Disparities in access to ear and hearing care in Cambodia: a mixed methods study on patient experiences

Abstract

Objective Chronic suppurative otitis media is a major global disease disproportionately affecting low- and middle-income countries, but few studies have explored access to care for those with ear and hearing disorders. Method In a tertiary hospital in Cambodia providing specialist ear services, a mixed method study was undertaken. This study had three arms: (1) quantitative analysis of patients undergoing ear surgery, (2) a questionnaire survey and (3) semi-structured in-depth interviews. Results Patients presented with advanced middle-ear disease and associated hearing loss at rates that are amongst the highest per capita levels globally. Patients reported several structural, financial and socio-cultural barriers to treatment. This study showed a significant burden of ear disease in Cambodia, which reflects a delay in receiving timely and effective treatment. Conclusion This study highlights the opportunity to integrate effective ear and hearing care into primary care service provision, strengthening the package of activities delivered at government facilities.

Access to ear and hearing care services in Cambodia: a qualitative enquiry into experiences of key informants

“…Stakeholders described a counterproductive inter-professional culture that points to a fragmented, unco-ordinated and highly variable delivery of ear and hearing care services. These findings substantiate and extend our previous study on patient experiences at a non-governmental organisation tertiary hospital in Phnom Penh, 4 where patients endured chronic symptoms for an average of 13–14 years before reaching formal care. Ineffective referral networks hinder access to treatment and contribute to high morbidity of ear disease; however, fostering interdisciplinary relationships across institutional boundaries can build the trust required for co-ordinated service planning and development.…”

“… 54 The Cambodian health system is strategically well placed to consider formal pathways to bring ear and hearing care under the national healthcare policy and strengthen the capacity of healthcare facilities and hospitals to better cater to the country's hearing healthcare needs. 3 , 4 Patients would benefit from the social health protection mechanisms already in place without reallocating funding arrangements.…”

“…In Cambodia, access to ear and hearing care is available through the public, private and non-governmental organisation sectors, but it is limited by the significant shortage of providers, location of facilities, paucity of equipment and resources, and a lack of policy implementation for hearing-related disability and rehabilitation. 4 In the public sector, there are nine hospitals with ENT departments across the country, with five situated in the capital. In the private sector, two major private hospitals have ENT departments, a few polyclinics have visiting ENT specialists, and to our knowledge, there are only two private hearing aid providers.…”