Community-Based Rehabilitation Promoting ear and hearing care through CBR


This document has been coordinated by the World Health Organization's units for Prevention of Blindness and Deafness, and Disability and Rehabilitation. Ms Sally Harvest was responsible for the overall coordination of this document.

 Hearing loss is the most prevalent sensory disability (1) and a problem that is increasing globally. More than 275 million people are reported to have moderate to profound hearing loss; many more have mild hearing loss and/or ear diseases such as otitis media (infection of the middle ear). These problems can cause lifelong — and occasionally life threatening — difficulties (2); they may have a profound effect on the ability of individuals to communicate with others, on their education, on their ability to obtain and keep employment, and on social relationships and may lead to stigmatization (3).

Recognizing the high prevalence of hearing loss, World Health Assembly (WHA) Resolution 48.9 acknowledged a general lack of human resources and of programmes to address ear diseases and hearing loss across the world (5). Many countries have neither the personnel trained in identification of hearing loss nor the equipment and facilities to deliver support services. In many countries, too, there is a severe shortage of staff, including audiologists, and of resources for hearing aid provision, support and aural rehabilitation programmes. In addition, ear and hearing care services are often outdated (6). It is estimated that there is only one ear, nose and throat (ENT) specialist per two million population in Africa generally, and none at all in some countries.

 Hearing loss impacts not just the individual but the entire family and society generally. Any responses to the needs created by hearing loss will therefore be more effective in a community-based approach to this issue — that is, in community based rehabilitation (CBR) programmes.


Introduction                                                   5

Integrating ear and hearing care into CBR programmes              6

Key concepts                                                   8

Specific issues related to hearing loss                             12

Integrating primary ear and hearing care and   

CBR programmes: suggested activities                       15

Health care and CBR workers                                    20

References                                                    23