The number of children with hearing difficulties is increasing throughout the world. Children who are born deaf can suffer permanent disadvantage in speech, language and educational development. What are the opportunities for promoting early detection and management of deafness in babies born in developing countries?

The importance of early detection of deafness in babies and children was recognised in a resolution of the World Health Assembly (WHA) in 1995. Screening of newborn children for hearing difficulties has become standard in developed countries. But this is not the case in developing nations. In this paper the author examines current criteria used to determine global health care financing priorities, and the opportunities for promoting interventions for early hearing detection services in developing countries.

Spending on health care in developing countries comes from a mix of public, private, and external donor finance. Hearing impairment screening for newborns does not figure among the priorities of the major global health actors such as the World Bank (WB) and UNICEF. Despite the relatively modest size of their contributions to total health spending, these multilateral donors have a strong influence on governments’ health financing priorities. However, high levels of out-of-pocket spending on health services indicate that individual preferences must be taken into account.

• In 2002, out-of-pocket spending made up 66 percent of total health care spending in low-income countries and 50 percent in lower middle-income countries. The corresponding figures for external donor finance were 8 percent and 0.9 percent respectively.
• Government criteria for expenditure include economic efficiency, and ethical and political considerations. Decisions to embark on screening services may rest on the ability to recover costs through health insurance or user fees.
• The WB and World Health Organisation set priorities using measures of the disease burden, including mortality rates, disability adjusted life years (DALYs), and cost-effectiveness analyses of existing interventions.
• There is no data on DALYs associated with childhood-onset hearing impairment. Without this, it is impossible to evaluate the cost-effectiveness of interventions for comparison with other diseases.
• Where hearing screening of newborns is offered for a fee via the private sector, the evidence indicates that the value people attach to services is higher than that suggested by the amount of public funding available for them.
• Evidence from pilot programmes demonstrates effective models for service delivery through public-private partnerships.

The lack of vital data required by current approaches to global health priority-setting means that the prospect for action in the short term is uncertain. The WHA resolution on detection and treatment of hearing difficulties in babies and young children has not yet been incorporated into global health priorities for developing countries. The author asserts the following. 

• Governments have a moral obligation to inform parents about the possibilities for early detection and intervention, regardless of their ability to pay, or the government’s ability to provide such services.
• It is unethical to withhold screening where follow-up services are poor, and to provide screening services without efforts to improve relevant intervention services.
• Action is needed to stimulate public-private partnerships that will provide effective interventions in the first year of life for those who wish to take advantage of them.

Source(s):
‘Addressing the Global Neglect of Childhood Hearing Impairment in Developing Countries’, PLOS Medicine 4:4, by B O Olusanya, 2007

id21 Research Highlight: 11 May 2008

Further Information:
Bolajoko  Olusanya
Unit of Audiological Medicine
Institute of Child Health
University College London
London, UK

Unit of Audiological Medicine, Institute of Child Health, University College London, UK

Maternal and Child Health Unit
Institute of Child Health and Primary Care
College of Medicine
University of Lagos
Lagos
Nigeria

Contact the contributor: b.olusanya@ich.ucl.ac.uk;

Maternal and Child Health Unit, Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Nigeria

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