The Impact of Covid-19 on Auditory Rehabilitation in LMIC

Low and middle income countries have long been known to have deficient health systems when compared to developed countries, owing to the inability of LMICs to possess a working system of health insurance that provides financial protection for specific sections of the population, increases healthcare service utilization and improves quality — and lastly, non-existent synergy with private entities to extend the reach of the health system.

It cannot be overlooked that over the last few years there have been some level of improvement in healthcare systems in LMICs, especially with the survival rates in areas of geriatric care that had previously led to increased deaths. The healthcare systems now have the capacity to considerably manage some of the conditions, hence reducing mortality; however, an area of the health system that is seriously lagging is the provision of continuous care for patients that require rehabilitation services post-survival.

Rehabilitation in LMIC

There is little evidence on access to rehabilitation services in LMICs, however access is expected to be quite limited considering the workforce of rehab professionals, which is a key component that determines access to services. In addition to that, review of healthcare systems in LMICs reported a similar challenge including limited knowledge of disability services, guidelines and accreditation standards, and non-coordination amongst health sectors.

The WHO estimates that there are less than 10 skilled rehabilitation practitioners per 1 million population in LMICs. With specific reference to hearing care professionals, there is less than 1 practitioner per 1 million people in Nigeria, while less than 5% of people requiring assistive hearing devices have their needs met. Needless to mention, unmet needs for rehabilitation have devastating impacts on individuals and their families, a huge economic burden to the country, and a reduction in quality of life experienced.

State of Audiology in LMIC

The unavailability of ear and hearing care services is thought to be associated with the non-existent comprehensive healthcare system in LMICs. This poses a significant challenge to the growing number of persons who require these services, thus giving rise to the emergence of the Audiology profession in these climes recently.

Approximately 80% of the 466 million persons living with disabling hearing loss are resident in LMICs, most of which lack the human or other infrastructural resources required to effectively combat the hidden disability that can easily go undetected and have compounding effects on quality of life.

Challenges in Audiological Service Provision due to Covid-19

The pandemic has been an eye opener towards many new ways in which service delivery can be implemented remotely in the healthcare sector, as questions surrounded how patients' needs could be met without flouting Covid-19 response orders and putting the professional and others at risk. For the Audiologist, meeting up with the needs of clients posed a challenge at first, as they constitute a specific section of persons whose therapeutic activities were tied around having human contact.

The response measures put in place to control the spread of Covid-19 only amounted to isolating the already isolated. Social isolation has been a marker of hearing loss, thus the physical distancing measures put in place to manage Covid-19 further reinforced the feelings of loneliness experienced by persons with hearing loss.

In addition, the mandatory use of face masks, which serves as an ally in the fight against Covid-19, presents a great challenge for persons with hearing loss as they reduce acoustic transmission of sounds and prevent speech reading. Asides the above, patients have reported that there is a high risk of knocking off their hearing devices when taking off their facial coverings. Lastly, the increased reliance on remote communication technologies inadvertently segregates these category of persons, as it may be difficult for them to follow the conversation due to sound distortion in these technologies.

Way Forward

Hearing rehabilitation professionals can continue to meet patient needs by making use of telehealth services when possible, although this can never replace face-to-face professional services. Professionals can also continue to support their clients and families by reaching out to them to show solidarity and make them aware of their availability to support their communication needs in ways that align with safety precautions.

Furthermore, persons with hearing loss can reduce the functional impact of Covid-19 by making use of masks with a plastic panel over the mouth, and by making use of speech-to-text mobile apps and written scripts to aid communication challenges.

In conclusion, improving access to rehabilitation care in LMICs needs to be seen as a priority area, and this can be done by ensuring there is a sincere leadership and governance structure that promotes disability-inclusive development, strong partnerships in the health sector, investment in infrastructure and human resources, and research.