank, which are public facilities, are not accessible because a ramp has been built, a lift installed or a toilet labelled “disabled-friendly”. It is accessible only when a person with a disability can enter, register, navigate, communicate, receive treatment, use the facilities and leave safely and independently, he added.
“Public money is being spent on buildings and infrastructure, yet officials do not always consult the State Commissioner for Persons with Disabilities on accessibility requirements. In many cases, even senior political leadership may not be fully aware of these specific execution gaps,” Dr Singh noted.
“If a building does not meet fire safety requirements, it does not get a fire NOC. If the required water and safety provisions are not in place, approvals are withheld. Accessibility should work in the same way. The law provides that a completion certificate should not be issued unless the building complies with prescribed accessibility standards,” Dr Singh said.
He said accessibility should be treated as part of universal design, rather than as a special provision for a small section of the population.
“The engineers and planners need to understand why these standards matter. If you build accessibility into the design from the beginning, it is not an additional burden. It becomes part of the building itself,” he asserted.
