Home / Blog / The community-based, “Wide Frequency Audibility” fitting method, created to provide meaningful benefits for people with hearing loss across the globe. The method is simple, sustainable, and scalable.


  • The community-based, “Wide Frequency Audibility” fitting method, created to provide meaningful benefits for people with hearing loss across the globe. The method is simple, sustainable, and scalable.
    15 Jul , 2016









    Efforts to help people with hearing loss in the developing world are ongoing and span the globe. These efforts are necessary because the numbers of people who experience hearing loss throughout the world, but for whom little or no assistance is available, is staggering. In sub-Saharan Africa, for example, it is estimated that more than 1.2 million children under the age of 14 have hearing loss of a moderate to severe degree bilaterally.The World Health Organization (WHO) global estimate for disabling hearing impairment (of a degree of severity >40 dB HL for adults and >30 dB HL for children in their best ear) was at least 278 million in the better ear in 2005, and the 1995 disease burden estimate tripled to about 360 million in 2015. It is on track to hit half a billion people in 2025. Two-thirds of individuals with hearing impairment are estimated to live in developing countries.

    For the continent of Africa, the ratio of audiologists to people with hearing loss is one for every million people. Not all hearing healthcare providers are audiologists, but even when others are included, the WHO estimates that fewer than 1-in-40 people who are in need of hearing aids for their hearing loss receive them. Indeed, the WHO has stated:



    “Hearing aids and cochlear implants are prohibitively costly in low-resource countries. And as current designs do not allow for long-term use, replacement costs also make these devices out of reach of poorer countries. In addition, batteries for hearing aids are relatively expensive and have a short usable life in hot and humid climates. Follow-up services for hearing aids by trained technicians are also generally costly…WHO estimates that global production of hearing aids meets less than 10% of the global need for these devices. Development of appropriately designed and affordable hearing aids and cochlear implants for use in different age groups and contexts is urgently needed.”


    Many governments in developing countries lack resources to work on the problem of hearing healthcare for their people. A lack of government support results in health systems in many developing countries being too weak and fragmented to enable the scaling-up of essential preventions and interventions required for adequate hearing healthcare.


    The inability of governments in countries with limited budgets to cater to diverse health needs has led to a growing trend towards local public-private partnerships for healthcare delivery in low- and middle-income countries. Also, in an effort to improve the lives of people with hearing loss in countries where hearing healthcare is unavailable, the WHO developed and published a “primary ear and hearing care training resource” to provide basic knowledge and skills in hearing heathcare to support training efforts in countries where such training is currently not available.


    The Starkey Hearing Foundation (SHF) has been working on providing hearing healthcare in the developing world for many years. Initial efforts were focused on providing hearing aids and fitting individuals with hearing loss. However, as the foundation’s creators recognized the need to do more to bring about lasting changes, they have expanded the program to meet the need. The SHF has developed a working community-based model for assisting people with hearing loss. The SHF model helps accomplish the goals of the WHO Primary Ear and Hearing Care Training initiative and is designed to provide assistance in a manner that is simple, sustainable, and scalable.


    The SHF has made a conscious decision to simplify the process of distributing their hearing aids to people so that as many people as possible can benefit. Additionally, this simple method is easy to learn so that local citizens of developing countries can be taught the method and be able to help their own citizens.


    William F. Austin, founder of Starkey Hearing Foundation, has developed the Wide Frequency Audibility (WFA®) fitting method. The WFA® method is one piece of the larger community-based model the SHF has put in place to both provide hearing aids and to develop hearing healthcare for people who are not receiving such care across the world.  


    In response to the dire need for hearing healthcare, the WHO produced a 3-level training system that includes basic training for primary caregivers, intermediate training for local providers with minimal training, and an advanced training module for professionals with higher-level training. The WFA fitting method and the SHF Community-based model are ideally suited to bring resources and knowledge to developing countries to train local providers at the intermediate level.


    The SHF community-based model of hearing healthcare is divided into four phases:

    Phase 1. Patient Identification

    Phase 2. The WFA Fitting Method

    Phase 3. Aftercare Program

    Phase 4. Listen and Speak

    Benefits of the Model:

    The SHF Community-based model with its four phases, including the WFA fitting method, is designed to provide hearing healthcare to individuals around the world who are not receiving such care. The model is designed to fill the need identified by international organizations like the WHO that have recognized an urgent need for simplified methods to provide as much care for as many people as possible; the alternative is that these individuals will not receive any care at all throughout their lives.


    The SHF has made a conscious choice to simplify their model to try and provide opportunities for as many people across the world to hear and have the opportunity to develop communication skills through auditory-verbal means. The Community-based model is designed as a sustainable and scalable effort. The model is sustainable because local individuals are being taught the simple skills to apply it and maintain it after the SHF has left the country. The model is simple enough that it can be scaled up or down, as necessary, to meet the needs of the tens of thousands of people in each developing country that are not receiving any hearing healthcare presently.


    It should also be noted that implementation of the SHF model does not hinder developing countries from educating and hiring more educated professionals to match the advanced training level of the WHO, or even to adopt the university training model of many developed nations. Indeed, it can be argued that the work of the SHF in fitting hearing aids and training intermediate-level hearing healthcare workers will ultimately create a market within developing countries for professionals with more advanced training in hearing healthcare within which they can work.


    The SHF is keenly interested in providing real benefit for each and every individual fit with hearing aids through the model. Even though the methods are simple compared to modern techniques, people fit with the model are receiving measurable and sustained benefits. Subjective reports from people fit with the WFA method has indicated that a large majority (>85%) are very satisfied with the benefit they are receiving. More objective data is in the process of being collected and will be published in the near future.


    Source: WFA, (WFA® is a registered trademark of the Starkey Hearing Foundation).

    ***This article has been truncated to include its most salient information***

    Image credit: Starkey Hearing Foundation


    Correspondence can be addressed to Dr Larsen at: jeffery.larsen@usu.edu