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Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Addressing hearing loss througha health care systems approach
Albert Francis Domingo, MD MScDivision of NCDs and Health through the Life-CourseWHO Regional Office for the Western Pacific Email: [email protected]
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Presentation Outline1. Goals for an ear and hearing care programme2. Essential attributes of a system for ear and
hearing care3. Building blocks for an ideal ear and hearing care
programme4. The WPR UHC Action Framework5. Designing a holistic model of care6. Integrating with other health programmes
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What do we want from anear and hearing care programme?• Reduce/prevent risk factors leading to hearing loss• In those already with hearing impairment– Prevent complications and further deterioration– Improve outcomes and functional level
• Avoid financial risk due to costs of care• Ensure equitable spread of improved outcomes
(i.e., leave no one behind)
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
To get what we want, how should we implement an ear and hearing care programme?Essential attributes(1-3/5)
Some domains for action
Quality Regulations and regulatory environmentEffective, responsive individual and population-based servicesIndividual, family and community engagement
Efficiency Health system architecture to meet population needsIncentives for appropriate provision and use of servicesManagerial efficiency and effectiveness
Equity Financial protectionService coverage and accessNon-discrimination
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
To get what we want, how should we implement an ear and hearing care programme?Essential attributes(4-5/5)
Some domains for action
Accountability Government leadership and rule of law for healthPartnerships for public policyTransparent monitoring and evaluation (M&E)
Sustainability and resilience
Public health preparednessCommunity capacityHealth system adaptability and sustainability
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the building blocks for an ideal ear and hearing care programme?
People-Centred Ear and Hearing Care ServicesHealth workforce
Resource generation and health financing
Essential medicines, commodities and technologies
Health information system
Good Governance
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
In summary: The WPR UHC Action Framework
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
The Continuum of Care
Health Risk exposure Risk contact
Latent disease/injur
y
Early disease/
injuryDisease
progression
Advanced disease/injur
y
Chronic disease
Impairmentor Death
Primary Prevention: Reduce risk exposure
Secondary Prevention:
Detect and intervene early
Tertiary Prevention:Reduce progress or
complications of established disease
Resource Generation,Financing, Stew
ardship
Interventions
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Healthy population
Population at risk
Population with sickness
Sick that need hospitalization but have no access to hospital care
Sickand
Hospitalized
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
The Supply Side of the Health System
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Designing a Holistic Model of Ear and Hearing CareContinuum
of CareLevel of Care
Self-care Family and household
level
Community level
General primary care
District hospitals
Referral hospitals
A B C D E F
Health Promotion
1
Disease Prevention
2
Screening, Risk Assessment, and
Diagnosis
3
Treatment and Rehabilitation
4
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
A Sample Holistic Model of Care for DiabetesContinuum
of CareLevel of Care
Self-care Family and household
level
Community level
General primary care
District hospitals
Referral hospitals
A B C D E F
Health Promotion
1 Healthy lifestyle
Healthy lifestyle
Regulation of the sale and marketing of sugar-sweetened beverages
Disease Prevention
2 Risk factor screening through medical history
Outpatient nutrition counselling
Screening, Risk Assessment, and
Diagnosis
3 Careful assessment of family history
Early detection
Fasting plasma glucose screening
HbA1C screening
Treatment and Rehabilitation
4 Adherence to medication
Foot care
Patient support groups
Periodic eye examination
Diabetic registry
Surgery and/or hemodialysis as indicated
Specialist management of co-morbid diseases (TB)
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the main causesof hearing loss?High Proportion Moderate Proportion Low Proportion
Inherited causes Excessive noise Nutritionally-related
Otitis media Ototoxic drugs & chemicals Trauma-related
Presbyacusis Ante- & peri-natal problems
Meniere’s disease
Infectious causes Tumours
Wax and foreign bodies Cerebrovascular disease
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the interventions to address hearing loss? (Pre-Natal)Disorder Primary Prev’n Secondary Prev’n Tertiary Prev’n
Rubella Immunization
Early detection by screening all or high-risk groups and treatment, if available
Hearing aidsSpecial educationRehabilitation
Toxoplasmosis Health education, treatment of the mother
Iodine deficiency Nutrition, supplementation
Ototoxicity Avoidance, rational use
Genetic causes Health education, counselling, identification of carriers
Congenital malformations
None Surgery, when appropriate
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the interventions to address hearing loss? (Peri-Natal/Neonatal)Disorder Primary Prev’n Secondary Prev’n Tertiary Prev’n
Low birth weight Nutrition, ante-natal care
Early detection by screening all or high-risk groups and treatment, if available
Hearing aidsSpecial educationRehabilitation
Birth trauma, hypoxia Improved birthing practices
Herpes simplex Caesarian section
Cytomegalovirus Personal hygiene, health education
Jaundice Detection of at-risk groups
Ototoxicity Avoidance, rational use
Noise-induced hearing loss from noisy incubators
Reduction in noise
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the interventions to address hearing loss? (Childhood)Disorder Primary Prev’n Secondary Prev’n Tertiary Prev’n
Impacted ear waxOtitis externaForeign bodies
Personal hygieneHealth education (e.g. avoid use of ear buds)
Health education & screening for early recognition of disease and hearing loss, prompt treatment of disease and/or complicationsCase follow-up
SurgeryHearing aidsSpecial educationRehabilitationSocial integration as appropriate
Acute & Chronic otitis media
Personal hygiene, better living conditionsProper management of upper respiratory tract infections, better nutrition, breastfeeding
Measles, mumps Immunization
Cerebral Malaria Vector reduction and prophylaxis
Meningitis Prophylaxis, immunization
Ototoxicity Avoidance, rational use
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
What are the interventions to address hearing loss? (Adults)Disorder Primary Prev’n Secondary Prev’n Tertiary Prev’n
Ototoxicity Avoidance, rational use
Early detectionRehabilitation (hearing aids, cochlear implants)Special educationSocial integration/ accessibility
Noise-induced hearing loss
EducationHearing conservation
Presbyacusis None Avoid ototoxic agents & noises
Trauma HelmetsSeat belts Surgery
Otosclerosis None
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Designing a Holistic Model of Ear and Hearing CareContinuum
of CareLevel of Care
Self-care Family and household
level
Community level
General primary care
District hospitals
Referral hospitals
A B C D E F
Health Promotion
1
Disease Prevention
2
Screening, Risk Assessment, and
Diagnosis
3
Treatment and Rehabilitation
4
• Neonatal hearing screening• Immunization• Regulations for noise reduction• Rational use of ototoxic drugs• Prompt treatment of ear
infections• Early detection by screening• Surgery
• Hearing aids• Special education• Accessibility policies• Social integration• Water and sanitation
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Who is/are the patient(s)?What are the diagnostics and therapeutics?
Figure from: GBD 2013 Risk Factors Collaborators (2015)
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
0-6 7-27 28-364
1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Self-harm and interpersonal violence; unintentional in-juries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuries
Self-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuriesSelf-harm and interpersonal violence; un-
intentional injuries; transport injuries
Major NCDs: Diabetes, uro-genital, blood, and endocrine diseases; cardiovascular dis-
eases; chronic respiratory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasmsMajor NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasmsMajor NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases;
neoplasms
Mental andsubstance use disorders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-ordersMental and substance use dis-
ordersMental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-orders
Mental and substance use dis-ordersMental and substance use dis-
ordersMental and substance use dis-
orders
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDs
Other NCDs
Maternal andneonatal disorders
Maternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disordersHIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TB
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other
common infectious diseases
Causes of Death over the Life-Course in the Western Pacific Region (2013, both sexes)Forces of nature, war, and legal intervention Nutritional deficienciesOther communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria
days yearsData from the Global Burden of Disease (2013) as published in The Lancet
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
How can we integrate ear and hearing care with other health programmes?
Consider linkages with• Immunization• Infectious disease
control• Rational drug use• Maternal, antenatal and
perinatal care• Occupational health
• Environmental health• Urban health• Habilitation and
rehabilitation• Healthy ageing
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
SDG3: Ensure healthy lives and promote well-being for all at all ages
• Reduce maternal mortality• End preventable deaths of newborns
and children under 5 years of age• End epidemics of AIDS, TB, malaria
and NTDs and combat hepatitis, water-borne diseases and other communicable diseases
• Reduce by one third premature mortality from NCDs and promote mental health
• Strengthen prevention and treatment of substance abuse
• Halve deaths and injuries from road traffic accidents; ensure universal access to sexual and reproductive health
• Achieve universal health coverage, access to quality essential health-care services and access to medicines and vaccines
• Substantially reduce deaths and illnesses from hazardous chemicals, pollutants and contaminants
• Strengthen implementation of the WHO FCTC, as appropriate
• Support R&D of vaccines and medicines in accordance with the Doha Declaration on the TRIPS Agreement and Public Health
• Substantially increase health financing and development of the health workforce in developing countries
• Strengthen country capacities for early warning, risk reduction and management of national and global health risks
Multi-country Workshop on Ear and Hearing Care in the Western Pacific Region6-7 December 2016 | Beijing, China
HEALTH AND THE ENVIRONMENTDivision of Noncommunicable Diseases and Health through the Lifecourse
Albert Francis Domingo, MD MScEmail: [email protected]
