Efforts to take hearing services from communities into classrooms are gaining ground, but high costs, stigma and limited awareness among parents and teachers continue to deny children timely care, according to health and disability advocates.

This was highlighted on Tuesday, March 3, during the celebration of World Hearing Day at GS Cyivugiza in Nyarugenge District, where the advocates and officials warned that without urgent action preventable hearing loss will keep undermining children’s learning and social development.

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Francois Xavier Karangwa, the Executive Director of the Umbrella of Organizations of Persons with Disabilities (UPLHS), said the price of hearing aids remains a major barrier for families.

"Even when subsidised by UNICEF, one hearing aid costs about $127 (approx. Rwf185,450), about $300 per two pieces. Without subsidies, most parents cannot afford them,” he said.

If the plan to include them under the Community-Based Health Insurance (Mutuelle de Santé) is implemented, access could improve.

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He added that delayed care worsens the problem, citing children who spend years with untreated earwax or infections that could have been resolved early.

"With early screening, many conditions can be treated. Even when disability occurs, children can still be supported,” he said.

Karangwa also pointed to stigma and discrimination as persistent challenges, noting that children with hearing difficulties are often misunderstood at school.

"Some sit in front because they cannot hear well, but teachers may not know why. When a child cannot communicate the problem clearly, they are punished for ‘disobedience’ instead of being helped,” he said.

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The shortages of Ear Nose and Throat (ENT) specialistS compound the problem. There are about 40 ENT proffessionals, including the ones still in training. Harmful practices, particularly in rural areas, also persist, with some parents putting traditional medicines in children’s ears, leading to permanent damage, Karangwa said.

For children who lose hearing ability entirely, communication remains difficult. Although a Rwandan sign language dictionary exists, few people can use it, and trained interpreters remain.

Jean Damascène Nsengiyumva, the Director General for School Health and Wellness in the Ministry of Education, said the hearing impairment often leads teachers to misjudge the learners.

"Some children used to be labelled as disobedient because they do not answer questions. Others would ask to sit in front are were moved to the back instead,” he said, adding that the ministry is promoting inclusive school environments.

Dr Athanase Rukundo, the Director General for Clinical and Public Health Services Governance at the Ministry of Health, said that schools were prioritised in this year’s campaign because that is where children spend most of their time.

"Hearing services are provided at health centre level, but better infrastructure is needed to improve care, including the availability of ENT specialists,” he said.

He added that the ministry plans to expand ENT services to all district hospitals. "University Teaching Hospitals and Level Two Teaching Hospitals already offer these services, and there are plans to extend them to district hospitals as well,” he said.

Dr Jean Claude Nshimiyimana, the head of the ENT department at the University of Rwanda's College of Medicine and Health Sciences, said limited knowledge of parents remains a key obstacle to timely care for children with hearing problems.

"Children learn to speak by hearing and repeating sounds. After the age of seven, it becomes much harder. Parents miss early signs such as lip-reading or lack of response,” he said, calling for stronger awareness at household and school levels.

For some, early screening has already made a difference. Esther Nikuze, a resident of Kinyinya Sector in Gasabo District, said her daughter initially struggled to understand instructions. "I would call her, but she often did not respond. At first, I thought it was just her being stubborn,” she said.

In October 2025, a hearing screening initiative reached the school Nikuze's daughter went to in Kacyiru. The family was advised to consult a specialist, and after treatment, her hearing improved significantly. "Now she can hear well and follow instructions,” Nikuze said.

Dr Kayitesi Mukara Batamuriza, Chairperson of Hearing Health Rwanda, which supports the screening of students and links them to health services, said the organisation is working with the ministries of health and education to screen 124,900 children. So far, 12,000 pupils in 83 public-aided schools in Gasabo District have been assessed.

"About 15 per cent of them had at least one hearing problem that could lead to disability if untreated, and 4 per cent had total hearing loss,” Batamuriza said. "Some parents still take children with ear infections to traditional healers instead of health facilities, which worsens the damage.”

She stressed that babies can be born with hearing impairments and that parents must learn to recognise simple warning signs. "There are symptoms that do not require special skills, and just paying enough attention can make a difference,” she said.