New Delhi : A study conducted by Sound Hearing 2030 in collaboration with Delhi’s Maulana Azad Medical College (MAMC) has said that utilizing community health workers (CHWs) as front-line providers of care and education while leveraging advances in digital technologies like mobile health (mHealth) is a promising public health strategy to increase hearing services accessibility.
Sound Hearing 2023 is a South Asian initiative to curb hearing loss by 2030.
The purpose of the study, a report of which has been submitted to the World Health Organisation (WHO) was to assess the feasibility of an end-to-end protocol, developed by the WHO technical working group on rehabilitation services in low-and-middle income countries (LMICs).
The study has been named as “Hearing aid service delivery approaches in low and middle-income (LMI) settings: A Feasibility.”
“It is well known that the prevalence of hearing loss has increased over the last few decades. The major reason being hearing loss is not addressed in a timely manner and this adversely affects people in terms of employment, socio-emotional well-being, education and quality of life. Across the globe, over 1.5 billion people have hearing loss of varying degrees. However, the majority of people with hearing loss reside in low-and-middle income countries (LMICs), where access to care is limited, not well integrated into public health systems, and prohibitively expensive,” the study, a copy of which is available with ETV Bharat revealed.
However, one of the most common rehabilitative measures for people with permanent forms of hearing loss, is hearing aids. Traditional clinic-based services require specialist diagnosis and provision of care using expensive and stationary equipment. These factors limit access and affordability of hearing care for people in LMICs. Additionally, under provision of hearing aids is a major challenge to individuals in LMICs. As a result, estimates have indicated that less than 3 percent of people in LMICs who could benefit from hearing aids, get them.
“Despite the growing need for hearing care, LMICs face significant systemic barriers that hinder effective service delivery. These include limited healthcare infrastructure, shortage of trained healthcare professionals, and the geographical dispersion of populations, often in remote areas. Moreover, cultural perceptions of hearing loss and the stigma associated with wearing hearing aids further complicate efforts to address this issue. These factors underscore the complexity of implementing traditional clinic-based hearing services in LMIC contexts,” the study said.
The survey was conducted in two sites of Delhi including Khwaja Mirdard area and Delhi Gate Health Centre.
A total of 140 households were screened at Delhi gate area and 247 households were surveyed in the Khwaja Mirdard area.
Talking to ETV Bharat, principal investigator of the study Dr Suneela Garg, Chair Program Advisory Committee, National Institute of Health & Family Welfare (NIHFW) said that initial 15 days period after the commencement of the project was the preparation phase that included training of Health care workers by the audiologist under supervision of ENT specialist.
“At the same time, this period was utilized for a rapid survey for identification of the participants and creating awareness among the community. Subjects screened with red flag signs were managed as per standard treatment Protocol,” she said.
The comprehensive household survey underscored the prevalence of hearing loss within the community, highlighting the critical need for accessible hearing care services. The successful fitting of hearing aids in a majority of eligible participants at the Delhi Gate site demonstrates the feasibility and potential impact of this intervention in improving auditory health in LMI settings.
“Out of the total screened population, 8.5 percent were found to be eligible for hearing aid fitting. Red flags were found in 37.5 percent of subjects. Amongst the eligible ones, 78 percent were fitted with hearing aids, whereas 12 percent subjects refused to get the hearing aid and 9 percent subjects were unavailable to get the hearing aid fitting done,” the findings said. Those subjects who were identified with red flags were counselled and were referred to ENT OPD for further management.
“This study responds to an urgent global health concern, addressing the escalating prevalence of hearing loss, particularly in LMICs where traditional hearing care services are often inaccessible or unaffordable. By pioneering the use of community health workers (CHWs) for the delivery of hearing care, we propose a scalable, community-centric solution aimed at drastically increasing the uptake of hearing aids among those in need,” said Dr Garg.
The study has conceptualized the empowerment of health care workers by building their capacity to identify hearing-related challenges and enhance their knowledge and skills. This can lead to increase in their self-efficacy, participation, and thus paving the way in channelizing the hearing solutions under the national health care delivery system.
“Training the health care workers can facilitate the lives of hearing aid users and improve their quality of life in case of need, affordability issues, heavy load in tertiary settings and other physical limitations,” Dr Garg said.
Dr AK Aggarwal, former dean, MAMC and honorary President of Sound Hearing 2030 was the second principal investigator of the study. Dr K Madan Gopal, Advisor & Head, Public Health Administration Division, National Health Systems Resource Center of the health ministry was one of the principal advisors of the study. Scientists from ICMR also contributed to the findings of the study.
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