Mapping legislative and regulatory frameworks for preventive audiology in Africa: progress and challenges

Abstract

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.