N.G.O.s have been able to access quality products at lower cost for humanitarian use (refer to Case Study 6). N.G.O.s, benefiting from these pricing agreements, believe that these humanitarian prices still incorporate a small profit margin for the manufacturer. Other models for procurement that N.G.O.s use, but that are less likely to be replicable at scale, include refurbishing donated product and accepting donated product from hearing aid companies through C.S.R..65
To combat limited awareness and stigma associated with hearing loss, N.G.O.s have adopted service delivery models in L.M.I.C.s that bring services closer to people. These models often involve using lower cadres of workers (refer to Case Study 7). Examples include door-to-door screening for hearing loss and provision of care; campaigns and outreach programs at schools and in communities; partnerships with government health facilities; and standalone hearing clinics, sometimes in partnership with universities or private health facilities.
These models also help overcome the need for the user to visit the audiology clinic multiple times before the hearing aids are working optimally and help reduce high drop-out or conversion rates. A study conducted in Malawi outlined that referral uptake for ear and hearing services was only 3% due to a variety of factors including location of the hospital, other indirect costs of seeking care, procedural problems within the outreach programme, awareness and understanding of hearing loss, and lack of visibility and availability of services.67