Exploring ear and hearing care in Cambodia

Delayed care for hearing loss can have catastrophic consequences. Unaddressed hearing loss can lead to communication difficulties, social isolation, and decreased quality of life, and is costly to society. Unfortunately, in many countries, timely access to quality hearing care remains unattainable. Chris Waterworth’s PhD research explored ear and hearing care (EHC) in Cambodia to understand the supply and demand-side dimensions of access.

A woman in blue scrubs is sitting in front a young girl wihose dark hair is in a pony tail.  The young girl is wearing large headphones and has her back top the camera

Chris’ first study investigated the experiences of individuals with ear disorders attending an NGO hospital in Phnom Penh, assessing the severity of their conditions and the delays they faced in accessing care. The second explored the supply of EHC services and access pathways from the perspective of providers and stakeholders in Cambodia.

The findings highlight EHC services in Cambodia are underdeveloped and lack integration with the health system. While comprehensive ENT services are available at National Hospitals, there is a lack of resources and training for EHC at health centres and district hospitals. Awareness and recognition of ear conditions and hearing loss are particularly low in rural areas, highlighting the need for public health education.

Access to EHC is hindered by factors such as perceived poor service quality and limited referral pathways. A preference for seeking care outside the public health system poses a financial burden on individuals and households and fragments the delivery of aural rehabilitation.  Difficulties in procuring hearing aids and limited coverage by social protection mechanisms means significant numbers of Cambodians in need of assistive hearing technologies are left untreated.

Efforts are underway to address accessibility issues through initiatives within the Government’s National Health Strategic Plan and the Package of Activities. However, a comprehensive strategy is necessary, along with further research to examine system-level barriers and infrastructural challenges. Integrating EHC services can involve adapting the activities offered within the district health system to include ear disease screenings, treatment, counselling, and community education. Nurses will play a vital role by incorporating EHC activities within their scope of practice through task-shifting or task-sharing strategies, especially in rural areas.

Expanding the activities at referral hospitals to include EHC services and ensuring an adequate workforce density of EHC professionals in each province, can improve diagnosis and treatment. Collaborative efforts involving the Ministry of Health, provincial and district authorities, and healthcare professionals are essential for successful integration of services in the country.

These planning processes and policy recommendations provide a framework for gradually incorporating EHC services within the existing health system in Cambodia. By leveraging the district and hospital infrastructure and empowering healthcare professionals, the aim is to improve accessibility and provide quality ear and hearing care to the Cambodian population.

Chris Waterworth, technical advisor at the Nossal Institute, has recently completed a PhD thesis on the unmet need for ear and hearing care (EHC) in Cambodia.

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Chris Waterworth