Awareness and Political Will

• Low interest to improve E.H.C., especially when positioned among competing priorities, leading to low levels of global and domestic financing

Service Delivery Infrastructure

• Provision of hearing aids should be within the broader context of the provision of E.H.C., which is able to both detect hearing loss and resolve many of the medical causes of hearing loss
• Much of the service delivery of hearing aids is taking place outside the government framework of healthcare provision. This results in inconsistent service delivery protocols, challenges in providing quality and reduced coverage

Procurement

• Low levels of government procurement of hearing aids
• Existing government practices do not result in the procurement of optimal or sufficient products
• L.M.I.C.s do not currently have access to the lowest priced products because of low procurement volumes

Awareness and Political Will

• Although many governments do not prioritise hearing loss, some have taken first steps to institute E.H.C., and appropriately channelled resources could accelerate their efforts
• Regional advocacy initiatives are underway that provide a starting point to generate increased political will

Service Delivery Infrastructure

• E.H.C. programs should be at least implemented at the Primary Health Care Level within the existing government framework of healthcare provision and thus require government support
• By demonstrating the feasibility and benefits of effective E.H.C., further investment from external donors can be generated

Procurement

• Public procurement of hearing aids increases coverage, provides an affordable or free option for users, and enables volume-based negotiations on a concise set of basic models, generating the lowest cost quality options

• Incorporate demand generation into national plans, i.e. development and dissemination of national awareness raising campaigns on hearing loss and hearing aids and support of associations representing hard of hearing persons. .
• Provide investment or technical support to countries with the political will to implement programs in alignment with global policies and standards once developed.
• Develop investment case and conduct budget impact analysis to support the incorporation of E.H.C. with hearing aid provision into national U.H.C. or health insurance/reimbursement models.

• Strengthen country procurement of hearing aids by:

  • Identifying existing procurement budgets and challenges;
  • Strengthening public procurement via the adoption of specifications and standards;
  • Improving participation of quality companies in public tenders.
• Invest in regional advocacy networks to encourage the development of E.H.C. national plans, develop and support awareness raising and anti-stigma campaigns, amplify current successes and encourage implementation of adopted E.H.C. national plans.

• Development and implementation of E.H.C. national programs that include the provision of hearing aids
• Tiered service delivery models developed and implemented in a country, with examples of best practice and cost-effective approaches
• Increased procurement of quality hearing aids in the public sector at lower cost
• Increased donor interest and engagement with E.H.C. stakeholders to build national E.H.C. programs

• Routine public procurement and provision of quality hearing aids and services, as part of in-country E.H.C. programs that are integrated with the health systems, deliver appropriate care at appropriate levels and are sustainable.