Imbalances in allocating public service resources are a universal problem worldwide, especially in urban and rural areas. As a developing country with a significant imbalance between urban and rural areas, China is representative of the unbalanced allocation of public service resources. Presently, China has entered the county urbanization stage. Therefore, this study can provide a new way to realize the equalization of urban and rural public services with the county as the basic unit. Taking counties as the primary study area, this paper analyzes the new trends of population mobility in China’s counties. It combines large-scale questionnaires and field surveys to investigate the new demand of rural residents for public services and the shortcomings of public service resource allocation. First, the county seat attracts a concentration of the county’s rural residents and returning population, whose high expectations for the county seat’s education and medical services have not yet been met. Second, the township assumes the vital function of elementary school education and medical services in rural areas, and the rural children have a great demand for elementary school education services in the township. However, there are still apparent shortcomings in support of teaching facilities and the quality of education services. Third, the problem of aging and hollowing out in rural areas is serious, and the education, medical and elderly service needs of left-behind children and the elderly are difficult to be guaranteed. Finally, this paper proposes targeted planning strategies and policy recommendations for allocating county public service resources at three levels based on the “county–town–village” hierarchy. Equalization of public services is an ideal goal of a country’s political, economic, and social development . In the However, the unbalanced supply of public services is a problem that all countries need to solve, and this imbalance is especially prominent between urban and rural areas. Even in developed European and American countries, there are significant differences in the resources and quality of public services such as education and health care between poor rural areas and urban areas with higher income . For devIn 2005, the concept of equalizing public services was first proposed in China’s 11th Five-Year Plan. Then, the 12th Five-Year Plan was offered to improve the basic public service system covering urban and rural residents and promote equitable access to essential public services. Finally, in the 14th Five-Year Plan, it was pointed out that the equalization of basic public service needs to be improved among regions, urban and rural areas, and different groups of people in China. These relevant national policies show that equalizing public services between urban and rural areas has become essential for China to build moderate prosperity in all respects and achieve shared prosperity. On the other hand, with China’s rapid urbanization process, the urbanization mode is gradually turning to a county urbanization basis.In 2022, the Chinese government issued “Opinions on Promoting Urbanization Construction with the County Seat as an important Carrier” which proposed to conform to the changing trend of population flow in county seats, complement and strengthen the weakness of county seats, and guide the development direction of county seats by classification. It indicates that county seats have become the main field of urbanization development. Furthermore, it is also emphasized to strengthen the supply of public services and improve the livelihood of county seats, which means that the county will become a critical unit to realize the equalization of public services.In general, countries worldwide are urgently seeking solutions to the unbalanced allocation of urban and rural public service resources. As a developing country with a significant imbalance between urban and rural areas, China is representative of the unbalanced allocation of public service resources. The development of county urbanization is characterized by Chinese national policy guidelines. The county becomes an integral unit to realize the equalization of public services.In this context, this paper attempts to analyze the problems and shortcomings of urban-rural public service resource allocation in the context of county urbanization, considering the new population flow trend in counties. We selected 81 sample counties in 28 provinces in China as the primary research unit. We used mobile phone signal data to analyze the population flow trend in the counties by determining the changes in the geographical location of users. At the same time, a large-scale questionnaire and field survey was conducted in the sample counties to summarize the usage and satisfaction of rural residents with public service facilities. Finally, combining the above analysis, we summarize the new demands of rural residents for public services and the shortcomings of public service resource allocation at the county scale. We propose targeted planning strategies and policies to equalize urban-rural public services. The remainder of this paper is organized as follows. The second part is a brief review of the literature regarding the equalization of public services. The third part introduces the study area, methodology, and data resources. The fourth part proceeds with the results and analysis. The fifth part proposes planning strategies and policy recommendations. Finally, the sixth part discusses and concludes this paper.The equalization of public services has always been an important research topic, especially in rural areas. As early as the 18th century, Adam Smith proposed in “The Wealth of Nations” that the state has to provide public services fairly . SamuelsIn developed European and American countries, the problem of unbalanced public service supply in rural areas has not been solved. For example, Cloke and Little studied public transport and retail opportunities concerning different social classes in rural areas of Gloucestershire, England, and they found that the social resources possessed by more affluent social groups in rural areas enable them to have more opportunities to enjoy public services than disadvantaged groups . SimilarIn terms of influencing factors of rural public service supply, many studies pointed out that population distribution and mobility trends were essential. For example, Moseley and Packman found that in rural areas of Britain, the population size of settlements could better explain the supply of public services, and large-scale settlements usually had better public service resources . AccordiHowever, compared with other countries, the equalization of urban and rural public services in China has its particularity caused by China’s unique administrative system . In ChinHowever, obtaining data at the county level is difficult, so most studies still take provinces or cities as the primary research units ,26,27,28In general, the research on the equalization of urban and rural public services based on counties reflects the special national conditions of China, which is of great significance in solving the problem of unbalanced development between urban and rural areas. At the same time, it can also provide experience for the international discussion on equalizing public services. Based on the literature review, it is found that existing studies mainly have the following limitations: (1) In selecting a research scale, most of them take cities or provinces as the primary research unit. Few take counties as the object, which shows a lack of pertinence in the context of China’s county urbanization. Moreover, most existing county-level studies focus on the specific type of county or counties within a particular region. Therefore, few studies have covered counties in the whole country. (2) The population flow trend can reflect residents’ actual demand for public services, which is a crucial factor affecting the equalization of public services. However, few studies consider the situation of population flow.As mentioned earlier, counties are the basic level of the national administration in China and are the most direct coordination platform to achieve equalization of public services. Therefore, this paper selects counties as the research object to improve the inadequacy of existing studies that mainly take the provincial scale as the research unit. At the same time, considering the vast territory of China and the significant differences in natural endowments, economic conditions, and locational environments among counties across the country, a nationwide selection of research subjects is needed to reflect the problems of public service resource allocation and make the research results more representative more comprehensively. However, with more than 1300 counties in China, it is challenging to conduct an in-depth research study on all of them, so this paper considers selecting 2 or 3 sample counties in each province as research subjects and using them as representatives to reflect the situation in that province. Furthermore, to ensure that the sample counties selected in each province can represent the general level of the rural areas, the selected counties are mainly located in the central agricultural production areas, and the economic development level is at the average level of the province.Moreover, we avoid selecting counties with a high level of economic development dominated by industries such as manufacturing or tourism. Based on this, 81 sample counties in 28 provinces were selected in this study, of which 2–3 counties were selected in each province . Table 1In addition, according to the characteristics of geography, climate, humanities, and economy, the country’s land area is divided into seven regions in complete reference to China’s geographical divisions: East China, South China, North China, Central China, Southwest China, Northwest China, and Northeast China. We summarize and compare the characteristics of urban-rural population flow trends and the shortcomings of public service resource allocation in different regions and make targeted recommendations. In short, this study is conducted on behalf of 81 sample counties in 28 provinces, which achieve full coverage of all regions nationwide and can reflect the overall situation of China’s county public service resource allocation and the status of each area comprehensively and objectively.The research team conducted the National Rural Construction Evaluation in 2021 for these 81 sample counties and collected a large amount of data, including local statistics, questionnaire data from villagers and village cadres, and mobile phone signal data. The local statistics include data on the economic development level, farmhouse construction, village construction, and county construction of the 81 sample counties in 2020, obtained from each county’s relevant departments.The research team conducted a questionnaire survey among villagers and village cadres in the 81 sample counties to investigate the allocation of rural public service facilities and the usage and satisfaction of rural residents with these facilities. The respondents assigned to the villagers’ questionnaire are the residents who have lived in the village for a long time. Moreover, the respondents of the village cadres’ questionnaire are the members of the village committees, who are familiar with village affairs. Each administrative village is required to finish only one village cadre questionnaire. To facilitate the collection of questionnaires, the research team built a mobile working platform for collecting villagers’ and village cadres’ questionnaires in the form of online questionnaires. Respondents completed the questionnaire by logging on to this mobile working platform. All the questionnaires were collected under the organization of the county government of the 81 sample counties. With the organization of the county government, the township government department organized a specified number of villagers and village cadres to complete the questionnaire. Each township in the sample counties needs at least 80 villagers to finish the questionnaire. In addition, three townships in the sample counties need to organize village cadres from all administrative villages to finish the village cadres’ questionnaire. The survey content of the villagers’ questionnaire includes respondents’ satisfaction with the use of public service facilities and service quality at the county, town, and village levels and includes the allocation of public service resources in administrative villages. Their complete structures and main contents are shown in Mobile phone signal data provided by China United Network Communications Group Co., Ltd. contains subscriber data for all townships in 81 sample counties between January 2020 and July 2021, which can be used to determine population flow based on changes in the geographical location of subscribers. In addition, we also traveled to Guangdong, Hunan, Hubei, Fujian, Shanxi, Hainan, and other provinces to conduct discussions with local county education bureaus, health care bureaus, and other relevant government departments, conduct field surveys in townships and villages, and interview township cadres, village cadres and villagers to understand the allocation of public service resources, service quality, as well as rural residents’ satisfaction with public services and their suggestions. In this paper, we analyzed the mobile phone signal data of 81 sample counties in China between January 2020 and July 2021 to summarize the population flow trend in China’s counties.The mobile phone signal data show that during 2020–2021, the number of permanent populations decreased in all 81 sample counties, with the average number of outflow population in the county reaching 47,792 and the average outflow population as a percentage of the permanent population reaching 13.29%. The outflow from counties in Xinjiang (22.34%), Hubei (18.37%), Guizhou (18.29%), Chongqing (16.52%), Henan (15.89%), Yunnan (15.48%), and Fujian (15.24%) province is evident, and the proportion of outflow from counties to the permanent population is higher than 15%.In terms of age structure, the county outflow population is dominated by the young and middle-aged population aged 19–39. Among the 81 sample counties, the average percentage of the outflow population aged 19–29 reached 44.63%, and the average rate of those aged 30–39 reached 17.97%. Yunnan (72.64%), Guizhou (72.50%), and Guangdong (70.76%) provinces have the most pronounced outflow of young and middle-aged people.The indicator “county population agglomeration degree” (county seat permanent population/county permanent population) is used to reflect the population agglomeration ability of counties. The mobile phone signal data show that the population agglomeration capacity of county seats in 81 sample counties generally increases between 2020 and 2021, and the average value of county population agglomeration degree increases from 45.97% to 48%, with 60 counties having an increase in this indicator. The mobile phone signal data show that among the 81 counties in 2020, an average of 11.55% of the outflow population returned to the county in 2021. An average of 41.25% of the returning population returns to the county seat for employment and living. It indicates that the county seat is becoming the main concentration of the returning population. Regarding age structure, the average percentage of the returning population aged 19–29 is 34.29%, which is lower than the average percentage of the same age group in the outflow population (44.63%). On the other hand, the average rate of the returning population aged 30–39 is 25.61%, which is higher than the average percentage of the same age group in the outflow population (17.97%). This indicates that at this stage, the returning population in the county is dominated by middle-aged and young people aged 19–39.The questionnaire survey of village cadres shows that an average of 14.6% of administrative villages in 81 sample counties show a high degree of hollowing out (the ratio of permanent population to household registration population is less than 30%). The average proportion of the resident population to household registration population in rural areas of the county is 0.65, with evident population outflow from rural areas and severe hollowing out of villages.According to the questionnaire survey of village cadres, the average proportion of the elderly population aged 65 or older in the permanent rural population of 81 sample counties is 25.8%, which is near twice the proportion of the people in the same age group (13.5%) in the seventh national population census of China. The mobile phone signal data show that the average proportion of the permanent population aged 60 years or older within the township and village is 14.2%. In contrast, the average ratio of the permanent population in this age group within the county seat is only 9.5%. This indicates that the aging of the people in rural areas of China is very prominent.As mentioned above, at this stage, the population flow in China’s counties shows a new trend of “overall dispersion and partial concentration”, which means that under the general direction of continuous population outflow from counties, especially from rural areas, the population within counties and the returning population have started to concentrate in the county seats.The questionnaire survey of villagers shows that the proportion of rural students attending elementary, middle, and high school in county seats in the 81 sample counties is 26.75%, 35.21%, and 59.38%, respectively. This means it has become common for rural students to go to the county to receive education, especially at the high school level. According to the statistics, 53.79% of elementary and middle school students in 81 sample counties are from rural areas. Now, enabling children to receive higher educational services has gradually become the most crucial reason rural families move to the county seat. According to the questionnaire of villagers, In addition to educational services, better medical services are also essential in attracting rural residents to move to the county. According to the questionnaire of villagers, 16.21% of those rural residents who had already purchased a house in the county seat said that their reasons for buying a house in the county seat included “access to the county seat’s medical services” Therefore, with the increasing demand of rural residents for education and medical service levels of county seats, increasing the allocation of education and medical service resources and improving their quality is essential to promote the construction of urbanization with the county seat as the carrier. However, the level of education and medical services in the county seat has not yet met the needs of rural residents, and there are still apparent shortcomings.In terms of education services, according to statistics, the percentage of candidates admitted to Project 985 and Project 211 universities in the 81 sample counties in 2020 is only 3.84%, which is lower than the average level of the prefecture-level cities (7.43%) to which these counties belong. According to the questionnaire of villagers, In terms of medical services, according to statistics, the average number of beds in medical institutions per 1000 people in 81 sample counties is 5.5 per 1000 people. The average number of licensed physicians per 1000 people is 2.4 per 1000 people, both of which are lower than the intermediate level of the municipal districts of the prefecture-level cities (9.0 per 1000 people and 4.0 per 1000 people) to which these counties belong. The questionnaire survey of villagers shows that 36.4% of rural residents would choose to go to provincial and municipal hospitals for better medical care when suffering from a severe illness. As mentioned above, the county seat has gathered 48% of the counties’ population and is the first choice of more than half of rural residents with severe illnesses. The population served by hospitals in county seats is much larger than the permanent population, the mismatch between the supply and demand of medical resources in the county seat is apparent, and the quality of medical services needs to be improved.With the continuous population exodus from rural areas, more and more rural children will study with their parents in the county seat or other locations outside the county. Many rural elementary schools are being abolished due to insufficient students to sustain their operations. The questionnaire survey of villagers shows that the proportion of rural children attending elementary school in townships is 51.19% in 81 sample counties. It has become a significant trend for rural children attending townships’ elementary schools. However, at this stage, the teaching facilities’ support and education service quality of China’s rural elementary schools still have apparent shortcomings. In terms of medical services, according to the questionnaire survey of villagers, an average of 33.64% of rural residents in the 81 sample counties choose to visit township health centers when they suffer from minor illnesses. This reflects that township hospitals also undertake part of the daily medical services for rural residents. In addition, according to the current epidemic prevention and control policies, village clinics are generally not allowed to receive patients with fever. Township hospitals must receive these patients and carry out the large-scale nucleic acid testing in rural areas. Therefore, the township hospital plays a vital role in preventing and controlling the epidemic in rural areas of China.In rural areas, with the continued exodus of young and middle-aged laborers, children and the elderly are the main groups left behind to live in villages long-term. Therefore, their needs for education, elderly care, and medical services need attention. The questionnaire survey of villagers shows that the average percent of rural children studying in kindergartens and elementary schools of administrative villages is 32.19% and 26.85%, respectively. This means that there are still many rural children’s needs for education services in villages that must be guaranteed. However, it has become a significant trend for rural children to move out with their parents or go to townships to study.At present, the most apparent contradiction of village-level education services is the necessity of guaranteeing the needs of rural children for education services and the difficulty of maintaining the operation of rural schools with a small number of students. It is not practical to set up a kindergarten or elementary school for only a few students in an administrative village, which leads to the closure of a few village kindergartens and elementary, and students in remote villages can only choose to go to the nearby village or the township to receive an education. According to the statistics, only 35.69% of administrative villages in the 81 sample counties had universal kindergarten on average in 2020. The questionnaire survey of village cadres shows that, on average, 19.31% and 19.15% of administrative villages in the 81 sample counties are more than 30 min away from the nearest kindergarten and elementary school, which means that a few rural students still face the problem of distance to school. Based on the data from the village cadres’ questionnaire, The aging problem in rural areas of China is serious. With the continuous outflow of the young and middle-aged labor force, the elderly left behind in rural areas are not cared for, and the pension problem is becoming increasingly prominent. At present, the supply of elderly services in rural areas is insufficient . StatistYangxi County belongs to Yangjiang City and is located in the southwest coastal area of Guangdong Province. It covered an area of 1435 square kilometers and had a permanent resident population of 434,000 in 2020, with an urbanization rate of 43%. In 2020, the GDP of Yangxi County was 28.182 billion yuan, with the fishery industry as the primary industry. The economic development level of Yangxi County is above the middle level among counties outside the Pearl River Delta in Guangdong Province.Currently, the aging of the rural population in Yangxi County is serious. The questionnaire of village cadres shows that the elderly population over 65 years old in rural areas accounts for 22.7%. In order to ensure the demand of the rural left-behind elderly for old-age care services, the county authorities required the construction of at least one elderly service facility in every administrative village. However, our field research found that the use of village elderly service facilities in Yangxi County is not good. Although all 131 administrative villages have elderly service facilities, only eight of them can provide elderly care services. In contrast, the other facilities provide lunch for the elderly or serve as a place for daily entertainment. Due to a lack of operating funds and staff, some village facilities are no longer providing services or have been closed for a long time. The same phenomenon has been found in Hunan, Qinghai, and other provinces. In addition, village-level medical services are vital for the health of left-behind children and the elderly. A total of 34.05% of the villagers said they would prefer to go to the village clinic when suffering from minor illnesses. At present, almost all administrative villages in China have village clinics. Statistics show that an average of 95.37% of administrative villages in 81 sample counties have at least one village clinic, and 88.06% of villagers said that the village clinic in the village they live in always has a doctor available (except on weekends and holidays) and that the villagers’ needs for medical treatment can be met at the village clinic. What is more, the villagers’ average satisfaction with the level of medical services at the village clinics has reached 56.15%. However, according to statistics released by the National Health Commission, there were 60,828 village clinics in China in 2020, a decrease of 7266 from 2019 and a total decrease of about 30,000 in the last five years.The reason for this is that, on the one hand, with the accelerated urbanization process, some village clinics have been upgraded to community health service stations. On the other hand, there is a significant departure of the rural population, a decrease in the number of patients, serious aging of the pastoral doctor team, and a lack of new members to replenish them, making it difficult for village clinics to maintain operations. Through a field survey, we learned that village doctors in China generally face a poor working environment and low salary, resulting in a low willingness of young doctors to work as village doctors .2. In 2020, the permanent resident population was 322,000, with an urbanization rate of 35%. Presently, Wengyuan County has realized the full coverage of administrative village clinics. However, according to the county health department staff, the number of administrative village doctors in remote areas of the county is insufficient. As a result, some villages still face the situation of no village doctors. Currently, the county health department has tried to send doctors from neighboring community health service stations to these remote villages at regular intervals, but the results are not good. During the field survey, we also observed that some village clinics were closed on weekdays, and there was no village doctor on duty. Furthermore, the villagers’ questionnaire survey results showed that only 18.49% of the villagers in Wengyuan County would choose to visit the village clinic when they had a minor illness, and the villagers’ satisfaction with the service quality of the village clinic is not high. In general, the allocation of rural medical service resources in China has been relatively complete, but there is a greater risk of a shortage of village doctors in the future. Wengyuan County belongs to Shaoguan City, located in the northern mountainous area of Guangdong Province, with an area of 2175 kmWith the growing demand of rural residents for a better life, relying solely on village-based equalization can no longer meet their needs for public services. The above analysis shows that rural residents have different requirements for public service supply in counties, townships, and villages. Therefore, this study proposes targeted planning strategies and policy recommendations for allocating public service resources in counties based on the “county–township–village” hierarchy.County seats are the carriers of county urbanization. The above analysis also reflects that education and medical services in county seats are essential factors in attracting rural residents and returning populations to cluster in county seats. In terms of planning strategies, it is recommended that the county seat’s status as a public service center for the whole county be highlighted in the county’s integrated planning. The improvement of the county seat’s education and medical service capacity should be included as a development guideline to guide the construction of the county seat’s public service facilities. The demand of rural residents should be considered when determining the scale of public service facilities in the county seat, and service provision capacity should be improved. It is recommended that the county’s health bureau and education bureau appropriately increase the standards for the number of healthcare facility beds per 1000 people and the number of occupational physicians per 1000 people for county hospitals, and the standards for the student–teacher ratio of county schools. The county’s educational and medical service resources can benefit more of the county’s population. Moreover, the county’s natural resources bureau needs to ensure the area of construction land for schools and hospitals in county seats when preparing the county’s territorial spatial plan. While meeting current needs, a particular land scale should be set aside to meet the continued growth in demand for education and medical services.In terms of policy recommendations, we suggest that the county’s health bureau and education bureau adopt policies to improve the quality of education services and medical services in the county seat and narrow the gap in service quality between the county and the city. It is effective to actively carry out distance education and telemedicine services by forming partnerships with schools and hospitals at the municipal and provincial levels. Through these means, the county population can enjoy the city’s education and medical service resources. The trend of population clustering in county seats in Central and Southwest China is more prominent, and the increase of county population agglomeration degree in the sample counties is more than 3% during 2020–2021, which is significantly higher than the other five regions. Therefore, Central China and Southwest China counties need to improve education and medical services in their county seats.2/person. It is also recommended that the service radius of the township boarding elementary school should be reasonably expanded according to the spatial distribution of villages within each township and the schooling needs of rural children. For administrative villages far from the township with a high demand for schooling, accessibility to the township elementary school can be improved by providing school buses. The county’s transportation bureau should guarantee the supply of school buses and reasonably plan the routes of school buses. The county’s education bureau should determine the specific operating arrangements of school buses.At present, townships assume a crucial educational service function in rural areas of China. However, there is still a significant gap between the service level of township elementary schools and the needs of rural students. So, there is a need to strengthen boarding elementary schools in the township. In terms of planning strategies, this paper argues that we should ensure that each township has at least one boarding elementary school and that the vast central townships  can be equipped with two to three elementary schools according to the actual situation. According to the current standard for the planning of the rural area, public facilities in China, and the actual situation of each region, the counties’ natural resources bureaus need to ensure that the land area target for township elementary schools should not be less than 1.2 mIn terms of policy recommendations, we suggest that the county’s education bureau expand the talent pool of township teachers and enhance the quality of teaching in township elementary schools by raising the level of remuneration of township teachers and increasing the number of temporary teachers. On the other hand, the county education bureaus should improve the hardware facilities in township elementary schools, narrow the gap between them and county seats’ schools, and achieve equalization of education services between urban and rural areas. The focus is on improving teaching facilities and boarding conditions, including facilities for living necessities such as toilets and showers, the sanitary environment of canteens, and the quality of school meals. At present, in some areas such as Chengmai County in Hainan Province, distance education in township schools has begun to be gradually implemented, and distance learning equipment has been deployed in central township schools to improve the quality of teaching in township schools, which is also a method worthy of reference for other areas.With the population exodus from rural areas, the problem of rural education facilities struggling to operate due to a lack of students is particularly acute. Children in the preschool stage are still young. They lack the necessary self-care skills, making it inconvenient for them to travel to surrounding villages to attend kindergarten. However, due to operational costs, most regions have certain restrictions on the size of administrative villages equipped with kindergartens. For example, Guangdong Province requires administrative villages with a resident population of more than 4000 to set up kindergartens, and Jiangxi Province requires more than 2000. According to the policy requirements, the vast majority of administrative villages are not necessary to set up kindergartens. Therefore, it is recommended that counties take diversified measures to guarantee early childhood education services in the village according to the actual local situation.In terms of planning strategies, this paper argues that it is not necessary to compel each administrative village to be equipped with a kindergarten. Instead, according to the current standard for the planning of rural area public facilities in China and the actual situation of each region, kindergartens should be required in large (1001–3000 people) or extensive (>3000 people) administrative villages. It also ensures that the proportion of construction land for the village’s kindergartens should be kept between 0.4% and 1.1%. At the same time, when we determine the service capacity of the kindergartens in central villages, we also need to consider the needs of the children in adjacent villages. If necessary, the kindergartens also need to be equipped with school buses. For administrative villages that do not have the conditions to set up kindergartens, one suggestion is to use the teaching facilities and teachers of village elementary schools to open kindergartens attached to them through new construction or renovation. Suppose there is already a preschool attached to the village elementary school. In that case, we can refer to the experience and practice of Yunnan Province and take the measure of “changing the class into a kindergarten” to turn the preschool into an independent kindergarten. Second, we encourage the establishment of private kindergartens with the help of social forces. By establishing a clear review and assessment mechanism, the local government can ensure that private kindergartens operate in compliance. Meanwhile, local governments subsidize funds for standardized private kindergartens that pass the examination to reduce operational pressure. In Southwestern, Northwestern, Northeastern, and Northern China, the understaffing of village kindergartens is even more pronounced, so extra attention needs to be paid to securing rural early childhood education services in these regions.Many studies have mentioned that better access to medical services must become priorities in rural area, and service providers becoming key figures in better access to care must become priorities in deprived areas ,25,43. AThe problem of hollowing out and aging in China’s rural areas is prominent, and the elderly left behind in rural areas need to be addressed urgently. However, due to the influence of traditional Chinese culture, aging in place is still the most mainstream way of aging in Chinese rural society. In fact, except for a minimal number of older people who are seriously ill, the majority of older people left behind are capable of taking care of themselves. So, providing them with nutritious and healthy meals and places for daily recreation can already meet most of the needs of the elderly. Therefore, it is recommended that the civil affairs department gradually increase the operating subsidies for rural elderly service facilities to guarantee the price and quality of daily meals. At the same time, tables, chairs, TVs, radios, and other facilities should be configured to enrich the daily lives of the elderly left behind. In addition, local governments can join the village committee to use the unused farmhouses in the village to provide senior care services to reduce construction costs. For the elderly left behind with serious illnesses or mobility problems, local governments can establish personal files, and organize caregivers to visit their homes regularly and provide elderly care services.Achieving equalization of public services is an ideal goal shared by all countries worldwide. However, the problem of uneven supply of public services has not yet been solved, especially in rural areas in developed European and American countries and other developing countries. A large number of studies based on theoretical analysis or empirical research focus on measuring the quality of public services and achieving the equalization of public services. Unlike other countries, China’s administrative system is based on counties at the primary level, making it unique in equalizing public services. In the current process of county urbanization that China is in, the county will become a fundamental unit in realizing equalizing public services. Therefore, based on relevant studies, this paper takes counties as the primary research unit to study the new trends of population mobility in China’s counties. We combine the large-scale questionnaire surveys and field research, analyze the new demands of rural residents for public services, and summarize the shortcomings of public service resource allocation at the county scale. The marginal contributions of this paper are divided into two main aspects. First, the study is conducted with counties as the basic unit, which fully reflects China’s unique national conditions and provides an empirical reference for the international discussion on public service equalization. The second is to analyze and summarize the current shortcomings of allocating urban and rural public service resources in counties based on the residents’ needs, considering the trend of population flow in counties and a large-scale questionnaire survey. This will make the proposed planning strategies and policy recommendations more relevant and informative.This paper agrees with existing studies that population distribution and mobility trends are important factors affecting public service supply. Therefore, it is of positive significance for us to grasp the population flow trend to equalize public service resources in urban and rural areas . UnderstThe study found that the problem of inequitable access to public services for marginalized rural groups, which exists in other countries, is equally severe in China ,16,17,20Compared with the studies on measures to equalize public services, this paper proposes targeted planning strategies and policy recommendations for allocating public service resources at the county, township, and village levels, based on China’s unique “county–town–village” hierarchy ,36,37. IHowever, there are still some limitations to this study. China is a vast country, and different counties’ geographical locations and development stages vary greatly. Mountainous counties with inconvenient transportation and more developed counties near large cities may also impact the strategy of their public service resource allocation. China’s national policy also mentions the need to classify counties and equalize public services by category. However, due to the limitation of article length, different types of counties are not analyzed and discussed in this paper. In the future study, we will select different types of sample counties for comparative analysis and propose more targeted planning strategies.


This paper presents an ontological review of the global research on access to geriatric disability care and a roadmap for future research to address the problem in India. First, the dominant research focus is on resources  that affect access to disability care; there is little focus on informational and technological resources. Second, functional disabilities are the dominant focus of the research, followed by cognitive, mental, and locomotor disabilities; there is little focus on speech, hearing, and visual disabilities. Third, barriers, inhibitors, and catalysts of physical access are the dominant focus, with relatively less focus on virtual access; there is very little emphasis on the drivers to access. Fourth, the primary, although not dominant, focus is on access for urban and rural populations; there is very little focus on access for underserved and indigenous populations. Future research must address these gaps systematically to improve access. This paper adds: (a) a systemic framework for the study of an important, complex, emerging problem; (b) a systematic review of the global research on the problem; and (c) a research roadmap to address the emerging problem in India. The world population is aging rapidly. The older population has overtaken the child population below 5 years in 2020 and is set to overtake the child population below 10 years by 2030 [India has been undergoing a significant demographic transition in the past 50 years. It has resulted in a tripling of the population over the age of 60 years  . As per As India’s population ages, the country will face a shrinking pool of productive age groups and resources to support the elderly population’s healthcare. In urban areas, the changing societal Indian structure, such as urbanization, youth migration, and working women, is leading to the disintegration of the joint family system leading to a lack of care and support for the elderly . A largeMost of the disabilities of the elderly are preventable and correctable. Timely and appropriate care can make the elderly more functional and thus improve their quality of life. While the accessibility of services for the elderly is an issue, disability is an important barrier to their accessing care. Other than the Ministry of Health’s recently introduced National Programme on Health Care for the Elderly (NPHCE), population aging is not a priority area, and the Government of India is yet to recognize its potential to become a major economic and health challenge .With rising longevity, multiple morbidities, co-morbidities, and disabilities have become progressively common in older persons. While the disability rate across all ages in India was 2.2 percent, the elderly (60+ years) disabled constituted 21 percent of the total . NSSO esHence, ensuring access to geriatric disability care will continue to increase in importance in India. The scale of this need will be very large given the size of India’s population, the scope of disabilities to be covered will be very wide given the diversity of its population, and the spread of the need will be very large given the geography of the country. There is not enough systemic understanding of the growing need for geriatric disability care, globally and in India. Consequently, the policies and practices for such care do not systematically address the emerging challenges. This study maps the existing global literature on access to geriatric disability care using an ontological framework adapted from our earlier publications on access to healthcare. The paper also highlights the emphases and gaps in the research which will help to develop a roadmap for research to improve access to geriatric disability care in India.The ontology of access to geriatric disability care defines the dimensions of the challenge, the elements of each dimension, and together the boundaries of the challenge. It is a hierarchical representation and visually represents the complex combinations of pathways  to address the challenge. The visualization is in structured natural English, making it easy to read and understand by experts and novices. It is like a ‘Google Map’, using which one can see all the ‘roads’ to address the challenge. The present ontology has evolved from earlier ontologies of access to healthcare  and acceGeriatric disability may be related to a person’s functional performance, locomotion, hearing, speech, seeing, mental faculties, and cognitive capabilities. These are listed in the ‘Disability’ column of the ontology in The disability care may be administered by a wide range of personnel listed in the ‘Personnel’ column. The list includes physicians , traditional healers, nurses, health workers/activists, Anganwadi workers, pharmacists, social workers, care providers, peers, family, community groups , rehabilitation workers, and oneself. The care may be administered individually or jointly by these personnel at a private, public, or an NGO-based healthcare facility. These are listed under the ‘Ownership’ column. Combining the four columns, there are 3 × 6 × 7 × 17 = 2142 pathways to rendering geriatric disability care. They include: (a) access to private functional disability care by nurse, (b) access to public curative–acute mental disability care by physician–specialist, and (c) access to NGO palliative locomotor disability care by care provider.The ‘Access’ to these pathways to geriatric care may be physical or virtual; they are listed in the corresponding column. The ability to access the variety of care will depend on the interplay of four types of ‘Forces’, namely: barriers to access, inhibitors of access, catalysts of access, and drivers of access. These are listed in the corresponding column of the ontology. These forces are derived from the seven types of ‘Resources’—spatial, temporal, financial, informational, human, technological, and infrastructural—and their subtypes are listed under the first column. Thus, there are 19 × 4 × 2 = 152 ways resources can affect access to geriatric disability care. They include: (a) spatial–distance barrier to physical access, (b) technological–IT catalyst of virtual access, and (c) financial–income driver of physical access.The forces that affect access will also depend on the type of ‘Population’ listed in the last column. The urban, rural, peri-urban, underserved, and indigenous populations will likely have different pathways by which resources affect access to geriatric disability care. Thus, the spatial–distance barrier to physical access for urban populations, rural populations, and indigenous populations can be very different. The same would be true for technological–IT catalysts of virtual access and financial–income drivers of physical access.In sum, the ontology encapsulates 2142 × 152 × 5 = 1,627,920 barriers to and facilitators of access to geriatric disability care. It (a) provides a unified framework to address the problem, (b) defines the elements, dimensions, and boundaries of the problem, and (c) encapsulates the combinatorial complexity of the problem. Three illustrative pathways are: (a) spatial–distance barrier to physical access to private functional disability care by nurse for urban older population, (b) technological–IT catalyst of virtual access to public curative–acute mental disability care by physician–specialist for rural older population, and (c) financial–income driver of physical access to NGO palliative locomotor disability care by care provider for underserved older population.The existing global literature was mapped onto the ontology to visually synthesize the state of the research on access to geriatric disability care. The monad map and the theme map were generated from the mapping. The maps visualize the landscape of the domain and highlight the barriers to and drivers of access to geriatric disability care.The corpus of research was created by searching Scopus on TITLE-ABSTRACT-KEYWORDS of the articles indexed in the database. The search process and results, following the PRISMA  reportinThe resulting items included different document types such as reviews, notes, letters, conference papers, editorials, and other types of documents. In the first iteration, we excluded 307 non-journal articles resulting in 1060 articles retained for further screening. In the first stage of screening, 3 incorrect entries were excluded. In the second stage of screening based on relevance, 476 articles were excluded leaving 581 articles to check for eligibility. In the last stage, 6 articles without abstracts were excluded from the corpus. The remaining 575 articles were included in the final mapping.The title, abstract, and keywords of the final 575 included articles were downloaded and imported into an Excel spreadsheet for mapping. The reference management software Zotero  was used to store the corpus of included articles.The final corpus of 575 articles was coded onto the ontology by four of the authors. The coding was performed in pairs. The corpus was divided into six approximately equal sets (corresponding to six pairs from the four coders) and assigned to each pair of coders. Each member of the pair coded the articles independently.The pair of coders iterated between themselves until they arrived at a consensus. Post the individual rounds of coding by each coder, discrepancies, if any, were discussed and arrived at a consensus for the final coding. After a preliminary round of coding, two elements highlighted in the corpus were added to the ontology. They are ‘infrastructure’ resource and ‘cognitive’ disability.To ensure reliability and validity, each of the four authors iterated the coding two times. A glossary of dimensions and elements was used to ensure the validity of coding. Some definitions in the glossary were clarified after the preliminary round of coding. Only the dimensions and elements explicitly articulated in the title, abstract, and keywords were coded. Implicit elements were not coded. Binary  coding was used. The coding was not scaled or weighted. The presence and absence of information convey equally important information in the analysis.All the coding was synthesized into one Excel spreadsheet for further analysis. It represents the synthesis of the corpus by the four authors coding in pairs, with multiple iterations and validation.The results of mapping the research corpus onto the ontology are presented through a monad map  and a thThe monad map in The number adjacent to the dimension name and the element is the frequency of its occurrence in the 575 journal articles that were reviewed and mapped. The bar below each element is proportional to the frequency relative to the maximum frequency among all the elements. Since each item can be coded to multiple elements of a dimension, the sum of the frequency of occurrence of elements may exceed the frequency of occurrence of the dimension to which the elements belong. The monad map is described below.The dominant focus of the articles is on the resources (537) followed by type of disability (334), access (275), force (263), type of care (251), personnel (211), population (103), and ownership (47). The articles cover a spectrum of resources that affect access to disability care. It is heavily focused on human resources, i.e., human other (306) and human sociological (195). In addition, spatial dwelling and financial income are highly emphasized. There is a medium focus on financial dependence (89), financial expenditure (75), infrastructure (68), spatial location (61), informational education (53), technological medical (51), human psychological (45), technological IT (44), temporal availability (37), spatial transportation (36), and cultural (32). There is little focus on informational stimulant (14), spatial distance (13), and temporal scheduling (3). There is no emphasis on technological transportation (0). Amongst disabilities, the articles dominantly focused on functional (197), cognitive (93), mental (83), and locomotor disability (78). There is less emphasis on visual (40) and hearing disability (23). The least focus is on speech disability (15). The type of access to care focuses mainly on physical access (248); there is less emphasis on virtual access (36).The forces for care dominantly focus on barriers (119) and catalyst (98) and less on inhibitor (89). There is the least emphasis on drivers (31) of access to care. The type of care is focused primarily on rehabilitative (94), followed by curative chronic (83) and preventive care (60). There is some focus on curative acute (35) and promotive care (23) and least on palliative care (14). Among the personnel, the majority focus is on physician specialist (54), care provider (54), and physician general (52). There is a moderate focus on community other (36), family (33), self (28), and nurse (21). There is less emphasis on social worker (18), rehabilitation worker (11), community youth groups (5), health worker/activist (3), community self-help groups (3), traditional healer (2), physician AYUSH (1), and pharmacist (1). There is no mention of Anganwadi (0) and peer (0).The focus on population segments is lesser than on other dimensions except for ownership, with a dominant focus on rural (58) and urban population (52). It is lesser on underserved (18) and peri-urban (11) and least on indigenous population (6). The articles focus least on ownership with a dominant focus on public (36), less on private (16), and least on NGO (5).While the monad map highlights the emphases on the elements of the ontology, the theme map visually summarizes the co-occurrence of the elements of the ontology in the population of articles. Some themes may be inferred intuitively from the monad map. For example, elements that occur frequently are likely to co-occur. However, the theme map formally computes and represents these co-occurrences, as described below.Hierarchical cluster analysis was performed using SPSS  with the simple matching coefficient (SMC) as the distance measure and the nearest-neighbor aggregation procedure. The dendrogram so derived is an exact visualization of the co-occurrence of the elements in the corpus. The detailed rationale for the choice of the clustering method and the presentation of the results are given in La Paz et al.  and Syn The primary research theme (in red) is the role of general human resources in physical access to disability care. It is a short segment of many potential pathways for access to disability care in the ontology—human resource other and physical access to disability care. The potential pathways may be barriers, inhibitors, catalysts, or drivers; include private, public, or NGO care providers; and include one or more types of disability, personnel, and population. Further, among the 19 resources, it includes only one, and among the two types of access, it includes one. The primary research theme is two-dimensional and one-leveled—it is simple.The secondary research theme (in brown) is the role of spatial–dwelling, financial–income, and human–sociological resources in access to functional disability care. It is three short segments of many potential pathways for access to disability care in the ontology. They are spatial–dwelling and access to functional disability care, financial–income and access to functional disability care, and human–sociology and access to functional disability care. These potential pathways may include different forces, ownerships, types of care, disabilities, personnel, and populations. Among the 19 resources, the theme includes three, and among the seven disabilities, it includes only one. The secondary research theme is also two-dimensional but two-leveled—it too is simple.The tertiary research theme (in yellow) is the role of financial dependence as a barrier to and catalyst of access to cognitive disability care. It is two short segments of many potential pathways in the ontology—financial–dependence barrier to cognitive disability care and financial–dependence catalyst of cognitive disability care. The potential pathways may include different types of access, ownerships, types of care, personnel, and populations. It includes one among 19 resources, two of four forces, and one among eight disabilities. The tertiary research theme is three-dimensional and two-leveled—it too is simple.The quaternary research theme (in blue) is the role of many resources  as inhibitors. They inhibit access to: (a) preventive, curative–chronic, and rehabilitative locomotive, and mental disability care, (b) by physician–general, physician–specialist, care provider, and community–other personnel, and (c) in urban and rural populations. It includes 288 long segments of many potential pathways in the ontology. The pathways may include different types of access and ownership. The theme is six-dimensional and many-leveled—it is complex.The quinary research theme (no color) summarizes the absence in the research corpus. Spatial–distance and spatial–transportation are not part of any theme, although spatial–location as an inhibitor is part of the quaternary theme, and spatial–dwelling affecting functional disability care is part of the secondary theme. Neither temporal–availability nor temporal–scheduling is associated with the forces that affect access or the other dimensions. Similarly, research on the force of information as a stimulant, human culture, information technology, and transportation technology in affecting access are absent in the corpus. Among the forces, thematic focus on drivers of access is absent, although barriers to, inhibitors of, and catalysts of access are included. Similarly, thematic inclusion of virtual access is absent, although physical access is part of the primary theme. Ownership of the care provider is not a thematic factor in the research corpus—there is no systematic distinction between the private, public, and NGO care providers. The theme highlights the exclusion of systematic promotive, curative–acute, and palliative care of the elderly disabled and at the same time of their hearing, speech, and visual disabilities. It also highlights the exclusion from the studies of a large variety of personnel that can provide elderly disability care—AYUSH physicians, traditional healers, nurses, health workers/activists, Anganwadi workers, pharmacists, social workers, peers, family, community (self-help and youth groups), rehabilitation workers, and the self. It also highlights the absence of systematic consideration of the peri-urban, underserved, and indigenous populations in the research. The quinary theme is eight-dimensional (same as the ontology) and many-leveled—there is a vast, complex, unresearched domain.Overall, the themes are in decreasing order of dominance in the research—the primary theme is the most dominant, and the quinary theme is absent. The three most dominant themes are simple; they are two- to three-dimensional and one- to two-leveled. The fourth theme encompasses more dimensions and layers; it is complex. The quinary (absent) theme is a vast complex domain across many dimensions and levels that is yet to be researched.The ontology-based analysis of the 575 research journal publications on access to geriatric disability care shows the selectivity and segmentation in the research. The monad map shows that the dominant focus of the articles is on the resources followed by type of disability, access, force, type of care, personnel, population, and ownership in descending order. While the research covers all the dimensions, the coverage of the elements under each dimension is not systematic. It neglects crucial elements that could play a key role in providing access to geriatric disability care. The emphases and gaps in each of the dimensions are discussed below.Among the resources, distance and transportation are key to ensuring that the elderly can access disability care. The elderly who are homebound in a country like India are acutely in need of transport services or mobile units to be able to access care . These tThere is only exploration of information being delivered to the elderly as educational. However, it does not explore information as behavior modifiers/stimulants. Technology has been studied only with reference to advances in medical equipment, aids and instruments, and technological assistance for the elderly in terms of information technology. There appears to be an assumption that the elderly may not be able to adapt to the recent technological advances. The availability or access to technology among the elderly is also a challenge considering many Indian households do not possess mobile phones or laptops, especially in rural areas . The speLast, cultural resources are also missing in the research. Cultural competency in care delivery is another barrier that healthcare providers must be mindful of to provide services that are respectful of and responsive to the health beliefs, practices, and needs of older adults of diverse backgrounds ,24.A large emphasis is laid on the forces that enable or disable access to healthcare, but overwhelmingly, it is tilted toward resources/traits that incapacitate the elderly, and there is very little focus on what factors can work to drive the elderly to access healthcare ,26. For The research corpus seems to be almost entirely focused only on physical access to care. This is consistent with research as it is missing the study of technological resources for the elderly. Especially during the COVID-19 pandemic when there has been disruption of physical access to care, more research is needed on improving the availability and uptake of virtual care by older persons. With the push for Digital India and telemedicine, research regarding elderly disability in India must also focus on this area to find solutions to make technology accessible to all . The limThe overall literature on the kind of facility where the elderly seek healthcare is sparse. It is the dimension that is the least emphasized in the corpus. In a country like India, where private healthcare costs are high, providing quality disability care through the public healthcare system supported by the non-governmental sector is vital . MoreoveMost of the disability care discussed in the literature is rehabilitative and chronic curative care followed by preventive care. Focus on palliative, acute curative, and promotive care is less emphasized. The World Health Organization  has identified palliative care as essential for improving the quality of life among those afflicted with life-threatening illnesses, and the care is obtained by 14 percent of those who need it . Health Among the disabilities that have been emphasized in the research, most have referred to functional disability due to chronic morbidities and aging causing difficulty in carrying out everyday activities. The high prevalence of activities of daily living (ADL) disabilities in lower-middle-income country settings ranging from 16.2 percent in China to 55.7 percent in the Indian population might be the reason for the focus on this aspect . Many stMental disabilities among older people are frequently not seen in the healthcare setting as they are construed as being part of old age by family members. Research to improve access to care is required in this regard . There iResearch on geriatric disability should focus on correctly identifying, labeling, and quantifying the disability as there are other social benefits provided by the government for the disabled. It will help the health system assess/budget the resources needed to be allocated for elderly care.The kind of care providers is mostly physicians either general or specialist or general care providers. There is very little engagement in the research corpus on how the older population can be independent and self-reliant or be supported by trained local human resources such as community or trained auxiliary health staff for healthcare. Personnel such as nurses and self-help groups can implement interventions such as healthy aging classes. Through these, one can build on the intrinsic capacity that will address physical and mental capacities . RehabilThe mention of rural and urban populations is limited to more of a description rather than comparing or setting the context of how these affect healthcare access for disability care. The study by Kalaiselvi et al. highlights how such population descriptions are merely used to describe the study setting  with fewThematically, the emphases and gaps highlight the segmented, selective, and siloed logic of the research. The primary theme highlights the role of human–other resources in physical access to disability care. It neglects the force the resource exerts, ownership of the care provider, type of care provided, disability cared for, personnel providing care, and population cared for. The bracket of human–other characteristics included various factors such as gender, age groups, ethnicity, race, occupation, education, and marital status. The research focus on these characteristics that affect physical access to care in terms of education, gender, and groups is one of the important nuances the research has covered. The research indicates older women have more unmet healthcare needs than their male counterparts . The useWhile the above factors are emphasized in the primary theme, it misses other critical resources that can be drivers of physical access to different types of care for disabilities which can be delivered by personnel for the geriatric population. For example, cultural resources can be improved to develop competence in providing physical care in a manner that creates respect for patient beliefs, to treat specific conditions, and to have customized interventions to modify behavior by healthcare providers . This wiPhysical access using its abundant human–other resources, such as paid and unpaid caretakers, has been the norm in India for disability care. These resources are easily available at a low cost. As the economy develops, the availability and cost of these resources will change and likely make such access costlier. The digitalization of care heralded by COVID-19 and current healthcare policies may provide a segue to change the emphasis, especially for disabilities that are amenable to tele-care, such as mental and cognitive disabilities.The secondary theme highlights the role of spatial–dwelling, financial–income, and human–sociological resources in access to functional disability care. The resources highlighted in accessing care for functional disability are emphasized in the research, particularly regarding the community–dwelling geriatric population. For this segment of the population, the resource of having Medicare provides them the benefit of accessing care following the Medicare claims for functional impairments . While tSpatial–dwelling, financial–income, and human–sociological forces have a significant bearing on the access to functional disability care in India. However, the characteristics of these forces must be interpreted in India’s context. The density, design, and development of these dwellings are different from those in the West, and within India, they are different between rural and urban areas; the financial income is generally lower; and the human sociology is very different and heterogenous across the country.The tertiary theme emphasizes financial dependence as a barrier to and catalyst of access to cognitive disability care. Research indicates that financial dependence to access care through formal sector pensions has been a critical catalyst in providing social security to the geriatric population with disability . In addiThough the theme covers the resource of financial dependence as a barrier and catalyst of access to cognitive disability care it ignores the role other resources play. It ignores the forces that could influence the type of access with the help of a provider in different settings. For example, several people are now inclined toward self-management interventions through technological advances. However, the geriatric population with cognitive disabilities has difficulties with self-managing their healthcare . These bIn many traditional multi-generational families in India, financial dependence on the older generation may be a catalyst and a facilitator of cognitive disability care. On the other hand, for families with limited financial resources, the dependence may be a barrier.The quaternary theme is less segmented and selective compared to the other themes. Though it is spread across most dimensions, it remains agnostic to two important dimensions, the type of access and ownership of the care provider. While it covers significant resources as inhibitors, it ignores the resources that could be a driver for virtual access to private care for disability care to the older population. For instance, given the challenges of the aging population and pandemics such as COVID-19, eHealth services have become integral for an inclusive, effective, and robust healthcare system. A study by Ali et al. suggests that with public and private efforts, there will be an increase in the availability of ICT infrastructure supporting the elderly population with disability . FurtherManagement of locomotor and mental disability care is likely to be more important in the individualistic countries of the West and less in the collective countries of India and the East. The impact of spatial–location, financial–expenditure, informational–education, human–psychological, technological–medical, and infrastructure resources as inhibitors of these types of disability care could be very different between the two types of society. For example, in individualistic countries, spatial–location (where they live) and technological–medical (monitoring) resources may be more important. On the other hand, informational–education (what to do) and human–psychological (motivation to do) resources may be more important in collectivist countries.The quinary theme highlights significant systematic oversights in all dimensions. For example, in resources, crucial elements such as spatial–distance and spatial–transportation are not part of any theme. Neither are temporal–availability nor temporal–scheduling. Research does not focus on the barriers the elderly persons with disability face due to the lack of transportation for those that live alone. Further, studies have proved that older adults with disabilities living alone have elevated odds of delayed care . Focus oFurther, the quinary theme highlights the exclusion of promotive, curative–acute, and palliative care of the elderly disabled and at the same time of their hearing, speech, and visual disabilities. The lack of attention to promotive and palliative care of the elderly disabled and the absence of a defined taxonomy of disabilities have made the research selective. Hearing loss not only affects spoken language, but it also impacts the cognition and mental health aspects. Interventions such as early screening and access to cochlear implants have the potential to ameliorate this burden . Access In a populous, collectivist country like India, the variety of personnel not emphasized in the research corpus could play a very important role. They include physicians–AYUSH, traditional healers, nurses, health workers/activists, Anganwadi workers, pharmacists, social workers, peers, family, community , rehabilitation workers, and oneself.In summary, the primary themes only discuss resources and physical access to disability care. Ownership of healthcare, whether it is public, private, or NGO, appears only in the quinary theme. The type of care, personnel, and population is present only in either quaternary or quinary themes. The primary focus of the research articles has been on the availability or lack of resources in accessing care for disability by the geriatric population mainly on human socio-economic factors . This highlights intrinsic factors/personal characteristics and emphasizes less extrinsic or structural resources such as the availability of health services, infrastructure, IT, or transportation. Physical access to care is emphasized disregarding the geriatric population using virtual access. Especially in the COVID-19 pandemic when there has been disruption of physical access to care, more research is needed on improving the availability and uptake of virtual care by older persons.Geriatric disability care is an important, growing challenge for India. In the following, we propose a roadmap for research to address the challenge based on: (a) the ontology that was proposed in the paper, (b) the analysis of the emphases and gaps in the global (including India-based) research on the subject, (c) limitations of the present research corpus, and (d) knowledge of conditions and needs particular to India. The research following the roadmap should become the input for translation into policies on and practices for geriatric disability care in India.The ontology is a comprehensive framework to visualize a roadmap for geriatric disability care research in India. It includes all the dimensions, elements of the dimensions, transverse pathways across dimensions, and associative pathways within dimensions that could be included in the roadmap. We discussed the strengths and shortcomings of the present global research corpus within this framework. We highlighted the emphases on and gaps in the coverage of the dimensions, elements, and pathways in the ontology. In addition, we noted two major limitations of the present corpus: first, the absence of a standard definition of the elderly—sometimes the geriatric population is grouped with all adults above 18 years—and second, the absence of a standard taxonomy of geriatric disability, including disability caused by chronic diseases.Develop a national standard definition of the elderly for India.Formalize the taxonomy of geriatric disability for India.Estimate the different disabilities among the different populations in each state and union territory of the country. Healthcare is a joint responsibility of the Central and State/Union Territory governments. The estimates must be a collaborative effort of the governments.The taxonomy of geriatric disability included in the ontology is appropriate and sufficient for the present. New elements could be added as the domain evolves. For example, primordial care could become the first stage of geriatric disability care. The present elements can be refined using subcategories to obtain a fine-grained roadmap. For example, locomotor disabilities may be with respect to fine motor skills  or coarse motor skills . The present taxonomy could be the foundation of the proposed roadmap. The prevalence of the different types of disabilities among the different populations will determine the priority given to each type of disability. Thus, the first three segments of the roadmap are to:Planning for the training and skill development of personnel listed in the ontology for different types of care for the various disabilities.Direction and deployment of the above personnel for effective and efficient care.The fourth segment is to define the potential role of different personnel in the different types of care for each disability. This can be represented as a simple Type × Personnel table for each disability. Research on these combinations could aid policymakers and practitioners in the following ways:The training, skill development, direction, and deployment must be based on evidence about the present emphases and gaps. They must: (a) reinforce Type × Disability × Personnel × Population combinations that have been effective, (b) redirect the combinations that have been ineffective, and (c) research innovative combinations that would be effective.The fifth segment is to describe the ownership mixes that could deliver the different types of care for the five population types physically and virtually. Given the emerging scale and scope of geriatric disability care in India, the Access × Ownership × Type combinations must be well differentiated and integrated to address the needs of the different populations. For example: (a) NGOs may be effective in providing virtual access to preventive locomotor disability care by a nurse for underserved older populations, (b) private facilities may be effective in providing physical access to rehabilitative mental disability care by a specialist physician for an urban older population, and (c) public facilities may be deployed to provide virtual speech disability care by a care provider for a peri-urban older population.The sixth segment is to identify and develop strategies to counter the barriers and inhibitors and deploy the catalysts and drivers to manage the different resource forces that could affect the above pathways to care. In formulating these strategies, one must learn from the global research, policies, and practices but customize them to local Indian conditions. Local feedback and learning systems must be built into the implementation of these strategies to aid their adaptation and evolution for greater effectiveness.This study provides a comprehensive framework for deconstructing a combinatorially complex problem. It provides a systemic framework for describing the problem and its dimensions, elements, and pathways. It defines the problem and its boundaries in easily understandable structured natural English. The framework can be applied to scientifically study the problem and apply the insights to develop appropriate policies and practices. It is a means to address a looming, large, emerging problem globally and in India. At present, there is no similar framework.The framework was used for a systematic, ontological review of the global (including India-based) research on the problem. The review highlights significant emphases and gaps in the research literature; they need to be addressed to develop effective solutions to the problem. It highlights some basic domain issues—such as the absence of a taxonomy of disabilities. It also highlights many other issues based on the research coverage. We believe this is the first such comprehensive review.The framework and the review together help develop a roadmap for research to address the emerging problem. It systematically highlights the pathways to be reinforced, those to be redirected, and those to be researched. A periodic review of the research using the framework could provide feedback to learn and redirect the trajectory of research and, consequently, policies and practices that translate the research. As of 23 July 2022, 191 more articles have been published on the subject. Such additions can be cumulatively added to a subsequent analysis. This too would be a unique contribution.A limitation of the study is the focus on articles in Scopus to the exclusion of articles in medical journals excluded from Scopus. Scopus includes articles from PubMed (Medline) but not other medical databases. In the future, the study could be extended to these articles too.A second limitation is the uneven distribution of the knowledge across countries and geographical regions. On the one hand, this may help the global–local knowledge transfer, in both directions. However, in the short term, it may also bias the definition and analysis of the problem toward the Western perspective.A last limitation of the study is that it is based on formalized knowledge encapsulated in peer-reviewed journal articles. A lot of non-formalized, cultural, local, indigenous, traditional knowledge may be relevant to address the problem. They may not have been formalized simply because nobody has published papers on them. The framework and the method provide an opportunity to formalize such knowledge and use them to address the problem.Access to geriatric disability care is a significant problem in India and globally. Given the scale and scope of the problem, the global research on the subject is inadequate, and India-based research is almost non-existent. India and the world must address the challenge systemically and systematically. The ontology of geriatric disability care defines the system’s dimensions, elements, and pathways to deliver such care. The present global research on the subject studied through the lens of the ontology is sparse, skewed, and siloed. The paper presents an analysis of the emphases and gaps in the research and discusses its inadequacies to address the challenge. Last, the paper presents a roadmap for geriatric disability research in India to address the country’s challenge based on the ontology. The roadmap for research can be generalized to other countries and the globe. The global ontology can be used to integrate different local instantiations to accommodate and adapt to local conditions and requirements.