Katijah Khoza-Shangase

Purpose: Efficient and contextually responsive resource utilisation is central to sustainable healthcare delivery, particularly in resource-constrained settings. Within South Africa's dual healthcare system, characterised by structural inequities, there is limited evidence on how practitioners operationalise resource use in practice. This study explored challenges associated with productive resource utilisation among audiology and speech therapy practitioners and identified strategies to enhance efficiency and sustainability across sectors. Design/methodology/approach: A qualitative design was employed using semi-structured interviews with 92 practitioners across public and private sectors and urban, peri-urban, and rural contexts in four South African provinces (Gauteng, KwaZulu-Natal, Western Cape, and Limpopo). Data were analysed thematically using Braun and Clarke's framework, with exploratory inferential analyses examining sectoral differences. Qualitative codes were quantified at participant level to allow descriptive and exploratory statistical comparison across sectors. Findings: Four themes emerged. First, public sector resource constraints included equipment shortages (80%), staffing limitations (75%) and budgetary constraints (85%), particularly in rural areas (χ2 = 17.89, p < 0.01). Second, private sector optimisation strategies emphasised efficiency through technology (70%) and staff training (60%), with higher digital tool use (t = 3.45, p < 0.01). Third, resource allocation priorities differed, with public practitioners prioritising equitable access and private practitioners personalised care (χ2 = 22.45, p < 0.001). Fourth, innovations included community partnerships, task-sharing and hybrid funding approaches. Originality/value: This study provides novel insight into how resource optimisation is enacted within a dual healthcare system in an LMIC. It demonstrates how systemic inequities shape decision-making and service delivery, offering contextually grounded strategies to inform health system strengthening, including implications for public–private integration and South Africa's National Health Insurance. By integrating thematic analysis with exploratory quantitative comparisons, the study extends existing literature beyond descriptive accounts of resource scarcity to illustrate how practitioners adapt operationally within structurally unequal healthcare environments.

Purpose: To critically examine the sources and implications of bias in artificial intelligence (AI) applications for audiology in Africa, focussing on cultural, linguistic, technical and ethical dimensions, and their implications for equitable hearing healthcare delivery. Design/methodology/approach: A systematic narrative review of peer-reviewed literature published (2000–2025) was conducted. Empirical studies, systematic and scoping reviews and conceptual papers on AI in audiology and related healthcare technologies were included. Data were extracted and synthesised thematically to identify patterns of bias relevant to African contexts. Findings: Forty studies met the inclusion criteria. Five interrelated sources of bias were identified: (1) data and representational bias due to underrepresentation of African populations, (2) algorithmic and model development bias linked to design and validation limitations, (3) linguistic bias in speech-processing technologies, particularly Automated Speech Recognition, (4) deployment and contextual bias associated with infrastructure and health system constraints in low- and middle-income settings and (5) ethical, governance and regulatory challenges affecting accountability and data sovereignty. Collectively, these biases contribute to inequitable diagnostic accuracy and access to AI-enabled care. Originality/value: This review advances the concept of “digital ear harm” to describe iatrogenic risks associated with biased AI in audiology and foregrounds Ubuntu as a relational ethical framework for mitigation. Unlike previous reviews that predominantly conceptualise AI bias as a technical or algorithmic challenge, this review demonstrates how data representation, linguistic diversity, cultural context and governance interact to shape healthcare equity in African audiology. It offers a contextually grounded synthesis and strategic directions for equitable, culturally responsive AI development in African audiology.

South Africa’s high HIV prevalence presents unique challenges, including potential impacts on hearing function in children born to women with HIV. While antiretroviral therapy (ART) has significant...

Background: Occupational noise-induced hearing loss (ONIHL) is a preventable yet highly prevalent occupational disease, particularly in the construction sector where workers are routinely exposed to hazardous noise levels. In South Africa and other low- and middle-income countries (LMICs), health and safety training is implemented; however, limited evidence exists on whether such training adequately supports effective hearing conservation. Examining the nature and content of informational counselling provided to construction workers is critical for identifying gaps in hearing conservation programmes (HCPs). Methods: A cross-sectional mixed-methods study was conducted among construction workers at selected worksites in South Africa using a paper-based questionnaire. Data collected included demographic characteristics, exposure to general health and safety information, receipt of ONIHL-specific counselling, awareness of HCPs, and methods of information delivery. Quantitative data were analysed using descriptive statistics and exploratory inferential analyses, while qualitative responses were analysed thematically to explore workers’ perceptions and experiences of informational counselling. Results: All participants (100%) reported receiving general health and safety information; however, only one-third (33%) reported receiving counselling related specifically to occupational noise exposure or hearing loss. Most workers (77%) indicated that they had not received any formal information about hearing conservation programmes, and fewer than half (47%) were aware of the long-term risks associated with noise exposure. Informational counselling was predominantly delivered verbally (67%), with limited use of written or digital formats. Qualitative findings showed that hearing health was largely framed in terms of hearing protection device use, with minimal emphasis on cumulative exposure, early signs of hearing loss, or audiological monitoring. Conclusions: Despite widespread safety training, informational counselling on ONIHL among construction workers in South Africa remains limited and narrowly focused. These findings highlight a disconnect between safety training compliance and meaningful hearing health literacy, highlighting the need to integrate comprehensive, audiology-informed counselling into construction-sector health and safety programmes.

Background: Hearing loss represents a significant and growing public health challenge in Africa, yet the legislative and regulatory frameworks underpinning preventive audiology remain fragmented, inconsistently operationalized, and insufficiently synthesized within the published literature. Aim: This structured narrative review critically maps and analyses the legislative, regulatory, and policy instruments shaping preventive audiology across the African continent, highlighting systemic gaps, implementation barriers, and opportunities for advancing equitable hearing healthcare. Methods: A structured narrative review was undertaken. Comprehensive searches of PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar were conducted to identify peer-reviewed literature and key legislative and policy documents published between 2000 and 2025. Data were extracted using a standardized framework that captured study characteristics, legislative scope, institutional oversight, operationalization, and systemic factors. Thematic analysis was used to synthesize findings across national, continental, and global frameworks. Results: Thirty-one sources met inclusion criteria, although available evidence was geographically concentrated in South Africa, with comparatively fewer studies from West, East, and North Africa, alongside continental and global normative frameworks. The evidence revealed a pronounced implementation gap: continental instruments, such as the African Union (AU) Protocol on the Rights of Persons with Disabilities, provide a strong rights-based foundation, yet national translation is limited. Among the countries represented in the included literature, Egypt was the only country identified as having a mandatory, country-wide universal newborn hearing screening program, whereas most sub-Saharan African countries rely on fragmented pilot projects or professional guidelines. Hearing care is frequently deprioritized relative to communicable diseases. Occupational noise regulations exist but enforcement is weak, particularly in high-risk industries such as mining. Key systemic barriers include workforce shortages, high out-of-pocket costs, lack of statutory early hearing detection and intervention (EHDI) mandates, and low public awareness. Emerging opportunities include tele-audiology, task-shifting, integration into universal health coverage (UHC), and alignment with locally driven research priorities. Conclusion: The available evidence suggests that many African countries would benefit from strengthening legislative and regulatory frameworks for preventive audiology. National laws should consider explicitly integrating ear and hearing care into UHC benefit packages, where appropriate, supporting tele-audiology and task-shifting, and strengthening enforcement of occupational standards.

Childhood hearing loss is classified as a sensory disability under the World Health Organisation’s (WHO) definition of disability, encompassing loss of function, activity limitations, and participa...

South Africa’s speech-language therapy (SLT) and audiology professions face challenges in achieving linguistic and cultural integration (i.e., the me

Background: Effective practice management is essential for the delivery, accessibility, and sustainability of audiology and speech-language therapy services. However, growing evidence suggests that practitioners are often underprepared for the administrative, financial, and leadership demands of their roles. Objectives: This narrative review examines how practitioners across different countries describe their experiences with managing audiology and speech-language therapy practices. The review synthesises peer-reviewed literature that captures the challenges, strategies, and recommendations reported by clinicians working in diverse healthcare contexts. Methods: A structured narrative review methodology, incorporating systematic search and screening procedures, was adopted. A total of 192 records were identified through database searching, of which 182 remained after duplicate removal. Following title and abstract screening, 37 full-text articles were assessed for eligibility, and 16 studies met the inclusion criteria. Sixteen peer-reviewed publications published between 2000 and April 2025 were identified through systematic database searches. Studies were included if they presented practitioner perspectives on any aspect of practice management. Thematic analysis was used to synthesise the data. Results: The analysis revealed nine interrelated themes: limited business and financial training; reimbursement complexities; ethical dilemmas; high workload and burnout; barriers to continuing professional development; private practice management challenges; gaps in human resource capacity; insufficient policy engagement; and the importance of interprofessional collaboration and person-centred care. Studies from high-, middle-, and low-income countries highlighted both globally shared and context-specific barriers. Practitioners emphasised the need for embedded business skills training, improved access to continued professional development (CPD), supportive regulatory environments, and clearer guidance from professional bodies. Discussion: The findings indicate that practice management challenges are systemic rather than isolated, reflecting broader gaps in health workforce preparation and policy support. The recurrence of similar themes across diverse settings highlights the need for integrated training models that combine clinical expertise with leadership, financial, and advocacy competencies to ensure sustainable and equitable service delivery. Conclusion: The results of the study highlight the global need for integrated, context-sensitive preparation in practice management within health professions education and systems. This review provides actionable insights to inform reforms in training, policy, and organisational support, better equipping practitioners for sustainable, high-quality service delivery.

Effective risk management is central to patient safety, regulatory compliance, and organizational sustainability in healthcare. In South Africa, audiology and speech therapy practitioners operate within a system characterized by resource constraints, regulatory complexity, and socio‐economic inequality, resulting in differentiated risk exposure across practice settings. This study explored risks encountered by practitioners and the strategies used to mitigate these risks. A qualitative design was employed in 2025 with 92 practitioners. Data were analyzed thematically, supported by descriptive and inferential analyses. Four interrelated risk domains emerged, with sectoral differences reflected across thematic and quantitative findings. Public sector practitioners reported significantly higher clinical risk, including diagnostic errors (65%) and delayed treatment (70%), particularly in rural settings ( χ ² = 18.21, p < 0.01). Additionally, operational risks such as staff shortages (75%) and equipment failure (70%) were also more prevalent. In contrast, private practitioners reported greater financial risk related to income volatility and overhead costs (70%; t = 3.12, p < 0.01). Legal and regulatory risks were evident across both sectors, while mitigation strategies included telehealth adoption and community partnerships. These findings demonstrate structurally produced risk, highlighting the need for integrated, context‐sensitive risk governance frameworks in resource‐constrained health systems.