Tech Transfer: What should a hearing aid/device be in Low and

Middle Income Countries Katherine D. Seelman, Ph.D.

Associate Dean and Professor Rehabilitation Science and Technology

University of Pittsburgh, USA

Ad Hoc Consultation on hearing device technology transfer to LMI Countries

Geneva, Switzerland 12.March 2013

World Health Organization

3/18/2013 1

We have hearing loss? What do we need? Ask us.

3/18/2013 2

What gives our lives meaning : A function of need and hearing loss

– Whom, what and where? We really want to communicate.

• Language development for my child

• Inclusion in social life with my family and community

• Learning and inclusion in school

• Get a job and communicate at work

• Maintain good health

3/18/2013 3

3/18/2013 4

What do end users need? Technology and services and public

education about hearing loss

Awareness

Training

Provision Evaluation

Identification & Assessment

Support for users

WHO http://whqlibdoc.who.int/publications/2004/9241592435_eng.pdf

Train us; train local community workers who will train health workers, teachers and teach the public

Hearing-related

• Advocacy skills

• Making and repairing aids

• Create a primary care health service with includes hearing care

• Causes and prevention • Learn to communicate with

people with hearing loss

• Audiologist trains local audio tech workers (train the trainer)

Hearing • Learn about hearing and

use of hearing aids – Identifying,

– Treating & managing disease and injury

– Conducting hearing tests

– Delivering hearing equipment

– Providing support, repair, maintenance

3/18/2013 5

http://www.aifo.it/english/research/reports/Rehab_Needs_article_DCID_april2011.pdf http://www.audiologyonline.com/interviews/interview-with-jackie-clark-ph-1517

3/18/2013 6

What we need: Affordability for end users; which technology?

• Procure high quality, low cost hearing aids, batteries and services for us • Choose aids that meet international technical performance

and best practice service criteria

• Leapfrog the grid with rechargeable batteries and chargeable and/or plug-in rechargers or use zinc batteries .

• Distribute product and deliver services near point of care. – Community-based rehabilitation—in the community

– Health services units

– Schools

– At home

3/18/2013 7

What we need: Availability for end users; which technology?

• Distribute product and deliver services near where we live, learn and work--point of care. – Community-based

rehabilitation—in the community

– Health services units

– At home

Audio technician with audio kit

Why do we adopt a hearing aid? Adoption and acceptance factors for end users. Which hearing

technology? • Technical features

– Hearing technology that helps to restore meaning to my life • High quality sound (tech. specs)

• Listening utility (sounds, gatherings, worship, phone)

• Simple to use

• No whistling/feedback, a volume control

• Durable and reliable

• Sustainable—repairs, maintenance, replacement

• Warranties

3/18/2013 8

Why do we adopt a hearing aid? Adoption and acceptance factors for end users. Which

technology?

– Psychosocial factors • I am a parent yearning to communicate with my child; to

help him develop language and learn in school. • My government and my culture may support my use of a

hearing aid but sometime they do not. – Some people believe that hearing loss is caused by

bewitchment.

– Others believe that home remedies are an effective cure for earache or ear infection.

• Public attitudes sometime assume that I am dumb. – People with hearing loss are unable to live independently and

contribute to the running of the household

• I feel ashamed when I am teased and bullied because I cannot hear or I wear a hearing aid.

3/18/2013 9

But tech transfer is not only about individuals

• Organizational structures and relationships with the purpose of coordinating and steering availability, affordability and adoption

• Facilitators, barriers and actors involved in the organization framework.

• Mapping activities that produce access for the end user.

3/18/2013 10

WHO. Health Tech Assessment http://whqlibdoc.who.int/publications /2011/9789241501361_eng.pdf

3/18/2013 11

A model of technology transfer adapted to medical devices

Original: Frost & Reich (2008). Access: How do good Health technologies get to poor people and poor countries? Harvard U. Press

3/18/2013 12

• Innovation

• Hearing environments

New technology: amplification apps

on cell phones, iPod-style body-worn hearing aid

New industry configurations: Apple, Omron,

Intricon, CEA, consumer electronics, ICT,

telecom

New Delivery systems:

Telerehabilitation and

teleaudiology; on-line hearing

tests

3/18/2013 13

Values (Development

model, concern for equity & equality; end user participation, safety,

effectiveness)

Measures Product example Value chain example (Manufacture,

purchase and procure, distribute, deliver service, use, evaluate)

Affordable (social investing, appropriate donation solicitation and provision innovation)

Under US$100 Market New industries, companies and products enter market

Solar hearing aid, battery, re-charger Mobile hearing mold kit Instant custom ear mold

Manufacture & design: materials R&D, no patent, made by people with disabilities Procurement: NGO market buys in bulk Distribution: Directly to project location Delivery: Point of care

Available (Re-mapping value chain of manufacturing, purchase, distribution, delivery, use)

HA brands Rechargeable battery brands HA Mold delivery systems, trainees, employment

Ear Molds DIY ( Do It Yourself ); Mobile hearing tech Kit

People with disabilities assemble, sell and distribute. Local service delivery: Itinerant trained workers Direct delivery to end user

Adoptable (Quality of life; incentives for provider incentives; evidence-based)

Feasibility study (end users and providers) acceptance & use studies

WHO research, AIFO research, INAHTA research

NGO and international organizations; adopt; government adoption; provider adoption; end user adoption.

Sustainable (local capacity building, increased ADLs, learning, working )

Economic, education, employment and participation measures

World Wide Hearing (WWHI)

CBR model: Build local skill capacity assembling, service delivery and repair, maintenance, replacement; evaluation

Toward a roadmap