Manchaiah, V.
American Speech-Language and Hearing Association (ASHA) Annual Convention, Philadelphia (USA), November 2016.
Publication year: 2016


Aim: Audiology practice and service delivery vary considerably across and within countries. This may be as a result of individual, social, and economical factors. This presentation aims to provide an understanding of the service delivery model that exists in promoting access to hearing health in underserved contexts with particular emphasis on the community-based hearing rehabilitation (CBHR) model in low and middle income countries and eHealth in high income countries.

Methods: Prevalence estimates for disabling hearing impairment were reviewed and a number of national and international examples of initiatives to facilitate use of hearing healthcare services are provided. Service delivery models that aim to provide access to hearing health in underserved contexts are reviewed and discussed with particular emphasis on evidence-based practice (EBP).

Results: The incidence and prevalence of hearing impairment vary considerably across countries, with over 80% of those with disabling hearing impairment living in low- and middle-income countries (World Health Organization, 2015). At any age, disabling hearing impairment can have profound impact on interpersonal communication, psychosocial well-being, quality of life and economic independence (Olusanya et al., 2014). Various factors (e.g., individual, social, policymaking and service delivery aspects) may facilitate or hinder access to and the success of hearing health programs. There are unique challenges in low- and middle-income countries when compared to high income countries and vice versa. This presentation will discuss a few examples of service delivery models that aim to provide access to hearing health in underserved contexts. For low- and middle-income counties the discussion will be based on the work of non-profit and non-governmental organizations (NGOs): All Ears Cambodia; Audiology India (Manchaiah, 2016); and Ear Aid Nepal. All these organizations have adopted a CBHR model (World Health Organization, 2004, 2012). There is limited (or no) evidence base for the outcome of CBHR services in low- and middle-income countries, although anecdotal reports have been generally positive (McPherson, 2014). However, there are some good examples of measuring hearing health outcomes in a unique and more appropriate way for the context being served (Borg et al., 2012). For high income-countries the discussion will be based on eHealth initiatives in Finland, Sweden and the United Kingdom to provide services on specialist areas such as tinnitus and vestibular disorders (Beukes et al., 2015; Pyykkö et al., Submitted; Thorén et al., 2015). Even in the high-income countries there have been limited professionals offering specialist services, which has created a need. Although, there is a clear research evidence to demonstrate the effectiveness of such programs, much work remains to be done on how to integrate such initiatives into routine care so that they both supplement each other.

Conclusions: Raising awareness about hearing health issues globally and the rise in income of the middle class (in low- and middle-income countries) have resulted in higher need and demand for hearing health services across the globe. Hence, innovative service delivery models are necessary to meet these growing needs. Hearing health should to go beyond the clinic and a public health perspective is necessary in order to provide access to hearing health in underserved contexts. Moreover, particular emphasis should be placed on developing and adopting evidence-based service delivery models that demonstrate reasonable outcome for the hearing healthcare services offered in the underserved contexts.