Hearing healthcare resources and services in South Africa

Abstract

Hearing loss is a significant global health concern. Its prevalence is exceptionally high in many African countries where hearing healthcare resources and services remain inaccessible. The aim of this research project was to describe audiologists’ perceptions of hearing healthcare resources and services in South Africa’s public healthcare system; to describe the current status of cochlear implantation in South Africa; and to describe audiologists’ perceptions of telehealth services for hearing loss in South Africa’s public healthcare system. Study I aimed to provide one of the first reports and descriptions of hearing healthcare resources and services in South Africa’s public healthcare system from the perspectives of audiologists employed within the public sector. A national self-developed telephonic survey study was conducted with audiologists employed across the different levels of care in South African public healthcare sector hospitals. Descriptive statistics and qualitative thematic analysis were used to analyze the data from the final sample of 100 audiologists employed across 100 different hospital settings. Most (82.0%) of the audiologists indicated that their hospitals did not have adequate hearing healthcare resources to render efficient audiology services to patients. In terms of human resources for hearing healthcare, there was a perceived shortage of audiologists and ENT specialists. Audiology equipment that was commonly reported as unavailable included hearing aid verification hardware (75.6%), Noah modular software (58.5%), a high-frequency tympanometer (51.2%), and an automated auditory brainstem response (AABR) screener (50.0%). Furthermore, universal newborn hearing screening (UNHS) services, adult aural rehabilitation services, and follow-up care for all assistive hearing devices post-warranty expiration were perceived as limited. Study II aimed to provide the first report and description of the general status of cochlear implantation in South Africa. Part one of the study provided an overview of cochlear implantation, and Part two described the current status of cochlear implantation in South Africa by retrospectively reviewing 10 of the 12 cochlear implant (CI) programme’s 2019 annual reports submitted to the South African Cochlear Implant Group (SACIG). Descriptive statistics were used to analyze the annual report data. Results revealed an increasing number of cochlear implantations performed countrywide, with 216 cochlear implantations performed in 2019. Furthermore, there was an increase in the number of established South African CI programmes in both the private and public healthcare sectors, with five of the CI programmes having financial allocations for CIs for public sector patients in 2019. Results also revealed the uneven geographic distribution and unequal accessibility of CI programmes regarding private and public healthcare, with the private sector accounting for most of the CI programmes. Study III provided one of the first reports describing the perceptions of 97 audiologists employed within public healthcare system hospitals across South Africa regarding telehealth practices within their hospital setting and barriers toward telehealth service delivery during Phase one of the study. A national electronic survey specifically developed for Study III was used for data collection in Phase one. Two synchronous virtual focus group discussions, consisting of four and five audiologists in each group, were conducted during Phase two of the study to facilitate a deeper and more rigorous understanding of telehealth services in South Africa’s public healthcare system. Descriptive statistics and qualitative thematic analysis were used to analyze the data for this study. Study results revealed that audiologists were cognizant of telehealth services’ potential to improve hearing healthcare efficiency within the public sector and that most (84.1%) of them were willing to use it. The actual uptake of telehealth services was however low (7.2%), despite the uptake almost doubling during the COVID-19 pandemic (19.6%). Prominent perceived barriers to telehealth were primarily related to hospital resources, including the unavailability of equipment for hearing and specialized assessments (88.4%), various internet-related barriers (including the unavailability (51.2%) and unreliability (77.9%) of internet access and insufficient bandwidth (74.4%), telehealth protocols (82.6%) and infrastructure (79.1%). Patient-related barriers to telehealth were also reported, including limited/ poor patient access to the internet (95.4%) and patients' lack of confidence in using digital technology (77.9%). The results of this research project highlighted that hearing healthcare resources and services are lacking in South Africa’s public healthcare system. Human and equipment resources for hearing healthcare were especially strained and adversely impacted service provision, including UNHS and aural rehabilitation. Similarly, the provision and follow-up care of assistive hearing devices (invasive and non-invasive) was challenged, particularly financial allocations for cochlear implantation in the public sector. Telehealth is a promising and feasible strategy to increase and improve hearing healthcare access at the hospital level, and audiologists in Study III indicated their willingness to use it. At a national level, hearing healthcare prioritization and resource mobilization is warranted to address the identified barriers (as indicated in Studies I-III) and improve the current status of hearing healthcare resources and service provision in South Africa’s public healthcare system. The global burden of hearing loss can only be adequately addressed at the South African national level once hearing healthcare resources are in place. This will allow for increased access to and improved hearing healthcare service delivery to all South Africans - across all provinces and all rural and urban areas.