Author(s)
Rolvix H. Patterson, MD, MPH
Chris Waterworth, AAudA
Sarah MortonAlyssa Platt, MA
Shelly Chadha, MBBS, MS, PhDCatherine M. McMahon, MAud, PhD
Susan D. Emmett, MD, MPH
Affiliation(s)
Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, USA; Department of Audiology and Speech Pathology, University of Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Australia; Duke Global Health Institute, Duke University, USA; Department of Noncommunicable Diseases, World Health Organization, Switzerland; HEAR Centre, Macquarie University, Australia;
Abstract:
Objective: Characterize global access to ear and hearing care (EHC) to inform future policy recommendations
Study Design: Cross-sectional survey
Setting: Subjects were surveyed via contact lists of the World Health Organization, Global Otolaryngology-Head and Neck
Surgery Initiative, and Global HEAR Collaborative.
Subjects: Otolaryngologists, audiologists, and other health professionals
Interventions: None
Main Outcome Measures: Workforce, training programs, affordability, government funding, and incorporation of EHC
into national health strategy by World Bank income group
Results: There were 124 survey responses representing 58 countries: 76% from low- and middle-income countries (LMICs)
and 24% from high-income countries (HICs). Regarding workforce, 38% of respondents (31% in LMICs, 60% in HICs)
agreed there is an adequate supply of ENT surgeons, 23% (12% in LMICs, 57% in HICs) for audiologists, 21% (10% in
LMICs, 57% in HICs) for speech-language pathologists, and 14% (12% in LICs, 20% in HICs) for EHC community health
workers. Only 13% (7% in LMICs, 30% in HICs) agreed there are adequate training programs for EHC workforce. On
affordability of care, 28% respondents (21% in LMICs, 50% in HICs) agreed that hearing aids are affordable and 23% that
cochlear implants are affordable (14% in LMICs, 53% in HICs). Finally, 20% of participants agreed that government
funding or investment is sufficient (13% in LMICs, 43% in HICs) and 44% that EHC care is included in national health
strategy (37% in LMICs, 67% in HICs).
Conclusions: Globally, EHC may be limited by systems-level barriers that disproportionately affect LMICs. Future policy
recommendations should advance EHC in national health strategies and funding priorities to address workforce and cost
barriers.
Professional Practice Gap & Educational Need: Despite global efforts to strengthen EHC, barriers to EHC remain illdefined.
Learning
Objective: Learners will gain an understanding of barriers to EHC across countries by World Bank income group.
Desired
Result: Learners will use this knowledge to improve understanding of EHC barriers and develop appropriate
policy- and program-level interventions.
Level of Evidence – Level V
Indicate IRB or IACUC: Exempt