Global Audiology/Africa/Mozambique

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General Information

Mozambique, officially the Republic of Mozambique, is a country located in Southeast Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west, and Eswatini and South Africa to the south and southwest. The sovereign state is separated from the Comoros, Mayotte, and Madagascar through the Mozambique Channel to the east. Portuguese is the official and most widely spoken language of the nation, spoken by 50.3% of the population. The Bantu languages that are indigenous to the country vary greatly in their regions.

History of Audiology

Before 1997: ear and hearing service delivery was virtually non-existent. Limited otolaryngologic services were localised in the capital of Maputo without audiological services. Efforts to address local hearing loss was dependent on inconsistent foreign aid. Social action workers would be directed by word of mouth to children in the community who exhibited hearing difficulties, whereupon a battery of various noise makers (i.e. keys jangling, pots banging, etc) were utilized to identify and refer candidates to attend the provincial classroom (Maxixe Primary School) that was equipped with a teacher trained in Mozambique and Portuguese sign language.

1997: Initiated and led by Dr. Jackie Clark, the University of Texas at Dallas and partners established a philanthropic program (Mozambique Audiology Program-MAP) at Chicuque Rural Hospital to introduce audiology services and identify auditory disorders in the country. Initially 10 local Medical Technicals, employed at the Chicuque Rural Training Hospital and trained to diagnose and treat basic medical disorders, task shared basic ear and hearing roles including ear care, fit hearing aids, and conducting screenings in the Inhambane Province 1998-2008: MAP continued to provide services in and around the Inhambane Province. The group from UT Dallas traveled annually to the rural areas of Chicuque and Maxixe, Mozambique training more technicians, providing equipment and resources, and aiding in the screening, testing, and treatment of deaf individuals in the population. While successful in improving access to ear and hearing services in rural areas, the program sustainability was challenged by funding, which was mainly from private fundraising of the humanitarian audiologist, and political roadblocks.

2008-Present: Through MAP the audiology technician workforce was trained but lacked sustainable funding and infrastructure. In 2008 the Minister of Health made the decision that foreign medical teams would no longer be able to provide professional service within the country. Following this policy change philanthropic audiology programs were following a change in policy within the ministry of health training of ear and hearing providers shifted from MAP to a process by which individuals were selected for specialized formal training abroad like in Nairobi, Kenya to return as audiologists, aiming to build a national workforce.

Present: Despite the development of service brought about by these initiatives, specialized audiology services remain limited and primarily available in urban areas, with significant barriers to access in rural areas.

Deaf education: In 1998 formal education for Deaf children was initiated by the government. However, in only 5 years later in 2004, Mozambique made the decision to mainstream hearing impaired children into the public school system. Manual communication is only offered until the fourth or fifth grade and one must have competency in oral and written Portuguese to pass to middle school. This limits the educational opportunity for the Deaf and hard of hearing. There is no exclusive school for deaf education in Mozambique.

Incidence and Prevalence of Hearing Loss

There is limited information available, which makes understanding the incidence of hearing loss in Mozambique challenging. However, two studies present results on the prevalence of hearing loss and otologic disorder in primary school children. Results of a study in the capital city of Maputo, Mozambique were presented in 1995 at a workshop in Nairobi, Kenya hosted by the WHO Regional Office for Africa. The study evaluated 1000 primary school aged children (5–16 years old). 18.6% presented with otitis media, and a total of 5% of the children exhibited otitis media and hearing impairment. The report did not state the type of hearing loss observed, how data was collected, or the cut-off values used for normal hearing. In 1998, a two-year study by MAP of over 2,600 students (aged 3–18) in Inhambane Province, hundreds of miles north of the capital city Maputo, found a 5% prevalence of hearing loss, often due to preventable infections and ear canal obstructions.

An otoscopic survey conducted in 2004 on 1518 primary school student's ears (ages 8–14 years) indicated at least 39% of the ears viewed had significant occlusion, and as a consequence appropriate preparation for the subsequent large scale hearing screening could be made with cerumen management and medical referrals plans.

Information About Audiology

Professionals providing hearing care services

• Social Action workers (community health workers): trained to perform community hearing screenings and refer to the medical technicals.
• Medical Technicians: primary ear and hearing professional trained to provide screening and basic diagnostic and treatment for hearing disorders to include: including identification and treatment of ear and hearing disorders, fitting hearing aids, creating ear molds, distributing hearing aid batteries, and troubleshooting and/or replacing hearing aids.
• Audiologist: Focus on early identification and addressing environmental and infectious causes of hearing loss. They conduct hearing screenings, especially for school age children, diagnostic testing, and managing of otitis media.
• Otolaryngologist: there is a significant shortage of ENT specialists in Mozambique, concentrated mostly in urban tertiary centers around Maputo, with a high reliance on task-shifting to primary health workers.

Audiological services

A MAP initiated free hearing clinic serves as the location for large scale community hearing screenings, diagnostic audiometric evaluation, hearing aid dispensing, and/or medical referral as needed. In and around the urban capital, ENT services are available and growing. Rurally, the limited number of ENT specialists has led to the training and equipping of primary healthcare workers with basic ENT skills to manage common occurrences of chronic ear disease. This effort to address middle ear infection in Gorongosa is being led in partnership with the University of Pittsburgh's Department of Otolaryngology-Head and Neck Surgery and the Department and the Eye & Ear Foundation. In addition to training they also provided equipment to help with identification.

Services offered by Otolaryngologists

Common procedures including tonsillectomy, adenoidectomy, pressure equalization tube placement (myringotomy), sinus surgery, and tumor removal are limited but more commonly available where as more advanced diagnostics and surgical treatments of ear disease are limited to higher cost private facilities such as Sunshine Hospital in Maputo. It offers tertiary care center that offers ENT services such as otology and neurotology. They house a multidisciplinary team of ENTs, audiologist, SLPs, and oncologist.

Laws related to hearing care services Examples of laws and policies related to hearing care are listed below. As a caveat, it is necessary to acknowledge that they can be undermined by poor enforcement, limited resources, and limited dissemination, particularly in rural areas.

• Patient Protection

Audiology services are included in the general medical laws overseen by the Ministry of Health (MISAU) which mandate confidentiality, informed consent, and protection from discrimination.

• Disability Rights

The Convention on the Rights of Persons with Disabilities obligates the government to ensure access to rehabilitation, healthcare, and assistive technologies like hearing aids.

• Education

Law No. 6/92 mandates that children with disabilities (including hearing impairments) are educated with provisions for specialized or integrated education.

• Occupational health and safety regulations

Obligates employers to provide hearing protection means to workers, particularly in industries with high noise exposure.

• Import and Regulation of Hearing Devices

Imported medical devices, including hearing aids, are subject to mandatory conformity assessment programs under INNOQ, IP (National Institute for Standardization and Quality), ensuring they meet quality technical standards for safety and health.

Scope of Practice and Licensing

Education of professionals working in hearing care services

The MAP program trained technicians from 1998-2008 in ear anatomy and physiology, evaluations efficacy, hearing and immittance screenings, diagnostic audiology with immittance measures, and evaluating the electroacoustic status of hearing aids for fittings. Currently, TECH Universidad offers a 6-week, online postgraduate certificate tailored for professionals in Mozambique. Similarly, Swiss International Hearing Academy (SIHA) provides a 9-month blended learning program (online and practical workshops) to train hearing professionals. Locally academic training in Speech Therapy and Audiology is available through the Instituto Superior de Ciências da Saúde (ISCISA) in Maputo.

Becoming an otolaryngologist in Mozambique requires a seven-year medical degree (licenciatura) from the University Eduardo Mondlane (UEM) in Maputo or the Catholic University of Mozambique (UCM) in Beira. Following general medical practice, postgraduate specialization is required, which often involves training abroad or through specialized international partnerships due to limited local specialty programs. The University of Cape Town (UCT) fellowship (South Africa) trains medical fellows from the Southern African region in otolaryngology. Partnerships with the MD Anderson Cancer Center and the University of Pittsburgh have been developed in Mozambique to train local ENT specialists in Head and Neck Oncology.

Professional and Regulatory Bodies

The African Otological Society was started by Dr. Greg Basura in 2023, the African Otological Society is an online society aimed at building otology and audiology capacity in Africa. Each month there is a presentation on a different featured country. They are also working to create otology and audiology resource-centric clinical practice guidelines to optimize care in low resourced areas. They maintain a relationship with the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), where University of Pittsburgh otolaryngology faculty regularly present at the annual meeting and are involved with committee work.

The Humanitarian Efforts Committee (HEC) engages at the national level and coordinates subcommittees, including the scholarly output committee, the communications subcommittee, and the education subcommittee. The HEC also oversees the international Visiting Scholars program, providing residents with financial support through grants/awards to engage in a global outreach experience. All the HEC work and awards to the IVS and Humanitarian Awards are showcased at the annual Humanitarian Efforts Forum at the AAO. Scope of Practice and Licensing Mozambique collaborates with neighboring countries (Malawi, Zimbabwe, Zambia) and regional bodies like the African Head and Neck Society (AfHNS) to standardize clinical practice guidelines for resource-limited settings. ENTs must register as a licensed medical practitioner to work in the Mozambican public health system.

Ongoing audiology research

The scope of audiological research in Mozambique is quite limited and very specific. Most of it comes from a few programs and focuses on public health–style hearing screening rather than advanced clinical research.

Challenges, Opportunities and Notes

Significant gaps exist in infrastructure for hearing services, training, and long-term sustainability, presenting opportunities for further research and development.

Audiology Charities

● Pacific Hearing Service: Conducts humanitarian trips to Mozambique providing hearing devices and training for caregivers of deaf and heard of hearing individuals.

● Hearing the Call: Partners with local organizations to provide free hearing care services and hearing aids in Mozambique.

● Mozambique Audiology Program (MAP): A philanthropic effort launched in 1997 and concluded in 2008 was dedicated to establishing sustainable audiology services and conducting mass hearing screenings, such as those in Chicuque and Maxixe.

● Entheos Audiology Cooperative: Involved in international hearing mission trips.

References

External Links

• Pacific Hearing Service
• Hearing the Call
• Entheos Audiology Cooperative
• https://www.entandaudiologynews.com/features/audiology-features/post/differing-outcomes-of-three-sub-saharan-africa-journeys-with-the-common-goal-of-task-sharing-in-audiology
• https://www.otolaryngology.pitt.edu/outreach/global-outreach

		Contributor to the original text
Madison Saunders