Bridging the policy-practice gap: A call for urgent early intervention and early education South African policy reform for children who are deaf or hard-of-hearing.

In the global context, South Africa demonstrates higher disabling-hearing-loss prevalence rates than high-income countries because of its contextual challenges such as high burden of disease and audiology service access inequity. While high-income countries demonstrate integrated Early Hearing Detection and Intervention (EHDI) programmes with mandated support, South Africa faces distinctive challenges in translating its early intervention policy precepts into actionable support systems, with fragmentation across health, social development, and education sectors for children who are deaf or hard-of-hearing (D or HH). Key barriers include delayed detection and diagnosis, reduced access to audiological services and education, cultural and linguistic incongruence, and inadequate data management systems, particularly as children who are D or HH transition between health, education and social development sectors.Contribution: Despite policy recognition of South African Sign Language and calls for inclusive education, service delivery remains siloed and reactive rather than proactive. The South African disconnect between policy intent and practice necessitates urgent reform through mandating implementation of EHDI guidelines, the integration of interdepartmental referral systems, and bottom-up legislative processes that incorporate grassroots stakeholder input. Culturally and linguistically responsive approaches and system integration, with cognisance of child and/or family culture and home language across system tiers (specifically the micro-, meso- and exo-system levels), are essential to ensure equitable developmental outcomes for children who are D or HH in South Africa. This clinical audiologist and researcher's opinion piece offers tangible recommendations for the way forward, including mandating EHDI guidelines, developing policy briefs, using early education as a nexus for diagnosis and intervention, and fostering bottom-up grassroots stakeholder involvement.