Disability Prevalence and the Awareness-Utilization Gap for Disability Services in an Urban Community of Delhi, India: A Cross-Sectional Study.

introductionDisability-related welfare schemes form a critical component of India's social protection architecture, yet community-level evidence on the gap between awareness and utilization in urban settings remains limited. This study aimed to estimate the prevalence of disability and its socio-demographic correlates and to assess awareness and utilization of disability-related services among adults in an urban community of Delhi, generating baseline data on the awareness-utilization gap for this setting.

methodA community-based cross-sectional study was conducted in Palam, an urban resettlement colony in Delhi, from April 2020 to March 2021. Adults aged ≥25 years residing in the area for at least six months were included, and 1,246 individuals were selected by systematic random sampling. Disability - encompassing locomotor, visual, hearing, and speech impairments - was assessed using the Washington Group Short Set of Questions on Disability alongside self-report. Awareness and utilization of services across healthcare, transport, rehabilitation, and social welfare domains were captured through face-to-face interviews using a pretested semi-structured schedule. Data were analyzed using descriptive statistics and chi-square or Fisher's exact tests.

resultsDisability was identified in 87 of 1,246 participants (6.9%; 95% CI: 5.6%-8.4%). Prevalence was significantly higher among males (59/655; 9.0%) than females (28/591; 4.7%; p = 0.003) and varied significantly by socio-economic status (p = 0.001). Locomotor disability was most common (47/87; 54.0%), followed by hearing (18/87; 20.7%), speech (18/87; 20.7%), and visual disabilities (17/87; 19.5%); some participants reported multiple impairment types, and percentages accordingly sum to more than 100%. Awareness was universal for disability certification, pensions, and transport fare concessions (100% each), with somewhat lower awareness of seat reservation (78/87; 89.7%) but very low for the Unique Disability ID (UDID) card (6.9%), health insurance (6.9%), and loan benefits (6.9%). Utilization was highest for seat reservation (73.6%), disability certification (67.8%), and pensions (55.2%), while no participant reported utilizing health insurance or loan benefits. As data collection coincided with the COVID-19 pandemic (April 2020-March 2021), reported utilization rates likely reflect pandemic-related service disruptions and should not be taken as indicative of baseline access.

conclusionDisability prevalence substantially exceeded national census estimates. Although awareness of several entitlements was high, utilization was consistently lower, with the widest gaps for health insurance, loan benefits, and vocational training. Procedural complexity and implementation failures, rather than information deficits, appear to be the primary barriers to service access. Pandemic-era disruptions likely contributed to the magnitude of the observed gaps. Bridging this divide requires simplified access pathways, targeted IEC (Information, Education, and Communication) campaigns for newer schemes such as the UDID card, and integration of disability services into routine primary healthcare.