Participatory accessibility audits as a tool for disability-inclusive health systems: Findings from two Indian states.

Introduction: Persons with disabilities face a higher need for healthcare but face challenges accessing healthcare. Despite policy developments in India, progress towards accessibility of healthcare facilities for persons with disabilities has been slow. Methods: This study used a participatory accessibility audit approach conducted in partnership with the government authorities to evaluate disability accessibility of 35 government hospitals in the states of Madhya Pradesh and Goa in India. A checklist was developed using reference guidelines and consultations with a community advisory board. After piloting, audits were conducted by persons with disabilities recruited as field investigators with training and support provided. Results: The audits showed that while hospitals have made efforts towards physical accessibility such as through ramps, many of them were inappropriate. There were large gaps in terms of accessibility for persons with sensory impairments. After the audits, the findings were shared at the state and district levels by the auditors and research team, and action plans were co-created with government officials. Early signs of change are being seen in certain districts. Conclusion: While the study shows mixed progress towards ensuring accessibility in government hospitals, it demonstrates a model of participatory accessibility audits. Participatory audits provide a rigorous, rights-based, and scalable model for accountability and change. They have widespread transferability for improving accessibility for disability communities in diverse sectors as well as for improving access to healthcare for diverse marginalised communities. However, ensuring success of the model depends on trusted partnerships between government, disabled people's organisations, health providers and researchers.