When Disability Stops Being a Number: The Struggle to Define Functional Inclusion

A student can enter school and still find that the system becomes harder to navigate as education progresses.

That sounds like a contradiction. If the law recognises a child’s right to education, and if schools are increasingly expected to include children with disabilities, why should disability continue to predict who remains in education and who disappears somewhere along the way?

The problem is that entry tells us only where participation begins. It tells us much less about whether a student can continue participating on meaningful terms.

For children with special needs, the difference becomes visible as they move from one stage of education to another. At the same time, in professional education, a similar question is emerging in a different form: should a disability certificate determine whether someone can become a doctor, or should the relevant question be whether that person can acquire and demonstrate the competencies required to practise medicine with appropriate support?

These may appear to be separate issues. They are not. Both expose the same institutional problem: education becomes genuinely inclusive only when institutions stop treating a person’s impairment as the final measure of what that person can do.

The first barrier is not always admission

According to UDISE+ 2024-25, 21,49,258 children with special needs were enrolled from pre-primary to higher secondary education. The figure is important, but by itself it tells us very little about whether these children are able to participate fully in education.

The problem becomes clearer when participation is followed across stages. The transition rate for children with special needs falls sharply as the educational system becomes more demanding. About 75% of primary-level CWSN transition to upper primary, but the figure falls to 48% between upper primary and secondary and to 46% between secondary and higher secondary. Girls constitute only 43 out of every 100 enrolled CWSN students.

That pattern matters because it changes the question.

If children enter school but increasingly disappear at higher stages, the problem cannot be understood simply as one of admission. Something about the educational environment becomes harder to navigate as the student progresses.

Part of that difficulty lies in infrastructure and accommodation. A school may technically admit a child, but that does not guarantee accessible classrooms, laboratories, toilets, transport or other facilities needed for continued participation. The gap between being allowed into an institution and being able to function within it becomes wider as educational demands increase.

The government itself now tracks several indicators of accessibility, including schools with ramps, CWSN-friendly toilets and other facilities. The existence of such indicators is significant because it recognises that inclusion cannot be measured through enrolment alone.

This is why the disability pipeline cannot be understood merely through enrolment numbers. The important question is what the institution expects a student to do once inside it.

The institution often defines the disability

There is a subtle shift in perspective here.

The conventional approach begins with the impairment: What is the person’s disability? How severe is it? What percentage has been certified?

The more difficult question begins somewhere else: What does the person actually need to do, and can those tasks be performed with appropriate support?

That distinction matters because the same physical limitation can have very different consequences in different environments.

A staircase may be an insurmountable barrier in one building and irrelevant in another with a lift. A requirement to manipulate an instrument may present a problem in one setting but become manageable with assistive technology or adapted equipment. Communication difficulties may matter differently depending on the availability of appropriate support.

The institution, therefore, is not simply a passive setting in which disability exists. Its design can determine how disabling an impairment becomes.

This is particularly important in higher education, where the question is no longer only whether a student can attend classes. Students may have to use laboratories, participate in clinical training, undertake fieldwork, complete practical assignments and meet professional standards.

India has already moved towards treating accessibility as an institutional responsibility. The Department of Empowerment of Persons with Disabilities lists Accessibility Guidelines and Standards for Higher Education Institutions and Universities, as well as an Accessibility Code for Educational Institutions, among the notified standards under the Rights of Persons with Disabilities framework.

An institution that defines capability without considering the environment risks confusing two different things: what a person cannot do and what an institution has failed to make possible.

Medicine exposes the problem sharply

The debate over medical education brings this distinction into unusually sharp focus.

For years, eligibility for medical education could be tied to arithmetic disability thresholds. Such a system has an apparent administrative advantage: it is simple. A percentage can be measured, recorded and applied.

But simplicity can become exclusion when the number becomes a substitute for the question it was supposed to answer.

A person with a particular percentage of disability may be capable of completing the academic and clinical requirements of an MBBS course. Another person with a similar percentage may face very different functional challenges. Treating both cases as identical assumes that the disability percentage itself tells us enough about professional capability.

The National Medical Commission’s approach has moved in a different direction. Its 2025 interim framework removed the earlier arithmetic threshold and placed emphasis on assessing a candidate’s functional ability to meet the academic and clinical demands of the MBBS course. The NMC described the approach in terms of functional ability, reasonable accommodation, accessibility standards and institutional preparedness.

The shift has since continued. In July 2026, the NMC issued new guidelines on assessment of persons with benchmark disabilities for MBBS admission, followed by a corrigendum and addendum in August, and also notified the constitution of enabling units for PwBD candidates in medical colleges.

The underlying principle is straightforward: disability, by itself, should not determine professional eligibility.

The important shift is therefore not from one percentage to another. It is from asking how disabled is the candidate? to asking what can the candidate actually do, with appropriate support, in the environment in which the profession will be practised?

That is a much more demanding question for regulators.

But functional assessment can create a new problem

A more sophisticated test is not automatically a fairer test.

The NMC itself has acknowledged that defining essential competencies for each disability is complex, multidimensional and dynamic, particularly because assistive devices and medical technologies continue to evolve. It has also recognised the need to balance inclusion with patient safety and clinical competence.

This is precisely where functional assessment can become difficult.

Some of the questions used in the earlier interim framework concerned everyday activities such as climbing stairs, handling objects, communicating in different environments or using instruments. Such questions may be relevant in particular contexts, but they can also become problematic if an environmental barrier is treated as evidence of individual incapacity.

Consider what happens when the two sides are confused.

Suppose a wheelchair user cannot independently climb a staircase. That fact may say very little about whether the person can learn medicine, understand clinical knowledge or perform a particular professional task. It may instead reveal that the hospital or medical college has no accessible route.

If the institution lacks a lift and the candidate is then declared incapable because they cannot use the stairs, the assessment has quietly shifted the burden from the institution to the individual.

This is the central danger in moving from medicalised exclusion to functional assessment. A functional test can become inclusive only when the function is assessed in an environment that is itself reasonably accessible.

Otherwise, the system merely changes the language of exclusion.

From a certificate to a capability

The significance of the NMC’s shift therefore goes beyond medical admissions.

It points towards a different philosophy of educational inclusion.

A disability certificate is useful for identifying eligibility for rights and support. But it cannot, by itself, describe the full range of a person’s educational or professional capability.

The revised framework recognises this by focusing on competencies. Yet it also creates a harder administrative problem: who decides what counts as an essential competency, under what conditions, and with what degree of flexibility?

Functional assessment inevitably involves judgement. Without sufficiently clear standards, two candidates with similar abilities could receive different decisions from different medical boards. The challenge, therefore, is to create assessment protocols that reduce subjectivity without turning the system back into a rigid checklist.

This is where inclusion stops being a slogan and becomes an institutional design problem.

A regulator must simultaneously achieve two things that can pull in opposite directions: maintain genuine professional standards while preventing disability from becoming a proxy for incapacity.

The answer cannot be to eliminate standards. Nor can it be to assume that a standard is neutral simply because everyone is asked to meet it.

The more meaningful question is whether the standard measures something genuinely essential to the profession.

The school pipeline tells the same story earlier

The school system shows why this matters long before a student reaches a medical college.

If CWSN transition falls from 75% at one stage to 48% and then 46% at subsequent transitions, the educational system is not merely confronting a problem of getting children through the school gate. It is confronting a problem of sustaining participation as the physical, academic and institutional demands change.

That has an important policy implication.

An inclusive school cannot be defined only by whether it admits a child with a disability. It has to be judged by whether the child can progress through it.

This changes what policymakers should look for. Enrolment is necessary, but it is an incomplete indicator. A school can report an enrolled child while the child remains effectively excluded from parts of school life.

The same principle applies to higher education. A college may comply with an admission requirement and still leave students struggling with inaccessible buildings, inflexible procedures or assumptions about what disabled people can and cannot do.

In other words, the unit of inclusion is not the admission form. It is the educational experience.

The hardest reform is changing the institution, not the student

This is also why disability policy cannot be reduced to changing eligibility rules.

Suppose a regulator replaces a rigid disability percentage with functional assessment. That is an improvement if it allows candidates to be judged on relevant capabilities rather than a broad category.

But if the institution remains physically inaccessible, the assessment may still punish the candidate for the institution’s own limitations.

The direction of reform therefore has to run in two directions at once.

The individual should be assessed on competencies that genuinely matter.

The institution should be assessed on whether it provides reasonable conditions under which those competencies can be demonstrated.

That second part is easy to overlook because it is harder to measure. A disability percentage fits neatly into a form. Institutional accessibility does not.

Yet the latter may be more important to whether inclusion actually works.

This is not merely an aspirational idea. The government has already created formal accessibility standards for higher education institutions and universities and a separate accessibility code for educational institutions. DEPwD also identifies creation of barrier-free environments in schools, colleges, academic and training institutions and hospitals as an area of implementation under the Rights of Persons with Disabilities framework.

The implication is important: functional assessment and institutional accessibility cannot be treated as separate policy questions.

The Supreme Court’s intervention in the medical-admission debate matters for the same reason. The rules were challenged on the ground that blanket exclusions were inconsistent with the Rights of Persons with Disabilities Act, 2016. The Court subsequently observed that systemic discrimination against persons with benchmark disabilities should be eliminated.

Judicial intervention can force institutions to reconsider exclusionary rules. But courts cannot redesign every classroom, hospital, laboratory or examination system. That requires administrative capacity and institutional willingness.

Inclusion is tested at the next stage

There is a temptation in education policy to celebrate progress at the point where a barrier is removed.

A quota is introduced. A student is admitted. A rule is changed. A certificate is issued.

But the real test comes afterwards.

Can the student continue?

Can the student participate?

Can the student demonstrate competence?

Can the institution adapt when the existing system was designed around someone else?

The experience of children with special needs suggests that the answer cannot be assumed. The decline in transitions across successive school stages shows that formal participation can coexist with attrition.

The medical education debate pushes the same problem into a more advanced setting. The NMC has moved away from an arithmetic disability threshold towards functional competency. That is an important conceptual change, but its success will depend on whether functional assessment is applied consistently and whether institutions distinguish between an individual’s capability and barriers created by their environment.

There is no longitudinal evidence yet to establish that the new assessment framework has improved the eventual educational or professional outcomes of disabled students. The reform should therefore be seen as a direction of travel rather than a completed success story.

And that distinction matters.

The deeper shift

For decades, institutions have often approached disability through a relatively simple sequence:

identify the impairment → classify the person → determine eligibility → provide or deny access.

A more inclusive system requires a different sequence:

identify the essential task → assess actual capability → provide reasonable support → remove institutional barriers → judge the outcome.

The second model is harder. It requires more judgement, better infrastructure and more accountable institutions.

But it also changes the location of the question.

The old system asks whether the person fits the institution.

The emerging system asks whether the institution can distinguish between a genuine professional requirement and a barrier created by its own design.

That is the real significance of moving from disability percentages to functional competency. It is not that every disabled person should automatically qualify for every course or profession. Educational and professional standards still matter. Rather, the standard should measure the capability that the education or profession genuinely requires, not use disability itself as a shortcut for deciding capability.

India’s disability-inclusive education challenge therefore runs deeper than admission numbers. A child who enters school but cannot progress, or an aspiring doctor who is technically eligible but assessed through the limitations of an inaccessible environment, is still encountering a system whose idea of inclusion remains incomplete.

The test of inclusion is therefore not simply whether the door is open.

It is whether the institution has made it possible for the person who enters to continue, participate and demonstrate what they are capable of doing.