Читать книгу Early Detection and Intervention in Audiology - Группа авторов - Страница 16

‘Functioning health systems require a qualified health workforce that is available, equitably distributed and accessible by the population’ (WHO, 2018, p. 8). Although the African continent has 25 percent of the global burden of disease, it has 3 percent of the worlds' health workers (Crisp, 2011). In many African countries, the primary health care (PHC) workforce has limited training, which results in primary care rarely being equipped to serve as a foundation for the health care system (Mash et al., 2018). However, countries such as Ghana, Botswana, Uganda, Kenya and Nigeria have established training programmes for family physicians, with Ethiopia and Malawi having implemented such training (Mash et al., 2018). In South Africa, family physicians are positioned at primary and district levels of health care. They require an extended range of procedural skills within a generalist environment, while providing support to the primary care platforms (Mash, Ogunbanjo, Naidoo, & Hellenberg, 2015).

Prevention and promotion are key aspects to service delivery in PHC platforms. Prevention and management of otolaryngology-related diseases require a team approach, with PHC delivered by professional nurses, clinical officers and general practitioners, and specialised care by ear, nose and throat (ENT) specialists, audiologists and other related specialities (Fagan, 2018).

Audiological and ENT services have been reported to be extremely poor in sub-Saharan Africa, with an inequitable distribution of services and limited training opportunities (Fagan & Jacobs, 2009). Hence, individuals requiring audiological and ENT services may not be able to effectively access them. Given the prevalence of hearing loss, this lack of availability of services raises concern for service provision. Furthermore, it risks leading to preventable auditory pathologies going undetected or untreated, which may result in hearing impairment, with a consequent negative impact on quality of life and economic productivity (Mulwafu, Ensink, Kuperd, & Fagan, 2017).

Mulwafu and colleagues (2017) report that there has been some improvement since 2009, with the establishment of six new ENT training programmes in sub-Saharan countries. Two new audiology and speech-therapy training programmes have been established in Ghana and Kenya, and new ENT training programmes in Rwanda, Zimbabwe and Ethiopia. In other countries, such as Malawi, Kenya, Mali, Togo and Cameroon, there has been little overall change in the number of qualifying ENT surgeons, audiologists and speech therapists per year (Mulwafu et al., 2017). In 2014, Zambia reportedly had five otolaryngologists and one audiologist in a population of 14 million (Mwamba, 2014).

A 2015 follow-up survey on services in sub-Saharan Africa indicated that in the 22 countries from which responses were obtained, there were a total of 847 ENT surgeons, 580 audiologists, 906 speech therapists and 264 ENT clinical officers (Mulwafu et al., 2017). When comparing these figures to those in 15 countries that participated in the 2009 survey (Fagan & Jacobs, 2009), results indicate an increase in the number of ENTs and audiologists. However, this increase needs to be viewed in relation to the overall increase in population size during this period, which may still reflect a significantly high patient-to-professional ratio, particularly in countries such as the Democratic Republic of Congo, Lesotho, Madagascar and Senegal (Mulwafu et al., 2017). Moreover, if data from South Africa, Kenya and Sudan were to be excluded, the actual number of audiologists may be even lower (Mulwafu et al., 2017). This human resource disparity has serious implications for the implementation of EHDI in these regions, particularly if the prevalence and incidence of hearing impairment is on the rise, as estimated by the WHO.