ANM Training Programme under NPPCD, Delhi

National Programme for Prevention and Control of Deafness (NPPCD)
26th–27th November, 2025 | 2 Batches

Introduction

The National Programme for Prevention and Control of Deafness (NPPCD), South District of Delhi, in collaboration with Sound Hearing 2030 and AGSG Health Foundation, organized a training programme to strengthen the competencies of healthcare providers in early detection, prevention, community awareness, and reporting of hearing loss.

The training was conducted in two batches, with Day 1 and Day 2 having identical content, ensuring uniform capacity building across groups. The only variation between the two days was in the clinical and etiological session, where different experts facilitated the module. All other sessions and resource persons remained the same.

Session 1: Hearing Loss in Overall Perspective & Launching of NPPCD Programme

Resource Person: Dr. Arun Kumar Agarwal

Day 1 began with an overview of the burden of hearing loss and the public health significance of NPPCD. Key discussions included global and Indian prevalence of hearing loss, the importance of early screening and intervention, strategic objectives and components of NPPCD to improve ear and hearing care services, and expected outcomes and participant responsibilities.

He explained the NPPCD overview and launch. The NPPCD was launched by the Ministry of Health and Family Welfare (MoHFW), Government of India, and the official pilot phase started in 2006–07 (January 2007), initially covering 25 districts across 10 States and 1 Union Territory.

Objectives & Long-Term Goals
The NPPCD aims at multiple levels—prevention, early detection, treatment, and rehabilitation.
Prevent avoidable hearing loss due to disease or injury.
Ensure early identification, diagnosis, and treatment of ear problems responsible for hearing loss and deafness.
Provide medical rehabilitation for persons of all age groups suffering from deafness.
Strengthen inter-sectoral linkages to support continuity of rehabilitation programmes for persons with deafness.
Build institutional capacity by equipping District Hospitals (DHs), Community Health Centres (CHCs), and Primary Health Centres (PHCs) with ENT/audiology infrastructure, diagnostic and therapeutic facilities, and trained manpower.
Reduce the total disease burden of hearing impairment/deafness by 25% compared to baseline by the end of the relevant plan period.

From the pilot 25 districts in 2006–07, the programme expanded significantly. By the mid-2010s, it covered 192 districts across 20 States and Union Territories. It was planned to extend to 384 districts by the end of the 12th Five Year Plan (2017). According to the latest official sources, NPPCD is now implemented in 587 districts across 36 States and Union Territories as of 2024. The programme is integrated under the larger umbrella of the National Health Mission (NHM) at state and district levels.

Session 2: NPPCD, Service Delivery & Referral System

Resource Person: Dr. Suneela Garg

Participants were oriented on NPPCD operations at different levels of care. Hearing loss is a major global public health issue, affecting communication, development, education, mental health, and overall quality of life. Globally, 1.5 billion people experience hearing loss, and 430 million require rehabilitation services. This number is expected to rise to 700 million by 2050.

WHO estimates (2018) show that 466 million people live with disabling hearing loss, including 34 million children. Around 60% of hearing loss is preventable. Nearly 1.1 billion young people are at risk of permanent hearing loss due to loud recreational listening. Around 200 million children globally experience preventable middle-ear infections. About 80% of affected individuals live in low- and middle-income countries where ear and hearing care services are inadequate.

In India, the burden is significant, as the country constitutes 17.5% of the world’s population and carries a large share of global hearing impairment cases.

Major Areas Covered Under the Programme
The programme is designed to deliver ear and hearing care services at primary, secondary, and tertiary healthcare levels.
Capacity building and infrastructure strengthening through ENT/audiology equipment such as audiometers, diagnostic tools, sound-treated rooms, surgical instruments for ear surgery, and BERA/OAE facilities.
Human resource and training development through training ENT specialists, audiologists, audiometric assistants, community-level health workers, ASHAs, and school health personnel for ear care, detection, and referral.
Service delivery through ear screening, especially newborn screening in hospitals, audiological evaluations (PTA, BERA/OAE), middle ear pathology management, ear surgeries such as tympanoplasty and mastoidectomy, hearing aid provision, speech and hearing rehabilitation, and referral networks.
Awareness, prevention, and outreach through IEC/BCC campaigns, school screening camps, and integration with maternal-child health, child development, and school health services.
Rehabilitation and long-term support through provision of hearing aids, referral for cochlear implants when needed, speech therapy, disability certification, and linkages for social support.

Impact of Unaddressed Hearing Loss
Listening and communication difficulties.
Speech and language development challenges.
Cognitive impact.
Reduced education levels.
Employment and financial instability.
Mental health issues, social isolation, identity concerns, and stigma.

Prevalence
NSSO 58th round (2002) identified hearing disability as the 2nd most common disability in India.
WHO protocol-based surveys (2003) estimated 6.3% prevalence of hearing impairment, approximately 80 million people.
Adult-onset deafness: 7.6%
Childhood-onset deafness: 2%
Sensorineural hearing loss (SNHL) prevalence among newborns: 2–3 per 1000 live births.

ICMR National Task Force Study (2020)
Total surveyed: 92,097 people across six major cities—Bangalore, Bhavnagar, Bhubaneshwar, Raipur, Shillong, and Shimla.
9.92% were diagnosed with hearing loss (>25 dB).
Causes included ear wax (15.9%), CSOM (5.2%), serous otitis media (3.0%), tympanic membrane perforation (0.5%), genetic causes (0.2%), non-infectious causes (10.3%), others (13.1%), and unknown causes (13.5%).

Objectives of NPPCD
1. Early detection, diagnosis, and treatment of ear diseases causing hearing loss.
2. Prevention of avoidable hearing loss through health promotion and disease prevention.
3. Rehabilitation of individuals with hearing impairment across all age groups.
4. Develop institutional capacity by establishing infrastructure, equipment, and trained manpower.
5. Strengthen inter-sectoral linkages for comprehensive rehabilitation services.

Capacity Building: District Hospitals
ENT surgeon.
Audiologist and Speech-Language Pathologist.
Audiometric assistant.
Instructor for young hearing-impaired children.
Equipment including operating microscopes, microdrills, audiometers, OAE, impedance audiometers, and sound-treated rooms.

Primary Health Centres
Otoscopes, tuning forks, wax removal kits, basic detection and screening tools, and school health doctors for screening.

Service Delivery Structure

Primary Level (SC/PHC/CHC)
Early identification of hearing impairment.
Basic primary ear care.
School-level screening in collaboration with RBSK.
Public awareness and community education.
Referral of suspected cases.

Secondary Level (District Hospital)
Diagnosis and management of ear diseases.
ENT services, audiometry, tympanometry, and OAE screening.
Ear surgeries such as tympanoplasty and mastoidectomy.
Hearing aid fitting and audiological rehabilitation.
Training of PHC doctors, health workers, and teachers.

IEC and Awareness Activities
Posters, TV clips, radio jingles, and flip charts.
Development of IEC strategy at central level using a programme mascot.
Involvement of NGOs, panchayats, and medical colleges.
Regular KAP (Knowledge, Attitude & Practices) surveys.
Focus on stigma reduction and early care seeking.

National Hearing Awareness Campaign – 3rd March
Conducted annually on World Hearing Day, with Gram Sabha activities in rural India, urban awareness programmes involving NGOs, local bodies, and medical colleges, community-level screening and education, and monitoring by district nodal officers.

Purpose
To highlight that more than 50% of hearing impairment is preventable and that early action can significantly reduce the burden.

Future Plans
Strengthening routine IEC activities.
Enhanced surveillance system.
Stronger referral networks.
Capacity-building at all healthcare levels.
Nationwide awareness campaigns.
Integration with national health programmes.

Session 3: Etiological Factors of Hearing Loss & Case Scenarios

Resource Persons: Dr. Ravi Meher (Day 1) and Dr. Nikhil Arora (Day 2)

Topics: Causes of Hearing Loss

1. Congenital Causes
Congenital hearing loss is present at birth and may result from conditions affecting the fetus during pregnancy or complications during childbirth.

Key Congenital Factors
Maternal infections during pregnancy (TORCH): Toxoplasmosis, Rubella, Cytomegalovirus (CMV), and Herpes can affect fetal cochlear development.
Prematurity & Low Birth Weight: Babies below 1500 g or born before 34 weeks have a higher risk of auditory system underdevelopment.
Birth Asphyxia / Hypoxia: Inadequate oxygen supply during delivery can damage the auditory nerve or brain centers.
Neonatal Hyperbilirubinemia (Severe Jaundice): High bilirubin levels may cause kernicterus, which impairs auditory pathways.
Ototoxic Drug Exposure in Pregnancy: Maternal intake of certain medications such as aminoglycosides can harm the fetus’s inner ear.

2. Genetic Causes
Genetic or hereditary hearing loss occurs due to mutations inherited from parents or arising spontaneously.

Types of Genetic Hearing Loss
Syndromic (30%): Hearing loss is part of a broader syndrome, including Usher syndrome, Waardenburg syndrome, and Alport syndrome.
Non-Syndromic (70%): Hearing loss occurs alone without other abnormalities. A common mutation is GJB2 (Connexin 26), and such loss is usually congenital and often severe to profound.

Genetic Transmission Patterns
Autosomal recessive.
Autosomal dominant.
X-linked.
Mitochondrial inheritance.

Genetic factors can cause sensorineural hearing loss and are usually permanent.

3. Infectious Causes
Infections can affect the outer, middle, or inner ear, leading to temporary or permanent hearing loss.

Common Infectious Causes
Otitis Media (Middle Ear Infection): Very common in children; fluid accumulation causes conductive hearing loss.
Chronic Suppurative Otitis Media: Long-term infection that can damage ossicles and cause permanent hearing loss.
Meningitis: Bacterial meningitis may damage the cochlea or auditory nerve, often causing profound SNHL.
Measles, Mumps, and Rubella: Viral infections that can affect the inner ear.
Cytomegalovirus (CMV): Leading cause of congenital infectious hearing loss.
COVID-19 (rare): Reported to cause sudden sensorineural hearing loss in some cases.

4. Traumatic Causes
Trauma can damage the external, middle, or inner ear structures, leading to conductive or sensorineural hearing loss.

Types of Trauma
Head Injury: Temporal bone fractures may disrupt the ossicles or damage the cochlea.
Acoustic Trauma: Exposure to loud noises or blasts damages hair cells in the cochlea and is common in industrial workers, military personnel, and urban youth exposed to loud music.
Barotrauma: Pressure changes during air travel or diving can rupture the eardrum.
Foreign Bodies or Physical Injury: Inserting objects into the ear canal can perforate the eardrum.
Ototoxic Drugs: Medications such as aminoglycosides and chemotherapy drugs can cause irreversible SNHL.

5. Age-Related Causes (Presbycusis)
Age-related hearing loss occurs gradually as the ear structures degenerate with aging.

Characteristics
Progressive sensorineural hearing loss.
Difficulty hearing high-frequency sounds.
Reduced speech clarity, especially in noisy environments.

Underlying Mechanisms
Degeneration of hair cells in the cochlea.
Reduced function of the auditory nerve.
Thickening or stiffening of the basilar membrane.
Reduced blood supply to inner ear structures.

Risk Factors
Long-term noise exposure.
Smoking.
Diabetes and hypertension.
Genetic predisposition.

Presbycusis is one of the most common causes of hearing loss in adults above 60 years.

Session 4: Role of IEC Material, World Hearing Day Registration & hearWHO App Demonstration

Resource Person: Ms. Janki Mehta

This session focused on the use of IEC materials for awareness generation, best practices in community-level behavioural communication, guidance for World Hearing Day registration, and demonstration and use of the hearWHO mobile app for self-screening and public awareness.

Session 5: Reporting Format under NPPCD

Resource Person: Dr. Sanjana Arora

Participants received hands-on guidance on monthly and quarterly NPPCD reporting formats, documentation of screening, referrals, and follow-up, and the importance of timely submission for programme monitoring.

Conclusion

NPPCD is a comprehensive national initiative aimed at reducing preventable hearing loss, improving early detection, providing quality ear care services, and ensuring rehabilitation for people with hearing impairment. Through capacity building, structured referrals, surveillance, and community awareness, the programme significantly contributes to reducing disability and improving quality of life across India.

Across the two days, the training successfully enabled stronger understanding of hearing loss epidemiology and public health relevance, enhanced competency in NPPCD service delivery, referral, and coordination, improved knowledge of hearing loss etiological and clinical decision-making, effective utilization of IEC materials for awareness generation, better skills in using digital tools like hearWHO for community benefit, and improved accuracy in programme reporting and monitoring.

Participants from both groups demonstrated active engagement, interactive discussion, and readiness to apply the programme skills in field settings.