WHO Primary Ear and Hearing Care Training in Samoa : The Hearing Journal

In October 2021, Dr. Sione Pifeleti successfully delivered the World Health Organization (WHO) Primary Ear and Hearing Care (PEHC) training package to a group of 19 workshop participants in Samoa. This was the first time this course was delivered in our country.

Participants in the first Primary Ear and Hearing Care training in Samoa. Samoa, World Health Organization.


PEHC training participants performing ear examinations. Photo credit: The Samoan Observer. Samoa, World Health Organization.


PEHC training participants performing ear examinations. Photo credit: The Samoan Observer. Samoa, World Health Organization.

Table 1:

Overview of the Primary Ear and Hearing Care Training (Intermediate Level).

Dr. Pifeleti is a General/ENT Surgeon and the Acting Head of the ENT Department of the Tupua Tamasese Meaole (TTM) Hospital in Apia, the capital city of Samoa. When he re-established the ENT Department in 2017, his dream was to simultaneously build the skills of health professional colleagues in primary ear and hearing care at the national level. The WHO PEHC training package was therefore submitted to the Samoan Qualifications Authority for accreditation; participants undergoing the training had to pass the course to be awarded a formally recognized qualification in basic primary ear and hearing health care provision. Accreditation was officially granted in March 2021 for all three levels of the training package–basic, intermediate, and advanced.



The first group of participants invited to the course in October 2021 were mostly colleagues from the national referral TTM Hospital: five medical registrars (district hospital, acute primary care clinic, emergency, pediatric, surgical) three ENT registered nurses, two registered nurses from the surgical unit (i.e., operating theatre), two registered nurses from the surgical ward, and four registered nurses representing the pediatric, emergency, obstetric & gynecology wards and the acute primary care clinic. A special invitation was also extended to the staff of SENESE, the non-government organization that cares for children with disabilities in Samoa. Their work includes school-based support for students with hearing impairment. Three SENESE staff members participated in the course.

The intermediate level of the WHO PEHC training package was selected as the most appropriate level for this first group of trainees. The course consisted of seven modules, shown in Table 1, which were facilitated over a two-day workshop. We were honored that Leausa Toleafoa Dr. Take Naseri, the CEO and Director-General of the Government of Samoa Ministry of Health, showed his support for the PEHC training by attending on the first day to formally open the workshop.


All course facilitators placed an emphasis on the course contents as they relate to our Samoan context (i.e., referral pathways). The first four modules were facilitated by Dr. Pifeleti. The fifth module on middle ear disease was presented by our visiting ENT Specialist Dr. Zhi Yu, who is in Samoa for six months under the Chinese Medical Team Volunteers program.

The last two modules were delivered by Australian research audiologist Dr. Annette Kaspar, who specializes in the development of strategies to address hearing loss in the Pacific Islands. She has been based in the Pacific Islands for 10 years and has spent the last two years working out of the ENT Department of Samoa. Given that the WHO PEHC training package was published in 2006, updated information was included based on the WHO World Report on Hearing that was launched in March 2021. Similar to her two ENT colleagues, Kaspar tailored the course contents to the Samoan context. For example, although there is currently no newborn/infant hearing screening program in any Pacific Island country, the updated national Samoan Baby Health Book will include a hearing development milestones checklist, a risk-factor for permanent hearing loss questionnaire, and basic information for parents on ear health care. Similarly, given that non-communicable diseases are a major public health crisis in the Pacific Islands, course participants were advised that the updated National Diabetes Guidelines for Samoa will include routine ear and hearing health screening in the care plan for all adults living with type 2 diabetes mellitus.

A highlight of the workshop for the course facilitators was the engagement of participants in the practical components and scenario activities. The enthusiasm of course participants for role playing parents, children, and the health workers generated much fun and laughter!


The WHO PEHC training package includes a pre- and post-test evaluation of each student for each module. As well as assessing for an improvement in knowledge, our course participants were required to achieve a minimum mark for each module to pass the course. We were delighted to see that all participants successfully achieved high scores for all modules and could be awarded the PEHC course certificate.

The course participants were also invited to complete a course evaluation form. Based on this first experience of delivering the PEHC training package, as well as course participant feedback, Pifeleti and Kaspar will make amendments to future PEHC course workshops as appropriate. This may include provision of the pre- and post-test questions in the FaaSamoan language, as well as in English. Over the next two years, our aim is to deliver the PEHC training 10 times (five times per year), particularly to community health workers in rural/remote parts of Samoa. The course facilitators will travel to rural/remote locations to enable maximum numbers for course participation and ensure the training is relevant and contextually appropriate (i.e., management/treatment plans are based on resource availability, referral pathways consider transport/cost difficulties).


It would be unethical for our department to provide health worker colleagues with improved knowledge in PEHC delivery without also equipping them to put their new skills into practice. Given that most district clinics report no functioning otoscopes, successful completion of the course will entitle the participants’ clinic to at least one otoscope. The provision of otoscopes will significantly improve primary ear and hearing health care and should, therefore, reduce the number of patients requiring referral to the hospital-based ENT department for advanced stages of ear disease and associated hearing loss.

We share our experience to promote similar initiatives in low- and middle-income countries, especially among our Pacific Island neighbors where ear and hearing health specialists are virtually nonexistent. Strengthening the skills of primary health workers should significantly reduce the avoidable burden of ear disease and hearing loss in the Pacific Islands. This aligns with the current philosophy of task-sharing, as advocated by the WHO Division on Prevention of Deafness and Blindness. We take this opportunity to thank the Royal Australasian College of Surgeons for their financial and resource contributions in making the WHO PEHC training dream for Samoa a reality.

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