India’s state-funded cochlear implant programmes are transforming hearing care, improving access for children and adults across socioeconomic divides.
India boasts a demographic landscape where a substantial portion of its population comprises children, and they play a pivotal role in shaping the nation’s future. These young minds represent the future innovators, leaders and workforce of the country. Their education, health and overall wellbeing are paramount, not only for their personal development but also for the progress of the entire nation. Nurturing and investing in this pool is essential for India’s economic growth and social development.
According to WHO estimates, approximately 63 million people in India suffer from significant auditory impairment, including an estimated 22 million children with deafness. A nationwide survey by the National Program for Prevention and Control of Deafness (NPPCD), has concluded that incidence of deafness is four per 1000 live births in India.
Hearing impairment in a child, especially when present from birth, can profoundly impact their quality of life. Cochlear implant (CI) is an established treatment for patients with bilateral severe to profound sensorineural hearing loss. It is a medical device that uses electricity to stimulate the spiral ganglion cells of the auditory nerve. Neuroplasticity, the ability of neurons to change or reorganise, underpins the success of early implantation.
Everything comes with a price and so does cochlear implantation. In a developing country like India, challenges of accessing cochlear implants is exacerbated by the economic disparities that exist in the country. A significant portion of the Indian population faces economic constraints, making it difficult for them to afford specialised treatments.
Figure 1: Operative setup for cochlear implantation, showcasing the surgical environment and equipment used.
Back in the early 2000s, India’s healthcare infrastructure was often strained and public subsidies for such treatment was limited. This disparity underlined the urgent need for improved accessibility and affordability of essential healthcare services in India.
Therefore, government-funded schemes and non-governmental organisations play a crucial role in supporting this population by providing access to advanced and expensive CI technology – either free of cost or at a subsidised rate.
In India the first cochlear implant surgery was done in the 1990s and that was in a private setup. Medical insurance companies did not, and still do not, cover cochlear implants but the government has been convinced to support many cochlear implant programmes.
Access to CIs in India varies significantly across states due to differences in socioeconomic and demographic profiles. Nearly two thirds of Indian states have some form of government-funded CI programme, providing beneficiaries with access to designated implant centres. However, the extent of accessibility and quality of care still depends on the state-specific policies, infrastructure and resource allocation. While some states have well-established programmes with multiple implant centres, others may have limited coverage, leading to disparities in access to CIs across the country. We have made remarkable strides in bridging this gap.
The journey of cochlear implants in Rajasthan began in September 2010, marking a significant milestone in the state’s healthcare history. The first CI recipient was a post-lingual 20-year-old gentleman who lost his hearing due to head injury in a road traffic accident. The success of this surgery helped the state get government funding for cochlear implants. Initially there was an age limit up to six years but, from 2022 onwards, the age limit has been reduced to four years.
Across India, the eligibility criteria for government-funded CIs vary, as each state sets its own guidelines based on available resources and healthcare priorities. In most cases, funding is limited to unilateral implantation, primarily for children between three to five years of age. Some states may have slightly broader criteria but, overall, access remains restricted, particularly for older children and adults. These criteria are shaped by budget constraints, clinical recommendations and the perceived long-term benefits of early intervention in paediatric patients. Our criteria has evolved to a broader inclusion and reduced age limit to improve accessibility and outcomes.
"According to WHO estimates, approximately 63 million people in India suffer from significant auditory impairment, including an estimated 22 million children with deafness"
While the government-funded CI programme has long focused on paediatric cases, the state is now shifting gears to address a broader need – adult cochlear implantation – recognising that hearing loss is not just a childhood disability but a lifelong challenge. Unlike before, where adults had little to no financial support for implantation, the state now allows government-funded CIs for adults, but with an added layer of scrutiny. Each case undergoes evaluation and approval from a state-level expert committee, ensuring that implants are provided to those who will benefit most. This marks a significant shift in the state’s approach, acknowledging that adults with severe to profound hearing loss also deserve access to advanced hearing solutions.
By making hearing care accessible at all ages, the state is paving the way for a more inclusive and comprehensive healthcare system – one that values hearing health throughout life, not just in childhood. However, while this progress is commendable, significant challenges remain, particularly in paediatric cochlear implantation.
Through the combined efforts of the government, responsible society, dedicated doctors and speech therapists, our CI programme has flourished. To date, approximately 1200 patients have benefited from this initiative and more than seven government centres now regularly perform CI surgeries. Additionally, an equivalent number of speech therapy centres have been approved for CI, further enhancing the comprehensive care and support provided to these children.
Figure 2: Therapy centre equipped with specialised tools and resources designed to facilitate auditory-verbal therapy for children with cochlear implants.
This success has been built over the years through continuous improvements in accessibility and awareness. Not only has the number of implant centres expanded, but the age of implantation has also seen a significant shift. In the early days of the programme, the average age of implantation was around four years. Today, due to greater awareness, improved screening and earlier diagnosis, the average age has decreased to approximately two to two and a half years. In 2011, our state had only one implant centre but, with sustained government support, the number has now grown to 10 centres, each running its own state-supported CI programme. Jaipur currently has two government-funded cochlear implant centres, catering to a large population in need of hearing rehabilitation. Over the years, the number of implant centres across the region has gradually increased, ensuring better access to care. This expansion has been facilitated through structured mentorship and training programmes, closely monitored by expert organisations such as the Cochlear Implant Group of India (CIGI) and the Society of ORL Surgeons. These programmes play a crucial role in training surgeons, audiologists and rehabilitation specialists, ensuring that high standards of care are maintained as new centres develop.
Government-funded CI programmes are a testament to the power of collective efforts in transforming lives. They offer not only the restoration of hearing but the promise of a brighter, more inclusive future for both children and adults who would otherwise be trapped in silence.
Our model demonstrates that with strong collaboration and strategic planning, even resource-limited regions can build effective healthcare programmes that change lives. Developing countries, where financial constraints often limit access to advanced medical treatments, can take inspiration from India’s state-funded CI initiatives. By adopting similar frameworks, they can ensure that individuals with hearing loss, regardless of their economic background, receive the care they deserve. Healthcare should not be a privilege but a fundamental right and, by learning from successful models, nations across the world can work towards a brighter, more inclusive future for all – where the gift of sound is accessible to everyone, not just in India, but across the globe.
Declaration of competing interests: None declared.
