Hearing aids in low- and middle-income countries: from evidence to scale

Hearing loss affects more than 1.5 billion people globally, with nearly 80% of disabling cases in low- and middle-income countries (LMICs). Despite being the most established rehabilitation technology, fewer than 10% of those in need in LMICs possess them, with rates as low as 2% across Africa and Southeast Asia.

This review synthesizes evidence on barriers to hearing aid access in LMICs, including workforce shortages, prohibitive costs and trade barriers, geographic centralization, and stigma across internalized, social, and structural dimensions, and evaluates strategies to overcome them. These include task-sharing using community health workers (CHWs), mobile health (mHealth) and tele-audiology, preset and over-the-counter (OTC) hearing aids, rechargeable devices, mHealth adherence support, and health systems policy reforms.

Closing this gap requires a shift toward decentralized, community-based care supported by digital technologies. Evidence supports CHW-facilitated hearing aid provision with structured counseling and mHealth acclimatization support, as a feasible, effective, and acceptable rehabilitation model. Future progress depends on embedding hearing care within universal health coverage, reforming cost-inflating trade policies, and investing in implementation science to evaluate the fidelity, scalability, and sustainability of effective models. These models also apply to underserved populations in high-income countries.