Effective communication underpins social participation, education, employment, and emotional well-being. In India, millions living with speech and hearing impairments face profound systemic barriers—not only in accessing clinical care, but in navigating fragmented, unsustainable service delivery models. While rehabilitation science has advanced clinically, the absence of coherent business and operational frameworks remains a critical bottleneck, particularly in densely populated and underserved regions like Delhi NCR. Objective This study aims to design a structured, contextually relevant business framework thatenhancestheorganisational effectiveness, financial sustainability, technological readiness, and patient-centred delivery of speech and hearing rehabilitation services in India. Methods A mixed-methods approach was employed, integrating qualitative interviews with rehabilitation professionals and administrators, quantitative surveys with service users, and desk reviews of operational data from public, private, and NGO-run centres. Principles of health systems management, disability rights, and organisational theory informed the research framework. Results Findings reveal widespread operational fragmentation, underutilisation of digital platforms, low patient engagement, and financial precarity across centres. Only 22% of surveyed facilities offered fully integrated services, while less than 15% maintained formal business continuity or financial planning protocols. Patient satisfaction was closely linked to centres demonstrating structured workflow, continuity of care, and participatory service models. Conclusion A comprehensive business framework is essential to address existing deficits and future-proof India’s communication rehabilitation ecosystem. By embedding strategic planning, technology integration, human resource development, and equity principles into operational models, the study provides a replicable blueprint for transforming fragmented rehabilitation centres into resilient, patient-centred ecosystems