Status and gaps in newborn hearing screening in South Africa: A cross-sectoral review

Abstract

Background: Newborn hearing screening (NHS) is recognised as a key component of early hearing detection and intervention (EHDI). In South Africa, implementation remains inconsistent across provinces and health sectors, with limited national coordination and policy support. Updated data are needed to identify progress and persisting gaps in service delivery.
Objectives: To describe the status of NHS in South Africa across public, private and non-governmental (NGO) sectors, focusing on the availability of services, equipment and personnel, and to identify barriers to implementation.
Method: A cross-sectional, descriptive online survey was distributed to audiologists practising in South Africa using REDCap (Research Electronic Data Capture). A total of 133 audiologists participated, representing all nine provinces and the public (52%), private (40%) and NGO (6%) sectors.
Results: Newborn hearing screening services were concentrated in urban provinces, mainly Gauteng and the Western Cape. The public sector accounted for 49% of services, largely at tertiary hospitals. Equipment availability was generally high. mHealth adoption was limited (4% in public sector only). Audiologists conducted most screenings, although task-shifting to trained non-audiologists occurred in NGOs. Major barriers included limited parental awareness, poor follow-up, staff shortages, funding constraints and a lack of medical aid coverage in the private sector.
Conclusion: Despite progress since the 2008 baseline, when only 7.5% of public hospitals offered NHS, coverage remains uneven, with persistent geographic and resource inequities. Integrating NHS into primary healthcare, expanding task-shifting and improving public awareness are essential for equitable access.
Contribution: This study provides the most recent cross-sectoral overview of NHS in South Africa, informing policy and supporting equitable EHDI scale-up aligned with World Health Organization (WHO) targets.