Institutionalization of assistive health technology in India: establishment of a national centre within the IIT-AIIMS ecosystem.

BACKGROUND: Assistive technology (AT) is now recognised as a major element of universal health coverage and rehabilitation systems. Over 2.5 billion individuals around the world need at least one assistive product and this number is expected to increase significantly by 2050. Despite international guidance through the World Health Organization Global Cooperation on Assistive Technology (GATE) and Rehabilitation 2030 initiatives, many low- and middle-income countries (LMICs) lack institutional mechanisms to integrate AT into mainstream public health systems. In India AT provision has historically been fragmented and welfare-orientated. OBJECTIVE: This paper provides a detail of the development of AT systems in India which subsequently led to the institutional development, governance architecture, and functional design of the National Centre of Assistive Health Technology (NCAHT) in India and discusses its potential implications for strengthening AT systems and policy implementation. METHODS: This paper employs a process-based institutional case study design. It explains the original institutional process undertaken by ICMR to establish NCAHT between 2017 and 2023. Primary data comprised ICMR concept notes, expert committee minutes, inter-ministerial consultation records, and formal institutional proposals generated during the establishment process. EVOLUTION OF NCAHT: India participation in WHO-GATE initiative and international rehabilitation system alignment offered a preparatory strategy that resulted in the NCAHT, 2022 in India. NCAHT is a project funded by the ICMR, and operates as a collaboration between the AlIMS Delhi & IIT Delhi. The Centre operates at the national and international levels in line with WHO 5P framework, ICMR-NLEAP, BIS-ICMR-Standards, WHO Rehabilitation-2030, integrated care for older people (ICOPE), Ear & Hearing Care (EHC), SPECS-2030 ecosystem. NCAHT has established institutional functions across twelve domains, collectively aimed at operationalizing AT as an integral component of health and rehabilitation systems rather than a welfare-driven intervention as discussed in this paper. CONCLUSIONS: NCAHT provides a systems-level framework which can be used to enhance access to AT within health and rehabilitation services. Its development presents lessons applicable to the development of AT systems in the low- and middle-income countries based on the coordinated governance, evidence-based validation, and multi-sector cooperation.