# A narrative review on cost considerations in early intervention for deaf and/or hard-of-hearing children in Africa

## TL;DR

This review explores how costs affect early intervention services for deaf and hard-of-hearing children in Africa, highlighting barriers and solutions for better access.

## Contribution

The paper synthesizes 26 studies to identify cost-related barriers and systemic solutions for early intervention services in African contexts.

## Key findings

- High out-of-pocket expenses and inadequate public funding limit access to early intervention services for DHH children in Africa.
- Integrated cost data and system-level enablers like task-shifting and community-based delivery can improve access and sustainability.
- Structural cost drivers, such as fragmented systems, require policy reforms and regional collaboration to ensure equitable EI services.

## Abstract

Early intervention (EI) is essential for the language, social, and educational development of deaf and/or hard-of-hearing (DHH) children. In African countries, however, the implementation of EI remains significantly constrained by cost considerations and systemic service gaps. This narrative review synthesizes findings from 26 peer-reviewed publications to explore how cost influences access to and sustainability of EI services in Africa. Seven interrelated themes were identified: (i) high out-of-pocket expenses that limit family access to services; (ii) inadequate public funding and heavy reliance on private or donor sources; (iii) cost-effectiveness of early screening and intervention when delivered at scale; (iv) lack of integrated cost data in national health planning; (v) inequitable access to hearing technologies due to procurement and pricing challenges; (vi) opportunities for system-level enablers such as intersectoral collaboration, task-shifting, and community-based delivery; and (vii) structural cost drivers unique to African contexts, including fragmented systems and infrastructure disparities. The findings highlight the need to embed economic evidence into policy planning, establish pooled procurement and subsidy schemes to reduce device costs, and integrate EI services into national insurance and essential health benefit packages. Culturally responsive, community-delivered models, supported by sustainable public financing and regional collaboration, are critical to ensure equity and long-term impact. Addressing these cost-related barriers through coordinated policy and system reforms will be key to achieving universal, inclusive, and sustainable EI services for DHH children in Africa.