Early hearing detection could help close the learning gap before it opens

A baby can be born healthy, cry strongly, feed well and go home within hours and still leave the health system with a serious condition no one has checked for.

Infant hearing loss is invisible in the first months of life, but its effects are not. When it is identified late, the consequences show up later in delayed language, school-readiness gaps, family stress and avoidable inequalities. Left unaddressed, hearing loss affects speech, language, cognitive and social development, and can lead to poorer educational outcomes and future job opportunities, often with lifelong disadvantage.

But the opposite is also true. When hearing loss is identified early and children are linked to the right interventions — including hearing aids, cochlear implants and family centred support services — many can develop language and learning outcomes in line with their hearing peers. The World Health Organisation (WHO) has been clear on this, and it is one of the reasons early identification is such a priority in child hearing care.

That is why early hearing detection and intervention matters. It is not a niche audiology service for a small group of children. It is a population-wide early childhood intervention.

This year’s World Hearing Day theme, “From communities to classrooms: hearing care for all children”, is a timely reminder that children’s hearing care cannot start only when they arrive at school. The WHO has made two priorities explicit: preventing avoidable childhood hearing loss and ensuring early identification and care for children with ear and hearing problems.

In SA, we should be honest: we do not need more proof that newborn hearing screening works. We need implementation.

About 6,000 infants are born with hearing loss in SA each year – that’s about 17 babies a day. Yet fewer than 10% of newborns receive a hearing screen. That means most babies who need early support are simply not found.

A gap across the full care pathway

This is not only a screening gap. It is a gap across the full care pathway, from screening through diagnosis to early support. International best practice is clear, with the 1-3-6 benchmarks: screening by 1 month, diagnosis by 3 months, and intervention by 6 months. In our South African research, we and others have reported average diagnosis ages beyond two years of age, and not uncommonly only at school entry – long after the period when early support can make the greatest difference for speech, language and learning.

Screening is the doorway, not the destination.

This is where SA’s response still breaks down: not only in screening coverage, but in the pathway from screening to diagnosis to support. Even when screening happens, it is often not integrated into a functioning early hearing detection and intervention system. Babies may be screened but not followed up. Families may be told to return, but not given clear counselling, reminders or a reliable referral route. Children are then lost between screening, diagnosis and treatment — and the opportunity for early intervention is missed.

A recent WHO status report on ear and hearing care in Africa reaches the same conclusion: SA does not lack evidence, tools or pilot experience. What is still missing is implementation at scale – making screening, follow-up and early support part of routine maternal and child healthcare, not isolated projects.

SA has already shown what workable models can look like.

In our local programmes, we have shown that community-linked hearing screening can work when it is built around touchpoints families already use, including immunisation clinics and midwife obstetric units. We have also learned a crucial operational lesson: programme design matters. When already overburdened clinic staff are expected to add hearing screening to a full workload, coverage suffers. When services are built around dedicated screening personnel, simple supervision and clear follow-up systems, uptake and continuity improve.

That is the lesson we should scale: not another one-off pilot, but a service model designed for how families actually move through maternal and child healthcare.

At the University of Pretoria’s WHO Collaborating Centre for the Prevention of Deafness and Hearing Loss, we see both sides of this challenge clearly: the consequences and lifelong costs of delayed identification, and the enormous opportunity that early detection and intervention create for children and their families.

So, what should happen next if World Hearing Day is to mean more than another awareness campaign?

First, newborn hearing screening and the follow-up pathway must be built into routine maternal and newborn care as a standard service, not an optional extra.

Whether this is driven through national policy, provincial implementation plans or medical scheme requirements, the principle should be clear: every baby must have a defined hearing screening pathway. The National Health Insurance Act provides an opportunity for sustainable and scalable public-private partnerships that enhance capacity of existing service delivery systems, making integrated universal newborn hearing screening achievable.

Second, SA should scale hearing screening and follow-up through the service points families already use.

Realistic

That includes midwife obstetric units, primary-care clinics, immunisation visits and community health outreach. Hospital-only models will continue to miss too many babies. Community-linked models are often the most realistic and equitable way to close the gap.

Third, we need dedicated screening personnel and simple supervision systems.

Task-sharing can work, but only when it is properly structured. Existing nurses and clinic staff are already carrying heavy workloads. Trained screeners and community health workers can support screening and follow-up, while audiologists oversee quality and referral pathways. Digital tools make this easier to do at scale: user-friendly screening apps, SMS or WhatsApp reminders, and simple data systems can help services reach more families and keep children connected to care.

Fourth, communication and follow-up must be treated as core clinical tasks.

A “refer” result is not self-explanatory. Families need clear counselling in their preferred language: what the result means, why follow-up matters, where to go next, and when. In practice, families are often trying to recover after birth, arrange transport, and return to care while juggling work and other children. Reminder systems – SMS, WhatsApp or call-back protocols – should be standard practice, not an afterthought.

Fifth, programmes must measure what matters.

Counting the number of babies screened is not enough. We should track coverage, referral rates, follow-up return rates, age at diagnosis and time to intervention. Those indicators tell us whether a programme is reaching children in time, not just recording numbers.

Finally, newborn hearing screening and follow-up must be treated as a shared national responsibility.

Audiologists cannot carry this alone. Maternity services, paediatrics, primary healthcare, provincial health managers, medical schemes, NGOs and caregiver organisations all have a role. The strongest programmes are built when everyone agrees on the pathway, protects it, and is accountable for keeping children moving through it.

Gaining national traction

The Hold My Hand and Change Ideas “Every Child Heard” policy brief is an important sign that this agenda is gaining national traction. Through the Hold My Hand Accelerator for Children and Teens, a partnership linked to the Presidency and DG Murray Trust, early hearing screening and referral is already being framed as a priority for young children. The next step is the one that matters most: converting that recognition into funded, accountable implementation across the maternal and child health system.

The public usually hears about hearing loss later: when a child is struggling at school, when speech is delayed, when families are already years into uncertainty. By then, the question is obvious: Why was this not picked up earlier?

In too many cases, the answer is simple and uncomfortable: because we still have not made early hearing detection part of routine care for most South African babies.

No child should wait years for a condition that can be identified within hours after birth. No caregiver should leave a facility without knowing whether their baby’s hearing was checked – and what to do next if there is a concern. If we are serious about giving children a fair start, early hearing detection and intervention must move from the margins to the centre of maternal and child health. DM

Professor De Wet Swanepoel is Professor of Audiology at the University of Pretoria, a WHO Collaborating Centre for the Prevention of Deafness and Hearing Loss. He also serves as Editor-in-Chief of the International Journal of Audiology.