title: Survey of ENT services in Africa: need for a comprehensive intervention.
abstract: BACKGROUND
  Burden of disease (BOD) is greatest in resource-starved regions such as Africa. Even though hearing disability ranks third on the list of non-fatal disabling conditions in low- and middle-income countries, ear, nose, and throat (ENT) disorders are not specifically coded for within the framework governing global BOD estimates, and in discussions about health challenges, non-communicable diseases receive scant attention. Implementing cost-effective interventions to address conditions largely neglected by global estimates of BOD such as hearing loss are important contributors to health and economic development.
  
  
  OBJECTIVE
  Establish a database of ENT, audiology, and speech therapy services in Sub-Saharan Africa; create awareness about the status of these services; propose effective intervention; gather data to lobby African governments, donor countries, and aid organizations; determine need for Developing World Forum for ENT, Audiology, and Speech Therapy services.
  
  
  METHODS
  Survey of ENT, audiology, and speech therapy services and training in 18 Sub-Saharan Africa countries.
  
  
  RESULTS
  There is an alarming paucity of services and training opportunities, and there is a large gap between higher technology, expensive health care in high-income countries and lower technology, low-cost practice in low-income countries.
  
  
  CONCLUSIONS
  Lower technology and lower cost Developing World medical practice should be recognized and fostered as a field of medical practice, teaching, and research. Developing World centers of excellence must be fostered to take a lead in teaching, training, and research. A Developing World Forum for ENT Surgery, Audiology, and Speech Therapy, directed and driven by Africa and the Developing World, supported by the First World, should be established, to develop a comprehensive intervention to turn around the severe shortage of services and expertise in the Developing World. Global health policies and practices should include new norms and standards which serve the interests of the global community, and are based on current realities of global health.
authors.affiliation: Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Johan J
authors.initials: JJ
authors.lastname: Fagan
authors.forename: Marian
authors.initials: M
authors.lastname: Jacobs