An exploration of Multi level barriers to Neonatal Hearing Screening (NHS) in Islamabad, Pakistan

Abstract

Hearing impairment (HI) in children is globally prevalent and neonatal hearing screening (NHS) programs detect hearing loss(HL) in newborns at the earliest stage for early intervention leading towards rehabilitation. Such NHS programs have been established in the developed countries since decades and are also being implemented in many developing countries except Pakistan. Initiation of NHS programs is not the priority of the health policy makers and except for the Government of Sindh the federal nor any of the provincial governments have legislated on NHS.The present study is based upon the perceptions of parents of hearing impaired (HI) children in the special schools and hospitals and puts forward the proposition that although HI children are suffering and eventually placing a financial and economic burden ,with its negative societal impact affecting the speech and language development and compromising on the quality of life of the HI child , no initiative has been taken by the federal government to address the lack of NHS in Pakistan.Interviews were conducted with the health policy makers and hospital administrators. The barriers to NHS comprise of policy, legislative and operational barriers and the priority accorded to NHS is at the lowest rung of the health care agenda in Pakistan. What is perceived to be lacking in the initiation, planning and implementation of any NHS program in Pakistan is that there is not enough priority accorded to it perhaps as it is not sensationalised in the electronic and press media to catch the attention of the policy makers. As HI is not a visible disability it is not perceived to be a serious public health issue amongst the public. The international health organizations have not put their weight and technical assistance nor voiced any support for initiating of NHS in Pakistan.Hence the health policy makers do not feel any compulsion to adhere to international declarations and conventions on NHS. The non existence of NHSand late detection of HI in Pakistan costs deeply in economic and financial terms to the state and individuals as well in the long term. Data about the prevalence of HL is available to some extent but admittedly there is paucity of research on NHS and the concerned health authorities have not advocated any research in the public sector.