EAR AND HEARING CARE SITUATION ANALYSIS TOOL (EHCSAT)
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1 EAR AND HEARING CARE SITUATION ANALYSIS TOOL (EHCSAT) Dr Suneela Garg Director Professor and Head, Department of Community Medicine, Maulana Azad Medical College,New Delhi, India Secretory General Sound Hearing 2030
2 INTRODUCTION Millions of people live with disabling hearing loss Most of the causes of hearing loss is preventable Ear and hearing care : comprehensive, evidence-based interventions to prevent, identify and treat ear diseases and hearing loss to rehabilitate and support persons with hearing loss Each country must develop a strategic plan, based on its demographic profile, requirements and resources
3 First step in formulation of strategy is to undertake a situation analysis Assessment of the existing situation of the country regarding ear and hearing care Gain an understanding of the epidemiology of hearing loss Assess status of the systems supporting ear and hearing care Understand the gap between the current situation and an optimal one
4 AIM of EHCSAT The Overall aim of the Ear and Hearing Care Assessment Tool (EHCSAT) is to facilitate planning for ear and hearing care Services at the National SubNational or Regional level
5 OBJECTIVES To assess the available direct and indirect policies, services and human resources for ear and hearing care. To describe the framework and functioning of the health care system, in context of ear and hearing care, within the country. To assess the need for ear and hearing care services
6 OBJECTIVES To identify available opportunities for promoting and sustaining integrated ear and hearing care along the continuum of care, across all levels within the health system using universal health coverage. (Continuum of care is a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care)
7 National and Subnational Ear and Hearing care planners Stakeholders EHCSAT Professionals Policymakers
8 METHODOLOGY METHODS FOR COLLECTING INFORMATION Interviews with relevant stakeholders Desk-based data collection
9 METHODOLOGY Review and analysis of information: Information gathered should be collated and organized in the provided format Sources of information should be recorded Grading questions: included at the end of each section helps to record the progress of the country in different aspects of ear and hearing care services, over a period of time
10 Content of EHCSAT EHCSAT has 4 sections: Section 1: General Country Information: Section 2: Assessment of health system capacity Section 3: Stakeholder s analysis: Section 4: Summary analysis Section to provide guidance on how to use EHCSAT
11 ECHSAT TOOL Section 1: General Country information Population distribution and profile Health status indicators Epidemiology of hearing loss Existing direct and indirect hearing care policies
12 Content of the tool Population distribution and Profile Health status indicators Age and gender distribution Rural-urban distribution Literacy rate Languages Life expectancy at birth Annual birth rate Under-five mortality rate % of births taking place in health facilities % of population using mobile phone services % of births taking place at home which are attended by skilled birth attendants % of population/area reached by internet services Incidence of MDR-TB Incidence of HIV-AIDS Immunization coverage
13 Content of the tool Epidemiology of hearing loss Healthcare strategy Prevalence of disabling hearing loss Maternal health and Child Health Age distribution of hearing loss Incidence of congenital/early onset childhood hearing loss (ECHL) Ranking the main causes of disabling hearing loss Eye care Disability and rehabilitation Occupational Health School Health Care of elderly Communicable diseases Multi drug resistant tuberculosis HIV/AIDS Non-communicable diseases Inclusive education 13
14 Grading the situation regarding the preparedness of the country for development and implementation of ear and hearing care strategies 1 There is no awareness about the need for ear and hearing care services amongst policy makers in the country. Development and implementation of a strategic plan for the hearing care is highly unlikely at present. 2 There is some awareness about the need for ear and hearing care services among policy makers. However, development and implementation of a strategic plan for the hearing care is unlikely at present 3 There is awareness about the need for ear and hearing care services among policy makers. A strategic plan for ear and hearing care is likely in the coming. 4 There is awareness about the need for ear and hearing care services among policy makers. The country is ready to develop and implement a national strategic plan, provided resources are available. 5 There is awareness about the need for ear and hearing care services among policy makers The country is ready to develop and implement a national strategic plan, and resources are available for this purpose. 14
15 ECHSAT TOOL ECHSAT TOOL Section 2: Assessment of health system capacity Leadership and Governance: information on national committee and existing plans and programmes for ear and hearing care. Service Delivery: information on provision of direct and integrated ear and hearing care along the continuum of care. Health workforce: health care providers (direct and indirect) for ear and hearing care, at all levels of the health care system
16 ECHSAT TOOL ECHSAT TOOL Section 2: Assessment of health system capacity Medical products and health technology: information on diagnostic tests, equipment, hearing and other devices and medicines. Health information and research: mechanism for recording and reporting health related information. Health financing: seek information on financing of ear and hearing care services and health insurance
17 Section 2: Leadership and Governance Existence of a Focal point and National Committee Existing strategic plan or policies for ear and hearing care(ehc) Hearing care programmes
18 Grading the situation regarding the existence and implementation of strategic plans, programmes/policies in the country 1 There is no government-led committee or appointed coordinator for EHC. There is no national strategy/plan and no other programmes to address ear and hearing care. 2 There is a government-led committee or appointed coordinator for EHC. There is no national strategy/plan for EHC at present. 3 There is a government-led committee or appointed coordinator for EHC. A national strategic plan has been developed but it is not yet implemented. 4 There is a government-led committee or appointed coordinator for EHC. There is a national strategic plan for EHC and activities are being implemented in some parts of the country, but not covering the entire country. 5 There is a government-led committee or appointed coordinator for EHC. There is a national strategic plan for EHC. Activities/programmes are being implemented throughout the country
19 Section 2: Service Delivery Does the country/area have a defined package of services for provision of primary health care? Primary level Secondary level Tertiary level Community Level Are the services in line with universal health coverage?
20 Grading the situation regarding services for provision of EHC in the country 1 EHC services (including surgical and audiological services) are not available at tertiary level nor secondary level or primary level. 2 EHC services (including surgical and audiological services) are available in limited centres at tertiary level only. There are no EHC services at primary and secondary levels. 3 EHC services (including surgical and audiological services) are available at all tertiary level centres. There are no EHC services at primary and secondary levels. 4 EHC services (including surgical and audiological services) are available at all tertiary and secondary level health facilities. No EHC services are provided at primary level health facilities. 5 EHC services (including surgical and audiological services) are available at all tertiary, secondary and primary level health facilities
21 Section 2: Health workforce Skills, numbers and status of training of : ENT Specialists Audiologist Speech therapist Hearing aid technicians Teachers of the deaf Sign language interpreters General physicians Health workers This includes workforce both in the public and private sector
22 Grading the situation regarding availability of human resources for ear and hearing care (EHC) within the country 1 There is a severe shortage of all levels of human resource required for EHC services in the country. 2 There are an adequate number of ENT specialists available in urban areas but not in rural parts of the country. There is shortage of other categories of human resources.* 3 There are an adequate number of human resources for EHC* available in urban areas. This is NOT so in rural parts of the country. 4 There are an adequate number of human resources for EHC** available in all urban areas and some rural areas of the country. 5 There are an adequate number of human resources for EHC** available in all urban areas and rural areas of the country. *: required for provision of audiological, rehabilitative, educational and support services. **: for provision of medical, surgical, audiological, rehabilitative, educational and support services. 22
23 Grading the situation regarding availability of educational facilities for training of human resources for EHC within the country 1 Educational facilities for development of human resources for EHC are not available in the country. 2 Training facilities for health workers in EHC are available. There are No educational facilities for professional training of ENT specialists, audiologists and others cadres. 3 Training facilities for health workers in EHC are available. Educational facilities for professional training of human resources for hearing care are also available, but these are inadequate to provide EHC for the entire country. 4 Training facilities for health workers are available as well educational facilities for professional training, and these are adequate to provide EHC for the entire country
24 Section 2: Medical products and Health technology Availability in the public health system of the following: Hearing aids Cochlear implants Loop system Medicines
25 Grading the situation regarding the availability and accessibility hearing devices in the country 1 There is NO availability of hearing aid services/cochlear implantation in the country. 2 Hearing aid services* are available but are not accessible to most (due to high cost or location of services). CI** are not accessible by majority. 3 Hearing aid services* are available and accessible to most persons in urban areas of the country. However, CI** are not accessible by majority. 4 Hearing aid services* are available and accessible to most persons in urban and rural parts of the country. However, CI** are not accessible by majority. 5 Hearing aid services are available and accessible to most persons in urban and rural parts of the country.. CI are available and accessible to those requiring them. * Hearing aid services including fitting and maintenance ** Cochlear implants including follow-up and therapy
26 Section 2: Health financing Gathers information about: Budget allocated by the government for ear and hearing care Availability of free services in the government sector Health insurance schemes that cover ear and hearing care services The sectors that provide health insurance services
27 Grading the situation regarding the health financing in the country. 1 EHC services are not affordable and no health financing is available. 2 Part of the expenses for EHC are covered through government-led health financing schemes, but it is still not affordable for the majority. 3 Most of the expenses for EHC are covered through government-led health financing schemes, and it is affordable for the majority. 4 Most of the expenses for EHC are covered through government-led health financing schemes, and it is affordable for all. 5 All expenses related to EHC are covered through government-led health financing schemes
28 Section 2: Health information and research Information about sources of health information are collected Existence of HMIS facilities in public and private sectors Existence of National and Regional surveys & how frequent Health research conducted in the field of ear and hearing care Epidemiological research Operational research
29 Grade the situation regarding the health information systems in the country. (Encircle the most suitable response): 1 There is NO functional health information system in the country. 2 There is NO government-led health information system in the country. Health-related indicators are collated by state/provincial governments or NGOs. 3 There is a government-led health information system in the country. It does not include any information/indicators on EHC. 4 There is a government-led health information system in the country. It includes some information/indicators on EHC. 5 There is a government-led health information system in the country. It includes all relevant information/indicators on EHC
30 ECHSAT TOOL Section 3 Section 3: Stakeholder s analysis: this section will list out potential stakeholders in ear and hearing care Departments within Ministry of Health (MoH) Other Ministeries/departments, other than MoH Professionals and academicians Civil Society Groups, including disabled persons organizations UN Agencies like WHO Industry partners Any other groups/individuals/organizations
31 Grading the situation regarding the interest and commitment among stakeholders towards EHC 1 There are no interested stakeholders among the governmental and nongovernmental sectors for promotion of EHC presently. 2 There is commitment towards EHC from few stakeholders. This is insufficient to drive forward the policy development and implementation process. 3 There is commitment towards EHC from multiple groups of stakeholders including government. However, there is lack of stakeholders which can provide financial support to drive the process. 4 There is commitment towards EHC from multiple groups of stakeholders including government and otherfinancial sponsors. 5 There is commitment towards EHC among all groups of stakeholders including financial sponsors
32 ECHSAT TOOL Section 4 Section 4: Summary analysis: aims to summarize the current situation, needs and challenges and make recommendations regarding next steps
33 Preparedness for EHC strategy Comments Leadership and governance Service Delivery Human resources Capacity for education and training Technology Health Financing Health Information Stakeholders participation
34 Benefits of EHCSAT EHCSAT would facilitate the conduct of a review of ear and hearing care services Highlight the gaps and needs for provision of integrated ear and hearing care services Information compiled from EHCSAT can be used for: advocacy development of a new / updating of existing strategic plan of EHC
35 Thank you
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