Hearing loss and ear disorders often go undetected and untreated, especially in infants and children. Disparities in health services and socioeconomic positions in Bhutan contribute to inequities in pediatric hearing care. The Hear, Listen and Speak (HLS) Program addresses the need for a better system by providing innovative and comprehensive solutions to gaps in pediatric hearing care in Bhutan.

Poverty and Health Care Disparities in Bhutan

In 2022, 10.1% of Bhutanese people lived below the national poverty line, with 87% of this population residing in rural areas. About 62% of Bhutan’s total population lives in rural areas, where access to services is more limited and socioeconomic conditions are generally poorer than in urban areas. Significant disparities in health care access exist between rural and urban populations, with rural residents having 3.4 times higher odds of using primary health centers rather than outpatient hospital services.

Socioeconomic Position and Hearing Loss

People with hearing loss are more likely to be unemployed, attain lower levels of education and earn lower wages. Meanwhile, people in lower socioeconomic positions are less likely to use hearing aids or access hearing care. Children in lower socioeconomic positions are less likely to receive early diagnosis and intervention.

They also have lower levels of device use and generally attend schools with fewer resources or rehabilitation programs. If hearing loss in childhood goes untreated, it can permanently impair speech and language acquisition, reducing a child’s likelihood of completing their primary education.

The Hear, Listen and Speak Program

The Ministry of Health of Bhutan launched the HLS Program in 2021 to address gaps in pediatric ear and hearing care for children ages 0-14 years with hearing loss and ear disorders. The national program provides early screening, diagnosis and intervention services. The HLS Program increases accessibility for rural populations by delivering the necessary technology, including hearing aid fittings, surgical capabilities and aftercare rehabilitation, at all levels of the health care continuum.

By equipping primary health centers with the technology to treat ear and hearing disorders, these services become decentralized and more accessible to rural communities. 

HLS Program Goals:

• Early detection and intervention: Establish hearing screening in schools across all 20 districts to secure early identification and referrals for children with ear and hearing disorders. 
• Integrated treatment and rehabilitation: Strengthen referral systems and service delivery to provide a wide variety of treatments, including hearing aid fittings, cochlear implants, surgeries and auditory-verbal therapy. 
• Capacity building and workforce development: Train local health workers to deliver quality hearing care in Bhutan, including audiologists, ENT technicians and school health coordinators.
• Infrastructure and technology strengthening: Establish earmold labs and digital referral systems and integrate hearing screening into health and education programs. 
• Community engagement and policy integration: Promote information on pediatric hearing loss and health care to communities and encourage people to advocate for more representation in national public health and education systems. 

Program Results

By June 2025, the program had screened more than 104,746 children and identified ear and hearing conditions in 14,003 children (13% of those screened). By strengthening referral pathways and continuum-of-care camps, 32% of the children identified with ear and hearing conditions were registered for treatment. About 87% of those registered received care, including 81 hearing aid fittings and 73 surgeries.

Furthermore, the HLS Program established the first earmold lab in the country at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), revolutionizing hearing care in Bhutan. Earmold impression and hearing aid services for children are now available at the JDWNRH through the earmold lab.

Conclusion

Bhutan is making significant strides to upgrade its pediatric hearing care system across all levels of care through the HLS Program. The program ensures the sustainability of ongoing prevention and treatment for hearing loss and ear disorders in children by establishing the country’s first earmold lab. It also builds capacity through training and by empowering health workers, schools and communities across Bhutan.

With a strong focus on early detection and intervention, the program improves treatment for the estimated 60% of pediatric hearing loss that is preventable with timely intervention.

– Sarah Merrill

Sarah is based in Matthews, NC, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr