4.6. While there is potential to increase adoption of affordable and quality hearing aids, there is currently a considerable
lack of effective public procurement in L.M.I.C.s.
Unlike the examples of H.I.C.s provided above, in L.M.I.C.s current investment in procurement and provision of hearing aids
by the public sector is low or non-existent. Governments are not prioritising procurement of hearing aids within limited budget
envelopes. Where a limited number of countries do procure hearing aids for public provision, procurement volumes tend to be
far below the immediate need, as characterised by growing waiting lists and the projected need that could be addressed with
hearing aids.
Additionally, tendering practices related to hearing aids demonstrate significant weaknesses, further limiting access to optimal
products:
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POOR SPECIFICATIONS. In some cases, tender documents do not provide sufficient specifications on the types of product required and do not align
with W.H.O. P.P.P. as governments and decision-makers are unaware of the P.P.P. or have not fully adopted it. In other cases,
the specifications promote the proliferation of products. This results in a fragmented market with multiple products that
are similar in functionality, and lack of consensus on which products would be best included in a public model of provision.
Experts suggest that meeting a range of user needs only requires a few, adjustable hearing aid models.
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PRICE OVER QUALITY. In the absence of strong specifications and clear quality standards, national procurements tend to go to the lowest bidder,
regardless of whether it is an appropriate or quality product. At these low prices, Big 5 manufacturers do not see the value
of competing. There are also examples in L.M.I.C.s where the government tenders local manufacturers, regardless of cost or
quality considerations.
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IMPORT DUTIES AND TAXES. In many countries, hearing aids are not exempt from import duties and taxes, such as sales or V.A.T., which can have a significant
impact on the price of the product to the consumer and the ability for governments to procure. In one middle income country
for example, import duties on hearing aids are as high as 15% and V.A.T. is 10%. This essentially increases the price of the
product by 26.5% to the buyer.