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Diagnosed hearing impairment without adequate intervention may have long-term consequences for the affected individual. Besides affecting communication abilities, it can influence vocational performance and result in isolation and stigmatisation (Yoshinaga-Itano, 2004). Specific international principles and goals for EI for hearing impairment guide service provision. These principles and goals are discussed in chapters 7 and 11, which deal with approaches to EI and family-centred EHDI, respectively.

EI services are particularly important in children who are considered at risk for developmental delay. It is well documented that a lack of intervention may have negative consequences for development, school readiness, educational outcomes and vocational opportunities (World Health Organization [WHO], 2012; Yoshinaga-Itano, 2004). EI services may be provided at different sites or levels of service delivery, including health care clinics, hospitals, EI centres, rehabilitation centres, community centres, homes and schools (WHO, 2012). Exploring models of care in the various levels of service delivery in South Africa is important to ensure efficacious intervention that is contextually responsive and responsible. Chapter 8 looks at how specific communicative therapy approaches can be delivered to children with hearing impairment and their families. It considers contextual factors such as patient-to-professional ratios, as well as cultural and linguistic diversity issues that may influence these options and patient outcomes.

EI for hearing impairment is a multi-staged process that commences with the provision, fitting and adjustment of amplification devices followed by early communication intervention (McPherson, 2014; Peer, 2015). Most high-income countries have been able to access hearing health care through private and publicly funded aural (re)habilitation systems. However, many LAMI countries have not had these same opportunities for access despite the higher prevalence of childhood hearing impairment (McPherson, 2014; Stevens et al., 2011). The challenges to implementation are further influenced by the availability of and access to EI services. Chapter 7 highlights these challenges and discusses contextual considerations in terms of the cultural and linguistic diversity in South Africa. The chapter also explores various modes of communication and communicative therapy approaches to EI, and addresses the value and implementation of auditory verbal therapy in the South African context.

Ensuring continuity of care is important in the multifaceted process of EHDI, and requires the involvement of various stakeholders from different government sectors such as health, social development and education. Access to education is a key priority of the South African government. However, this access does not always practically translate into inclusivity in the educational sector for children with hearing impairment. Access has therefore not necessarily transformed into success in the educational setting for these learners. Addressing hearing impairment as a barrier to learning is vital to facilitate success, and to ensure maximal benefits from EHDI implementation. While chapter 7 highlights educational access for children with hearing impairment in sub-Saharan Africa, chapter 9 discusses EI in the South African basic education setting. It offers recommendations for inclusive education and explores telehealth in the form of tele-audiology as well as task shifting to facilitate this process.