WHO issues guidance to improve access to hearing care in low- and middle-income settings

Geneva, 1 March 2024 — For World Hearing Day, marked on 3 March, the World Health Organization (WHO) has released new technical guidance on hearing aid service delivery approaches for low- and middle-income settings. This document is designed to provide practical guidance to countries in developing hearing aid services in areas that lack human resources for assessing hearing, as well as fitting and maintaining hearing aids.

The guidance, developed with support from the ATScale Global Partnership for Assistive Technology, is based on the principle of task sharing among specialists and trained non-specialists. It includes two approaches, one targeting adults, with the other for children 5 years and over, and is accompanied by resources with tips for healthy ear care practices, use of hearing aids and how to support people living with hearing loss.

“Over 400 million people with hearing loss could benefit from using hearing devices. However, less than 20% of these needs are fulfilled,” said WHO Director for the Department for Noncommunicable Diseases, Dr Bente Mikkelsen. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over $1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services.”

The release of the new guide coincides with World Hearing Day. The theme for 2024 is ‘Changing mindsets: Let’s make ear and hearing care a reality for all’, highlighting the importance of correcting misconceptions of hearing loss that are common among the general public and primary health providers.

Existing mindsets limit access to hearing care

The first of two key challenges in ear and hearing care is the lack of health system capacity for the provision of integrated ear and hearing care throughout people’s lives, as evidenced by a lack of policies, human resources and dedicated finances. The service delivery approaches detailed by WHO aim to overcome this challenge by better utilizing non-specialists in providing hearing care to increase capacity’.

The second key challenge relates to misperceptions and stigmatizing mindsets about hearing loss and ear diseases, which are deeply ingrained within societies and often limit the success of efforts to improve hearing care. Common misperceptions include the idea that hearing loss is an inevitable part of old age and that hearing aids do not work well or are too expensive.

“Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.”

Misperceptions are also prevalent among primary health care providers who may consider this to be a ‘specialized’ or ‘difficult to provide’ service, resulting in failure to identify and treat even those conditions that do not need specialist care.

Changing mindsets

Changing mindsets related to ear and hearing care is crucial for improving access and mitigating the cost of unaddressed hearing loss. To address common myths and misperceptions, WHO has released a number of information products and resources to raise public awareness. A factsheet for health professionals provides a clear rationale and directions for engagement of primary level service providers in hearing care provision.

Governments should take steps to integrate ear and hearing care within primary health care, implement community-based approaches that bring services close to people and lead initiatives to raise awareness and mitigate stigma related to hearing loss. Health care providers must also play their role by ensuring they give due attention and care to people with common ear and hearing problems. Civil society groups, parents, teachers, and physicians can use WHO’s awareness materials and community resources to inform people about the importance of ear and hearing care