Developing self-sustainable hearing centers in the developing world – case study of EARs Inc project in Dominican Republic

Abstract

Purpose: This paper presents the case study of the project EARS Ind developed in the Dominican Republic (DR) with the purpose of increasing access and affordability of hearing aid technology for the hearing impaired. This case study demonstrates how a program can fit hearing aids to patients with hearing impairments can be developed in low and middle income countries. Methods: The project planning documents and project statistics and reports were reviewed. A questionnaire and follow-up interviews were used to gain a clear understanding of the situation in the EARS Inc. DR hearing aid project. Results: The case study is presented of the development and services in the DR with a particular focus on the choices made in regard to hearing aid services including manufacturer choices, procurement, distribution, pricing and service delivery. The development of these services included the simultaneous development of a training program, ear mould laboratory, hearing aid repair services, also sales of batteries and accessories as well as the development of calibration services. Conclusions: The development of comprehensive diagnostic and rehabilitation services requires equipping and training local staff.

Implications for Rehabilitation

• A good hearing aid fitting is more than technology – patient education and the clinician fitting the hearing aid are important.

• Access to follow-up services including battery supplies, hearing aid adjustments and hearing aid repairs is essential to any hearing aid fitting program in low and middle income countries.

• Check the WHO guidelines for hearing aid provision in developing countries when planning a program.

• When working in a country co-ordinate with local professional involved in hearing health where available.

• Audiology
• developing countries
• hearing aids
• hearing health
• hearing technology
• sustainable hearing programs
• humanitarian
• training

Notes

¹The cost of a hard acrylic ear mould is $18USD, $22.40USD for a silicon earmould and $33.60USD for a shell for an ITE. This is based on the price of the products with a charge per hour for the technician who makes the earmoulds in the earmould laboratory on site.

² The clinical director and the project director were trained in 2012 at the University of North Carolina using funds granted by the Hear the World foundation.

³ There are a large number of people in the Dominican Republic without documents; these maybe Dominicans who were not registered by their parents after their birth, illegal immigrants or children of illegal immigrants (typically from Haiti).

⁴ This figure is the 10.28million population figure from 2013 and includes the projected 1.4% population growth in the last year.

⁵For discussion on this see article by Harvey Dillon and Gitte Keidser 2011 [16].