Abstract
Background:
Despite progress, there are still gaps and inequalities in achieving universal health coverage (UHC), particularly among marginalized populations such as people with visual disability (VD). This study aimed to evaluate access to disability-related healthcare among people with VD in India.
Methods:
Data from the Survey of Persons with Disabilities in India, the 76th round of the National Sample Survey (NSS), which was conducted between July 2018 and December 2018, were used in this study. Binomial logistic regression was used to find the association between access to disability-related healthcare and sociodemographic characteristics.
Results:
The prevalence of VD in the general population was 0.23%. About 15% of people with VD did not have access to healthcare for disability. Access was lower in the older age group (Adjusted Odds Ratio (AOR) =0.68) than in the younger age group, females (AOR = 0.89), persons with low literacy (AOR = 0.72), low consumption expenditure (AOR = 0.60), and people belonging to the scheduled tribes (STs) (AOR = 0.57). Affordability was the leading reason for poor accessibility. About 55% of people with VD had zero out-of-pocket expenditure (OOPE), 35.8% had monthly OOPE below INR 1000, and 1.3% had monthly OOPE INR >5000.
Conclusion:
The study found gaps in access to healthcare in people with VD in India. This population is falling behind in the core elements of UHC, i.e. affordability and inequality. India should adopt a comprehensive strategy that includes age-specific interventions, improved rural access, measures for socioeconomic equity, gender sensitivity, and expanded public health insurance coverage and social security schemes for people with VD.
Keywords: Blindness, health services for persons with disabilities, universal health coverage, vision disorders, visually impaired persons
INTRODUCTION
Nations reiterated their strong political commitment to achieving universal health coverage (UHC) during the 2019 United Nations General Assembly High-Level Meeting on UHC.[1] Although significant progress has been made toward achieving UHC, inequalities remain a major challenge to achieving it.[2] India has also made significant progress in achieving the provisions of UHC.[3] Despite progress, there are still gaps and inequalities in access to healthcare, particularly among marginalized populations such as people with disabilities.[2,3]
The population of people with disability represents approximately one billion people, which is equivalent to around one out of every seven people worldwide.[4] In India, around 60 million people live with a disability, 12% of them with a visual disability (VD).[5] People with disability have a greater need for healthcare.[6] In addition to general healthcare, they often require disability-specific healthcare, such as rehabilitation and assistive technology. Disability-specific treatment, access to assistive devices, and rehabilitation services were included in disability-related healthcare.[7] A World Health Organization (WHO) report showed that people with VD had a greater unmet need for disability-related healthcare due to poor accessibility, availability, and acceptability of services.[8] These can be further aggravated by rural residence, older age, female, low socioeconomic status, etc.[8]
People with VD also face greater healthcare expenses, as they require more frequent healthcare visits and incur indirect costs associated with these visits (such as the need to have a person accompany them and accessible transportation).[8] However, their ability to pay for these expenses is likely limited due to their lower financial independence.[8]
By evaluating these existing gaps and barriers, policymakers can create targeted strategies to increase accessibility, affordability, and quality of healthcare services for this vulnerable population. Therefore, this study aimed to assess access to disability-related healthcare among people with VD in India. The study also aimed to find out the prevalence of VD in India.
MATERIAL AND METHODS
The study used data obtained from the National Statistical Office (NSO), which was previously known as the National Sample Survey Organization. It was started by the Ministry of Statistics and Implementation in 1950. The purpose of this organization is to conduct periodic surveys to provide essential statistical data on various subjects, including household socioeconomic status, demography, health, disability, industries, agriculture, etc.[9]
The specific NSO data set used in this study was the Survey of Persons with Disabilities in India, National Sample Survey (NSS) 76th round, which was administered between July 2018 and December 2018.[7] Data were collected in a stratified two-stage sampling design, with 5378 rural and 3614 urban first-stage units (FSUs). A rural village and urban frame survey (UFS) was divided into several subunits (SUs). FSUs were villages/UFS blocks/SUs according to the situation. The second-stage units were households (HHs) in both rural and urban areas. The survey included 81004 rural HH and 37147 urban HH. The survey sample included a total of 576569 individuals, 402589 from rural areas, and 173980 from urban areas.[7]
In the national survey, data were collected through face-to-face interviews using a structured questionnaire on disability and disability-related healthcare—accessibility, out-of-pocket expenditure (OOPE), aid/appliances, social security provisions, etc., (Schedule 26).[7] We limit our analysis to VD.
Visual disability (VD): A person with any of the following conditions was considered a person with VD[7]:
No perception of light (PL) with or without the help of spectacles;
Has PL but has blurred vision even after using spectacles, contact lenses, etc., Such persons can move independently with the help of remaining vision;
Has PL but cannot see properly to move around independently; and
Has blurred vision but had no occasion to test if her/his eyesight would improve after taking corrective measures.
In cases II, III, and IV, if a person was unable to count fingers at a 10-foot distance, then it was taken as a person with VD. Further, VD was categorized as follows: a) blindness—No PL, PL present but unable to count fingers at 3 feet distance; b) low vision—PL present, but unable to count fingers up to a distance of 3–10 feet. Presenting visual acuity was measured for all cases. A person with one eye and not with any of the above-mentioned specific conditions was not considered a person with a VD.[7]
Aid/Applications: High-powered glasses, contact lenses, and canes (smart and regular) were considered aids/appliances.[7]
OOPE on disability-related healthcare: It was recorded in the following heads: Infrequent medical expenditure during the last 365 days (A), Infrequent non-medical expenditure during the last 365 days (B), Usual monthly medical expenditure (C), Usual monthly non-medical expenditure (D).
Medical expenditures included doctor’s fees, medicines, diagnostic tests, bed charges, attendant charges, equipment/appliances cost, caregiver, etc., whereas non-medical expenditures included transport, registration fees, food, lodging charges, and other incidental charges incurred for treatment.
Average monthly OOPE: A/12 + B/12 +C +D
Catastrophic health expenditure 10% (CHE 10): When a household’s OOPE incurred on disability-related healthcare in the previous year exceeds 10% of their total annual consumption expenditure, it was considered as an instance of CHE-10%.
Monthly per capita consumption expenditure (MPCE): The monthly consumer expenditure of a household refers to the aggregate monetary value of all goods and services that are regularly consumed within the domestic sphere.
Statistical analysis
Data were analyzed using IBM SPSS Statistics, version 20.0. Armonk, NY: IBM Corp. Categorical variables were presented as proportions. Continuous variables were presented as mean (SD) and median (interquartile range). Survey weights provided by the NSO were used to calculate the proportions. The weights were Second Stage Stratum (SSS) wise and binomial logistic regression was used to find the association between VD and sociodemographic characteristics. Mann Whitney U test was used to find the difference in median OOPE between VD only and VD with other disability. P value < 0.05 was considered significant for all calculations.
RESULTS
Prevalence of VD by sociodemographic characteristics
The prevalence of VD was 0.23%. Among the general population, 0.14% had blindness and 0.09% had low vision. The prevalence was higher in rural than urban areas (Adjusted Odds Ratio (AOR) =1.01). The prevalence of VD increased with age. It was higher in the elderly (AOR = 42.22), middle age group (AOR = 18.18), adolescents (AOR = 4.05), 6–9 years of age children (AOR = 2.58) than in children under five years of age. The prevalence of VD was higher among women and transgenders than men. The prevalence of VD decreased with increases in educational level, i.e., primary (AOR = 0.52), secondary (AOR = 0.36), graduation, and above (AOR = 0.26). The prevalence was almost similar in the first four MPCE quintiles, but it was lower in the richest category (AOR-0.84). It was higher in the population of the scheduled tribe (ST) than in others (AOR = 1.09). It was less in married (AOR = 0.49) than in divorced/separated persons [Table 1].
Table 1.
Prevalence of visual disability (VD) by sociodemographic characteristics
| Variable | Category | Total (n=576569) | VD Yes (n=11967) | Weighted prevalence (%) (0.23) | AOR (95% CI) | P |
|---|---|---|---|---|---|---|
| Sector | Rural | 402589 | 8804 (2.2) | 0.27 | 1.01 (0.97-1.06) | 0.634 |
| Urban | 173980 | 3163 (1.8) | 0.18 | 1 | ||
| Age | Under 5 | 46645 | 182 (0.4) | 0.04 | 1 | |
| 6–9 years | 39332 | 289 (0.7) | 0.06 | 2.58 (2.13-3.12) | <0.01* | |
| 10–19 years | 110160 | 999 (0.9) | 0.09 | 4.05 (3.44-4.76) | <0.01* | |
| 20–45 years | 229293 | 2483 (1.1) | 0.11 | 8.07 (6.88-9.46) | <0.01* | |
| 46–60 years | 84566 | 2449 (2.9) | 0.34 | 18.18 (15.38-21.48) | <0.01* | |
| ≥61 years | 66573 | 5565 (8.4) | 1.53 | 42.22 (35.75-49.86) | <0.01* | |
| Gender | Male | 295545 | 6009 (2.0) | 0.23 | 1 | |
| Female | 280925 | 5953 (2.1) | 0.24 | 0.74 (0.72-0.77) | <0.01* | |
| Transgender | 99 | 5 (5.1) | 0.36 | 1.36 (0.53-3.50) | 0.515 | |
| Education | Not literate | 179698 | 7155 (4.0) | 0.55 | 1 | |
| Literate below primary | 91778 | 1375 (1.5) | 0.15 | 0.61 (0.58-0.65) | <0.01* | |
| Primary | 74737 | 1104 (1.5) | 0.16 | 0.52 (0.48-0.55) | <0.01* | |
| Middle | 79640 | 967 (1.2) | 0.13 | 0.45 (0.42-0.49) | <0.01* | |
| Secondary | 66166 | 672 (1.0) | 0.10 | 0.36 (0.33-0.39) | <0.01* | |
| Senior Secondary | 46992 | 387 (0.8) | 0.07 | 0.29 (0.27-0.33) | <0.01* | |
| Graduation and above | 37557 | 307 (0.8) | 0.06 | 0.26 (0.23-0.29) | <0.01* | |
| Religion | Hindu | 445535 | 9471 (2.1) | 0.24 | 1 | |
| Muslim | 88508 | 1599 (1.8) | 0.20 | 1.04 (0.99-1.11) | 0.139 | |
| Others | 42526 | 897 (2.1) | 0.22 | 1.03 (0.96-1.11) | 0.391 | |
| MPCE | Poorest | 115318 | 2236 (1.9) | 0.25 | 1 | |
| Poor | 115302 | 2384 (2.1) | 0.26 | 0.97 (0.92-1.03) | 0.380 | |
| Middle | 119121 | 2580 (2.2) | 0.26 | 0.95 (0.89-1.01) | 0.105 | |
| Rich | 115519 | 2401 (2.2) | 0.23 | 0.91 (0.85-0.97) | 0.002 | |
| Richest | 115309 | 2366 (2.1) | 0.18 | 0.84 (0.79-0.90) | <0.01* | |
| Social group | Schedule tribe | 66462 | 1491 (2.2) | 0.23 | 1.09 (1.01-1.17) | 0.015 |
| Schedule caste | 108498 | 2407 (2.2) | 0.27 | 1.05 (0.99-1.10) | 0.145 | |
| Other backward castes | 251606 | 5199 (2.1) | 0.24 | 1.04 (0.99-1.09) | 0.103 | |
| Others | 150003 | 2879 (1.9) | 0.21 | 1 | ||
| Marital Status | Never married | 254957 | 2718 (1.1) | 0.10 | 1.19 (0.96-1.48) | 0.098 |
| Married | 280811 | 5538 (2.0) | 0.22 | 0.49 (0.39-0.60) | <0.01 | |
| Widowed | 37835 | 3611 (9.5) | 0.43 | 1.04 (0.85-1.29) | 0.648 | |
| Divorced/Separated | 2966 | 100 (3.4) | 0.66 | 1 |
AOR - Adjusted Odds Ratio, *Statistically significant, MPCE - Monthly per capita consumption expenditure
Table 2 shows details of VD. About 45% of cases of VD were due to diseases and 7.8% were due to injury. The most common place of injury was home (38.1%) followed by workplace (24.7%) and roads (21.9%). Among people with VD, 62.2% had blindness and 37.8% had low vision. Approximately, one-fifth of those with VD had VD since birth. Almost half of the people acquired it after the age of 50 years.
Table 2.
Details of visual disability among people with VD
| Number (n) | % | |
|---|---|---|
| Cause of disability (n=11967) | ||
| Disease | 5579 | 46.6 |
| Burn | 62 | 0.5 |
| Injury other than burn | 872 | 7.3 |
| Others | 5454 | 45.6 |
| Place of injury (n=934) | ||
| Road | 201 | 21.5 |
| Workplace | 227 | 24.3 |
| Home | 350 | 37.5 |
| Other places | 140 | 14.9 |
| Since Birth | 16 | 1.7 |
| Category of disability (n=11967) | ||
| Blindness | 7443 | 62.2 (Weighted Prevalence-0.14%) |
| Low vision | 4524 | 37.8 (Weighted Prevalence-0.09%) |
| Age of onset (n=11967) | ||
| Since birth | 2466 | 20.6 |
| From birth to 15 years | 1154 | 9.6 |
| 16–50 years | 2817 | 23.5 |
| ≥51 years | 5480 | 45.8 |
| Not known | 50 | 0.4 |
Access to disability-related healthcare
Table 3 shows access to disability-related healthcare among people with VD. About 15% of people with VD did not have access to healthcare for disability. The reasons were affordability (7%), availability (1.5%), and perceived need (5%). About half of people with VD were advised of aid/appliances. Among those, about three-fourths had access to these aids/appliances. Affordability (20.5%) and availability (3.9%) were the main reasons for not having access to these aids/appliances. A majority (75.9%) of people with VD did not get any direct support from the government or any other organization for their disability-related healthcare. Table 4 shows that access to treatment was lower in the older age group (AOR = 0.68) than in the younger age group, females (AOR = 0.89), persons with low literacy (AOR = 0.72), low consumption expenditure (AOR = 0.60), and people belonging to the STs (AOR = 0.57). Similarly, access to aid/applications was lower in people with low literacy (AOR = 0.54), low consumption expenditure (AOR = 0.33), and people belonging to marginalized communities such as the ST (AOR = 0.61), scheduled caste (SC) (AOR = 0.59), and other backward caste (AOR = 0.78).
Table 3.
Access to disability-related healthcare among people with visual disability
| Variable | Category | Category | Number (n) | % |
|---|---|---|---|---|
| Access to treatment/advice (n=11967) | Yes | Consulting doctors | 9765 | 81.6 |
| Others | 454 | 3.8 | ||
| Attending special school/therapy | 25 | 0.2 | ||
| No | Cannot afford | 839 | 7.0 | |
| Not available | 172 | 1.4 | ||
| Not required | 602 | 5.0 | ||
| Not known | 110 | 0.9 | ||
| Access to advised aid/appliances (5562) | Yes | 3919 | 70.5 | |
| No | Cannot afford | 1142 | 20.5 | |
| Not available | 217 | 3.9 | ||
| Others | 284 | 5.1 | ||
| Receipt of any Help (n=11967) | Yes | From government | 2774 | 23.2 |
| From other organization | 222 | 1.9 | ||
| No | 8971 | 74.9 |
Table 4.
Factors affecting access to disability-related healthcare among persons with visual disability
| Variable | Category | Accessibility to treatment AOR (95% CI) | P | Accessibility to aid/appliances AOR (95% CI) | P |
|---|---|---|---|---|---|
| Sector | Rural | 1.04 (0.90-1.10) | 0.618 | 1.07 (0.92-1.24) | 0.409 |
| Urban | 1 | 1 | |||
| Age | 0–19 years | 1 | 1 | ||
| 20–50 years | 0.70 (0.58-0.85) | <0.01* | 0.90 (0.73-1.11) | 0.341 | |
| >51 years | 0.68 (0.57-0.80) | <0.01* | 1.19 (0.99-1.45) | 0.070 | |
| Gender | Male | 1 | 1 | ||
| Female | 0.89 (0.81-0.99) | 0.047* | 0.89 (0.79-1.01) | 0.070 | |
| Transgender | 0.23 (0.04-1.43) | 0.117 | 0.46 (0.02-9.65) | 0.611 | |
| Education | Up to Primary | 0.72 (0.63-0.84) | <0.01* | 0.54 (0.46-0.64) | <0.01* |
| Above primary | 1 | 1 | |||
| Religion | Hindu | 1 | 1 | ||
| Muslim | 1.28 (1.07-1.52) | 0.006* | 0.92 (0.77-1.10) | 0.363 | |
| Others | 1.03 (0.84-1.27) | 0.774 | 1.19 (0.93-1.52) | 0.162 | |
| MPCE | Poorest | 0.60 (0.50-0.73) | <0.01* | 0.33 (0.26-0.41) | <0.01* |
| Poor | 0.80 (0.67-0.97) | 0.019* | 0.51 (0.42-0.64) | <0.01* | |
| Middle | 0.90 (0.75-1.08) | 0.266 | 0.66 (0.54-0.82) | <0.01* | |
| Rich | 0.99 (0.83-1.19) | 0.925 | 0.71 (0.58-0.87) | 0.001* | |
| Richest | 1 | 1 | |||
| Social group | Schedule tribe | 0.57 (0.48-0.69) | <0.01* | 0.61 (0.49-0.76) | <0.01* |
| Schedule caste | 0.85 (0.73-1.00) | 0.053 | 0.59 (0.49-0.72) | <0.01* | |
| Other backward castes | 0.92 (0.79-1.06) | 0.281 | 0.78 (0.66-0.91) | 0.002* | |
| Others | 1 | 1 |
AOR - Adjusted Odds Ratio, *Statistically significant
Table 5 shows OOPEs incurred on disability-related healthcare. The mean (SD) monthly OOPE was INR 472.42 (1673.18). The median OOPE was higher among VD with other disability than VD only. About 55% of people with VD had zero OOPE, 35.8% had OOPE below INR 1000, and 1.3% had monthly OOPE INR > 5000, which was lesser among people with VD only (0.9%) than VD with other disability (3.8%). CHE was present in only three persons.
Table 5.
Out-of-pocket expenditure incurred on disability-related healthcare among people with VD
| All (11967) | VD with other disability (n=1746) | Only VD (n=10221) | |
|---|---|---|---|
| Monthly medical expenditure | |||
| Mean (SD), INR | 384.31 (1508.46) | 779.07 (2423.26) | 316.87 (1276.87) |
| Median (IQR)*, INR | 0 (384.31) | 150.0 (500.0) | 0 (384.31) |
| Zero expenses, n (%) | 6719 (56.1) | 826 (47.3) | 5893 (57.7) |
| Up to INR 1000, n (%) | 4362 (36.5) | 634 (36.3) | 2728 (36.5) |
| INR 1001-5000, n (%) | 772 (6.5) | 234 (13.4) | 538 (5.3) |
| > INR 5000, n (%) | 114 (0.9) | 52 (3.0) | 62 (0.6) |
| Monthly non-medical expenditure | |||
| Mean (SD), INR | 88.11 (293.38) | 139.63 (432.31) | 79.30 (261.40) |
| Median (IQR)*, INR | 0 (88.11) | 2.1 (88.4) | 0 (88.11) |
| Zero expenses, n (%) | 6820 (57.0) | 873 (50.0) | 59.47 (58.2) |
| Up to INR 1000, n (%) | 4993 (41.7) | 828 (47.4) | 4165 (40.7) |
| INR 1001-5000, n (%) | 149 (1.2) | 42 (2.4) | 107 (1.0) |
| > INR 5000, n (%) | 5 (0.04) | 3 (0.2) | 2 (0.01) |
| Monthly total expenditure | |||
| Mean (SD), INR | 472.42 (1673.18) | 918.71 (2699.81) | 396.18 (1411.88) |
| Median (IQR)*, INR | 0 (472.42) | 200 (616.7) | 0 (472.42) |
| Zero expenses, n (%) | 6539 (54.6) | 798 (45.7) | 5741 (56.2) |
| Up to INR 1000, n (%) | 4287 (35.8) | 616 (35.3) | 3671 (35.9) |
| INR 1001-5000, n (%) | 983 (8.2) | 265 (15.2) | 718 (0.7) |
| > INR 5000, n (%) | 158 (1.3) | 67 (3.8) | 91 (0.9) |
| CHE 10% | |||
| n (%) | 3 (0.03) | 1 (0.05) | 2 (0.01) |
*Mann Whitney U test significant (P<0.05) between VD with other disability and VD only
DISCUSSION
The study highlighted the prevalence of VD and access, availability, and financial hardship for disability-related healthcare among people with VD.
Prevalence of VD
The prevalence of VD, blindness, and low vision in India was found to be 0.23%, 0.14%, and 0.09%, respectively. The prevalence of VD among the children <19 years of age group was found in a range from 0.04 to 0.09%, which was comparable to the findings of a study by Kemmanu et al.[10] In the elderly, the prevalence of VD was found to be 1.53%. Ehrlich et al.[11] and Vashist et al.[12] reported a 2.14% and 1.99% prevalence of blindness among persons >50 years of age, respectively. Vashist et al.[13] also reported a 0.05% prevalence of blindness among the 0–49 age group in India. Based on these proportions, the prevalence of blindness in India was estimated to be 0.3%,[12] which was higher than our findings, i.e., 0.14%. This disparity may be due to different criteria used to define blindness, low vision, and VD. Though the survey adopted the definition of VD from the Rights of Persons with Disabilities Act, 2016, the assessment of VD was done differently than the Act (RPwD 2016).[7] These findings highlight the urgent need to address the growing burden of VD among older adults in India. The prevalence was higher in rural areas, which was consistent with the findings of other studies.[11,12] Similarly, females, less education, marginalized communities, and less consumption expenditure were also associated with a higher prevalence of VD, which was similar to findings from other studies.[11,12] The greater incidence of blindness in individuals belonging to these groups can potentially be attributed to the inequality observed in their ability to obtain the necessary eye care services for prevention and treatment.
This study also showed disparities in the utilization of eye care services between different populations, contributing to variations in the prevalence of VD.
Accessibility
About 85% of people with VD had access to eye treatment-related services, and 70% had access to suggested aids/appliances. Similarly, Banks LM et al.[6] also found 27% of unmet needs for treatment or services in people with VD in the Maldives. Whereas Pryor W et al.[14] found a 70% unmet need for assistive products among people with disability in Bangladesh.
In recent years, there has been a considerable increase in access to services as a result of the initiatives undertaken by various non-governmental organizations and the government’s national program aimed at addressing visual impairment.[12,15] Despite this, a quarter of the population still lacks access. In this study, older age, women, less education, less consumption expenditure, and marginalized communities such as ST and SC were associated with poor access to eye-related healthcare services among people with VD. Similarly, Marmamula S also reported that poor accessibility was further aggravated by person-related vulnerability factors, such as gender, socioeconomic status, and perceived financial burden of eye care services.[16]
Elderly people tend to use eye care services less frequently, often perceiving declining vision as an inherent aspect of the natural aging process.[16] In addition, they may lack awareness about the availability of effective treatments for various ocular conditions or the potential benefits that can improve their visual functioning.[16] Studies conducted in low- and middle-income countries consistently suggest that women are less likely to receive cataract surgery compared to men.[17,18] This gender-based disparity in the use of eye care services can be attributed to various socioeconomic and cultural factors. These include obstacles women face when accessing health facilities due to limited financial autonomy and lack of exposure to travel beyond their immediate community.[8] Factors affecting socioeconomic status such as income, social groups, and education are consistently reported as significant determinants of eye-related care utilization. Similar to the findings of our study, those with higher levels of socioeconomic disadvantage tend to have lower rates of utilizing eye care.[19,20]
Availability
Some people with VD also mentioned that treatment services (1.4%) and aid/appliances (3.9%) for their ailments were not available. This was similar to a survey of the general population by Marmamula S et al.,[16] where they found that 3.7% of the population mentioned “non-availability” as the reason for not utilizing eye care services. Over the last few decades, there has been a substantial increase in service availability as a result of the combined efforts of various non-governmental organizations and governmental initiatives aimed at preventing blindness.[15]
Affordability
Despite the improvement in service availability, affordability remained the main barrier to accessibility. Affordability was also a major barrier to service utilization in the general population and vulnerable marginalized communities.[16,21] Although CHEs were observed in very few individuals, monthly expenditures on eye care were still high. About 10% of people with VD still incur > INR 1000 for their eye-related disability. CHE was reported to be 12% of people with disability in Vietnam.[22] The relatively low OOPE in India could be due to public-funded health insurance schemes such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Central government health insurance scheme (CGHS), Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances (ADIP), etc., Public-funded health insurances aim to zero out-of-pocket expenses for healthcare,[23,24] but the study showed that half of the people with VD still have OOPE in this study and only 23.2% of people with VD received government grants for disability-related healthcare. OOPE increases in case of multiple disabilities.
Future implications
The study emphasizes the urgent need for India to adopt a comprehensive and targeted strategy to reduce the prevalence of VD and improve access to healthcare services for people with disabilities. To achieve these objectives, it is recommended to implement interventions specifically tailored to different age groups, improve the accessibility of eye care services in rural areas, address socioeconomic inequalities, incorporate approaches sensitive to gender issues, and strengthen service availability while maintaining affordability. By expanding publicly funded health insurance coverage and other social security programs that will provide robust financial support to marginalized communities and empower women by removing existing barriers, India can effectively reduce the burden of VD.
Strengths and limitations
The use of nationally representative data from a household survey in the study ensures that the findings have good external validity and provide information on both the prevalence of VD and access to healthcare. When interpreting the findings of this study, it is important to consider a few limitations. The study is based on secondary data, which limits its ability to assess the prevalence and access to healthcare without using specific questions and methods. However, the study aim was similar to the survey objectives. The assessment focused on expenditures from the past month, with some infrequent expenses in the last year. However, infrequent expenditures may be subject to recall bias due to a long recall period. The health needs related to disabilities might not be accurately captured as they relied on self-reported data. Furthermore, while the survey determined whether people needed disability-related health services/products and used them, it did not measure whether these adequately met their individual needs. Therefore, the evaluations of the unmet need are likely underestimated in this study.
CONCLUSION
The study highlighted the prevalence of VD in India and the access to disability-related healthcare among people with VD. The prevalence of VD in India was found to be 0.23%, with a higher prevalence in rural areas and among females, marginalized communities, and those with lower socioeconomic status. The study also found that affordability was a major barrier to accessing eye care services. To achieve UHC for people with VD, India should adopt a comprehensive and targeted approach that includes age-specific tailored interventions, improved access in rural areas, addressing socioeconomic inequalities, a gender-sensitive approach, and improved service availability. Affordability can be ensured by expanding publicly funded health insurance coverage and other social security schemes.
Ethics approval
The study used data that are publicly made available by the Ministry of Statistics and Programme Implementation of the Government of India. Participants were not directly approached.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
The authors acknowledge the Ministry of Statistics and Programme Implementation, Government of India, for providing data from the National Sample Survey for analysis.
Funding Statement
This research did not receive any grant from any funding agencies in the public, commercial, or non-profit sectors.
REFERENCES
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