3.6. W.H.O. global guidelines related to hearing aid provision in low-resource settings (L.R.S.) are outdated and lack specificity, which has led to a variety of approaches to hearing aid provision.

W.H.O. developed the “Guidelines for Hearing Aids and Services for Developing Countries”35 in 2004. Since hearing aid provision should happen in the context of E.H.C., W.H.O. supplemented these guidelines with the “Primary Ear and Hearing Care Training Resources”36 in 2012 and with the “Preferred profile for hearing aid technology suitable for L.M.I.C.s” in 2017 (henceforth referred to as the W.H.O. Preferred Product Profile or W.H.O. P.P.P.—refer to Appendix D.).37

The 2004 Guidelines lack specificity on personnel, provision and product:

• PERSONNEL. There is limited guidance on who is allowed to provide hearing aids and what the standards are for their training, accreditation, and long-term skills building. Some countries have very restrictive policies that require licensed audiologists or E.N.T. surgeons to provide hearing aids and as a result curtail general access to this service, while others have limited regulation, which may lead to substandard service.
• PROVISION. Although new technologies (refer to section 4.10) for the detection and diagnosis of hearing loss exist, it is unclear how these may change the guidelines for provision and how they compare to existing audiometry technology. There is also limited guidance on the provision of earmoulds using the latest technology.
• PRODUCTS. Although the W.H.O. P.P.P. provides transparency on the desired product specifications for hearing aids, there remains contention among experts about the appropriateness of digital hearing aids that are manually programmable (“trimmer-based”) versus those that are software programmable. New classes of hearing aid products (refer to section 4.11) such as self-programmable, pre-programmable, and over-the-counter are mentioned, but there is no clear guidance, largely due to lack of evidence.

These also do not incorporate guidance on the latest advancements in technologies for screening and fitting earmoulds or hearing aids (discussed in section 4.12). Lastly, specific training resources for hearing aid provision in L.R.S. are limited. While audiologists and others in the sector may disagree on technical aspects of service delivery, there is a consensus that delivery must avail the use of audiometry, ensure appropriate fitting, and be provided in a context where long-term support is available. This consensus has been captured in the voluntary development of some guidelines and standards, such as the forthcoming “Suggested Guidelines for Humanitarian Hearing Care Outreach Programs” developed by the Coalition for Global Hearing Health.38

While plans to update the W.H.O. Guidelines or the W.H.O. P.P.P. do not currently exists, the W.H.O. is open to developing new target service delivery profiles and product profiles through a consensus process with the hearing community.