
 establish a database of ent , audiology , and speech therapy services in sub - saharan africa.create an awareness in the first world about the status of these services.plan and promote effective , targeted support for these services.gather data to lobby african governments , donor countries , and aid organizations.determine the need for a developing world forum for ent surgery , audiology , and speech therapy . 
 
establish a database of ent , audiology , and speech therapy services in sub - saharan africa .
plan and promote effective , targeted support for these services . gather data to lobby african governments , donor countries , and aid organizations . determine the need for a developing world forum for ent surgery , audiology , and speech therapy .

 establish a database of ent , audiology , and speech therapy services in sub - saharan africa.create an awareness in the first world about the status of these services.plan and promote effective , targeted support for these services.gather data to lobby african governments , donor countries , and aid organizations.determine the need for a developing world forum for ent surgery , audiology , and speech therapy . 
 
establish a database of ent , audiology , and speech therapy services in sub - saharan africa .
plan and promote effective , targeted support for these services . gather data to lobby african governments , donor countries , and aid organizations . determine the need for a developing world forum for ent surgery , audiology , and speech therapy .
a questionnaire was distributed by email to an ad hoc group of ent surgeons and audiologists in sub - saharan african countries in which there were known to be ent services .
participants were traced through personal contacts and the pan african federation of oto - rhino - laryngological societies ( pafos ) database , and proved to be challenging or impossible in some countries .
questions were asked about the availability of ent , audiology , and speech therapy services and equipment ( nil / poor / good / excellent ) , about training programs for ent surgeons , audiologists , and speech therapists , about the availability of services in rural areas , and about their opinions about how to improve the situation .
the number of ent surgeons , audiologists , and speech therapists per country , and compares it to the uk .
the uk has the poorest ratio of ent surgeons to population in europe , and is intending to further improve this ratio to 1/75,000 ( 4 ) .
some african countries have no ent , audiology or speech therapy services at all . 
 
comparisons of ent surgeons , audiologists , and speech therapists/100 000 people , with the uk .
comparisons of ent surgeons , audiologists , and speech therapists/100,000 people , with the uk table 2 presents a summary of ent , audiology , and speech therapy training programs .
many countries have no training programs , especially for audiology and speech therapy . if one applies the current ratios of ent surgeons , audiologists , and speech therapists in the uk to the total population ( 521.7 m ) of the countries surveyed , then the shortage of personnel in these 18 countries is as follows : ent : 5,251496  =  4,755 ; audiology : 21,381525  =  20,856 ; speech therapy : 85,5251,182  =  84,343 . 
  in all the countries surveyed , the overwhelming majority of people depend on the state health services .
table 3  6 present summaries of the levels of clinical services in the state sector in the countries surveyed .
countries with access to ent services outside major cities table 4 highlights the poor access to simple , routine audiology , hearing aids and the most basic hearing restoration surgery such as ventilation tubes and tympanoplasties . 
 
countries with access to hearing - related services table 5 demonstrates that there is very poor access even for relatively low - cost oncologic surgery , and that laryngectomees are not offered the opportunity of post - laryngectomy voice restoration . 
 
countries with head and neck oncologic surgery table 6 presents the poor access that patients have to modern sinus and rhinologic surgery , and the reliance that is still placed on open as opposed to endoscopic sinus surgery . in some countries ,
countries with sinus and rhinologic surgery table 7 highlights the limitations to delivering a modern ent service due to a lack of equipment . 
 
in engaging for health ( 2006 ) , the world health organization released a plan for global health for the next decade , and proposed the following major policy thrusts ( 5):investing in health to reduce poverty.building individual and global health security.promoting universal coverage , gender equality , and health - related human rights.tracking the determinants of health.strengthening health systems and equitable access.harnessing knowledge , science , and technology.strengthening governance , leadership , and accountability.there has been an unprecedented global response in the past 10 years , with large increases in funding being directed at global health improvement .
recognition of the dire circumstances in africa has placed the subcontinent at the forefront of such efforts through initiatives around aids / hiv , malaria , and tuberculosis .
these efforts are however uncoordinated , and the disconnection between vast donor funding and lack of development of health systems is lamentable ( 6 ) , for in most cases , the financial aid targets particular diseases , such as hiv / aids and malaria ; interventions , such as arv programs or bed nets ; or a list of challenges which are unconnected to strengthening of health systems and indigenous institutions which have the potential for making a sustainable impact on health .
a further reality is that the design of several of these initiatives is dominated by the wealthy world , with limited input by those most affected , leading to programs which may not serve short- or , indeed , long - term health development needs .
efforts to address specific health challenges lie in the realm of innovative , targeted interventions , based on careful analysis of the problem , and designed by those who have practical experience of , and insight into , appropriate and effective solutions . investing in health to reduce poverty . building individual and global health security . promoting universal coverage , gender equality , and health - related human rights . tracking the determinants of health . strengthening health systems and equitable access . harnessing knowledge , science , and technology . strengthening governance , leadership , and accountability .
it is common knowledge that all the countries surveyed in this study have an enormous ent - related bod .
this audit presents a disturbing picture of under - resourced , understaffed , and outdated ent , audiology , and speech therapy services in africa . patients still die from simple ent infections and curable cancers , and do not have access to the most basic hearing tests or hearing rehabilitation .
the audit also highlights the lack of training facilities , critical to improving the shortage of qualified staff .
while we acknowledge the great importance of non - specialist ent , audiology and speech services provided by nurses and other medical personnel , it is only through the leadership , training , research , and specialized clinical services provided by a critical mass of resident , well - trained specialists in these fields , that these services will become self - sustaining and countries may one day become independent of foreign medical assistance .
what is clearly needed is a comprehensive , multipronged , multinational program to improve the quality of , and access to , ent , audiology , and speech therapy services in africa .
such a program has to be carefully planned to take into consideration political , infrastructural , and staffing realities , and will have to be planned jointly with local medical practitioners , academics , academic institutions , governments , and international donor and health organizations in order to be effective , cost - effective , and sustainable .
vorobiof and abratt reported that 21 african countries do not have radiation therapy facilities ( 7 ) .
hence , reliance in these countries has to be placed on a purely surgical approach to cancers of the head and neck .
our study also highlights the lack of modern equipment and reliance on outdated surgical techniques . for these reasons ,
ent surgeons in poorer countries are compelled to practice lower  technology , lower cost type surgery compared to their counterparts in the developed world .
this chiasm between high technology , high - cost medical practice in the first world versus lower technology , lower cost medical practice in the developing world , is rapidly increasing , and will continue to accelerate .
it is unlikely that the poor who live in the developing world will ever have ready access to new , high technology , high - cost medical advances .
with changing medical practice in the first world due to advances such as imaging , chemotherapy , irradiation , neuronavigation , robotics , minimally invasive surgery , interventional angiography , genetics , and pharmaceuticals etc , younger generations of first world medical practitioners have become unfamiliar with medical and surgical care appropriate to the developing world , even though it might have been the standard of care in the first world as recently as 10 years ago .
diseases such as leprosy , tuberculosis , hiv , malaria , rheumatic fever , complicated mastoiditis and sinusitis , etc .
are essentially diseases of the developing world and are rarely encountered in the first world .
consequently , medical practitioners in developing world countries can no longer turn to centers of excellence in the first world for guidance about sound , lower technology , lower cost healthcare .
it is therefore crucial that we acknowledge the existence of two tracks of medical practice i.e. a higher technology , higher cost first world medical practice versus a lower technology , lower cost developing world medical practice .
developing world medicine and surgery should be recognized and fostered as very important fields of clinical practice , teaching , and research that cater for > 50% of the world 's people .
centers of excellence in the developing world need to be fostered and need to take the lead in terms of teaching , training , and research in developing world medical practice . a developing world forum for ent surgery , audiology , and speech therapy , directed and driven by africa and the developing world , but supported by the first world ,
should be established , and should develop a comprehensive intervention to turn around the severe shortage of clinical services and expertise in africa and the developing world . a key element would be to establish and/or strengthen centers of clinical , teaching , and research excellence in the developing world . teaching institutions in the first ,
but in particular in the developing world should provide specialist training and clinical fellowships to under - resourced countries , with an emphasis on staff training at teaching hospitals .
but the answers to the challenge of africa 's health and that of global health inequity also lie with global health policies and practices , including developing new norms and standards for health care which serve the interests of the global community , and are based on the current realities of global health , and which strive to advance efforts to promote health equity .
 backgroundburden 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.objectivesestablish 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.designsurvey of ent , audiology , and speech therapy services and training in 18 sub - saharan africa countries.resultsthere 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.conclusionslower 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 . 
Present investigation
Aims of study
Materials and methods
Results
Discussion