2. INTRODUCTION
Hearing loss is the most common sensory deficit in humans today and is the second leading
cause for ‘Years Lived with Disability (YLD)’ , the first being depression.
As per WHO estimate, in India there are approximately 63 million people who are suffering from
significant auditory impairment.
There are 291 persons per 1 lakh population who are suffering from severe hearing loss.
Noise is the insidious of all industrial pollutants involving every industry and causing severe hearing
loss in every country in the world.
3. Reasons
Occupational hearing loss includes acoustic , traumatic
injury and noise induced hearing loss.
Noise induced hearing loss is the second most common
acquired hearing loss after age related loss.
50% of causes of hearing impairment are preventable and
can be corrected surgically and can be rehabilitated with
the use of hearing aids , speech and hearing therapy.
4. CAUSES OF HEARING LOSS
Aging process
Occupational hazards (those who are working in noisy areas )
Wax in the ear
Chronic ear infection
Diseases of tympanum
A hole in tympanic membrane
Growths and masses in the ear & bones
cancer like diseases
5. Types of Deafness
Conductive deafness :
Due to defect in the conducting mechanism of the ear namely external and
middle ear.
Sensori-neural deafness / Perceptive deafness :
Due to lesions in the labyrinth, 8th nerve & central connections.
It includes psychogenic deafness.
Mixed deafness :
Both the above mentioned types are present.
6. NPPCD
The Program was initiated in 2007 on pilot mode in 25 districts of 11 State/UTs.
In first phase manner , the program was extended to 203 districts of 20
State/UTs by 2012.
In 12th five year plan, its proposed to expand the program to additional 200
districts in a phased manner probably covering all the states and union
territories by 2017.
7. OBJECTIVES LONGTERM
• To reduce the total disease burden by 25% by the end of 11th five year plan.
• IMMEDIATE
• Early identification, diagnosis and treatment of ear problems responsible for
hearing loss and deafness.
• To prevent the avoidable hearing loss on account of the disease/injury.
8. To medically rehabilitate persons of all age groups
suffering with deafness.
To strengthen the existing intersectoral linkage for
continuity of the rehabilitation program.
To develop institutional capacity for ear care services by
providing support for equipment, material and training
personnel.
9. STRATEGIES
To strengthen the service delivery including rehabilitation.
To develop human resources for ear care
To promote out reach activities and public awareness
through innovative and effective IEC strategies with special
emphasis on prevention of deafness.
10. ORGANISATIONAL STRUCTURE
Health Minister
Additional Secretary
Joint Secretary
Central Coordination Committee
Secretary Health & Family Welfare
Additional Director General Director General of Health Services
Deputy Director General Director (Public Health) Under Secretary(Public Health)
Program Manager
Chief Medical Officer
11. COMPONENTS OF THE PROGRAM
1. Training of all the manpower
2. 2) Infrastructure Building
3. 3) Service provision 4) IEC activities
12. CENTRAL LEVEL
Central Coordination Committee will be constituted at the central level.
This will consist of following members :
1.Representative of DGHS - 2
2.Representative of WHO - 1
3.ENT specialists and experts - 2
4.Audiologists and speech therapists – 2
5. Public Health expert - 1
6.Representative of Rehabilitation Council of India (RCI) - 1
13. • This Committee will evaluate and monitor the implementation plan
for program .
• Central Cell will be set up at the central level in the DGHS to provide
necessary leadership, technical support to the State and District
level functionaries.
14. STATE LEVEL
State Health Society and Program Committee is placed under NRHM
It will function for …. –
Preparation of district plans for implementation of NPPCD ,
Monitoring and supervise implementation of program ,
- Release and Monitoring of flow of funds to the District Health
Societies.
15. State Technical Committee will have
State Nodal Officer ;
ENT Specialist / Surgeon Audiologist - 1 to provide
technical guidance and expertise to the State Health
Society
16. DISTRICT LEVEL
At the district level ,the District
Health Society and Program
Committee will function for ….
Planning and Implementation of
the program ,
Financial and material
management ,
Social mobilization and public
awareness ,
Orientation of various
functionaries of health ,
Arrangement for Screening camps
and monitoring the activities for
NGOs
17. District Hospital will post …
District Nodal Officer ;
ENT Surgeon - 1
Audiologist - 1 and
they will be the key persons for the implementation of the program in the
district.
They can also employ additional staff:
Teacher for young hearing impaired – on contractual basis, to look after the
therapy and training of young hearing impaired children at district level.
18. PROGRAM IMPLEMENTATION
Center of Excellence
The State Medical College
which supports the program
Main Focus of Activity of the Program
The District Hospital
The program will be strengthened through training of … - ENT doctors -
Audiologist
They would be provided with equipment for proper diagnostic, therapeutic, &
rehabilitation activities.
19. The doctors at PHC & CHC will also be given training as well as the basic
diagnostic equipment to enable them to diagnose, treat & refer the
patients requiring treatment.
The Multipurpose workers at the sub central level and the gross level
functionaries (AWWs, ASHA), including Mahila Mandals will be
sensitized about the program which would facilitate in creating
awareness and mobilizing the communities.
The School Health system will play a very important role in the
program. The ear check up will be done by the PHC or CHC doctors
20. SCREENING TESTS
1) Audiometry BERA ( Brainstem
Evoked Response Audiometry) –
Simple Automated Reliable But COST is
prohibiting
factor to make it
available in all
the places
21. Behavioral Observation Audiometry (BOA)
Assess the baby’s response to different frequency intensity and
duration of sounds presented
Respond to 70db noise :-
i) a new born baby – eye blink , eye widening or startle
ii) between age of 6 – 16 weeks – arousal , eye blink or eye shift can
be useful to detect to indicate hearing impairment in early life
22. ACHIEVEMENTS
Modules of training of doctors
multipurpose workers and technicians have been developed.
In some places such as Delhi, training of trainers has been started.
In many districts, hearing aids are distributed to poor children.
This program is integrated with the NRHM framework.
23. COMMENTS
Once again loading the information about deafness and burden of detection
and mobilization of deafness on ASHA and AWWs indicates poor planning.
These part time workers cannot be the pillars of the health who are neither
the permanent health staff nor skilled enough to handle.
24. Once again a series of training program will start for all
levels of health professionals without identifying the
impact factors of previous trainings on other subjects
In 12th Five Year Plan not much emphasis is given on
this program.
Similarly in NRHM, it is low priority.
