From rights to reality: a critical review of policies governing services for deaf and hard-of-hearing children in LMICs

Abstract

Background Despite global recognition of the rights of Deaf and hard-of-hearing (DHH) children, significant gaps persist between policy commitments and service delivery, particularly in low- and middle-income countries (LMICs). International frameworks such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) mandate early intervention, inclusive education, and linguistic access; however, implementation remains uneven. Aim To critically examine policies governing services for DHH children, with a focus on alignment between international rights instruments and national implementation realities across Africa and other LMICs. Methods A systematic narrative review of peer-reviewed literature published between 2000 and 2025 was conducted across PubMed, Scopus, Web of Science, ScienceDirect, and EBSCOhost, with supplementary searches via Google Scholar. Data were extracted using a structured framework and synthesized using deductive thematic analysis. Particular attention was paid to policy implementation processes, contextual influences on service delivery, and factors shaping the translation of rights-based commitments into practice. Results Twenty-five studies were included, predominantly from LMIC contexts. Findings revealed strong rights-based policy commitments aligned with international frameworks; however, implementation was consistently limited. Six key themes emerged: (1) robust policy commitments with weak operationalisation; (2) fragmented or absent early hearing detection and intervention (EHDI) systems; (3) an “inclusion paradox” in education, characterized by placement without adequate support; (4) emerging but under-resourced sign language recognition; (5) pervasive structural barriers, including resource constraints, workforce shortages, and inequities; and (6) a persistent policy–practice gap across sectors. Conclusion While rights-based frameworks are well established, their translation into practice remains constrained by structural inequities, contextual implementation challenges, epistemic injustice, and unadapted policy transfer. Contextually responsive, equity-driven implementation, grounded in local realities rather than imported models, is required to realize meaningful outcomes for DHH children.