It is estimated that at least two thirds of the world's population of persons with disabling hearing impairment reside in developing countries. Yet, little and slow progress have been reported in these countries towards tackling this problem principally on account of inadequate resources. The prospects for improvement remain uncertain. This paper re-examines the peculiar nature of hearing impairment prevention within the context of the existing health-care needs of most of these nations. It establishes that the failure to recognize the dynamics of the social change that underlie an effective national programme on hearing impairment prevention may, in itself, forestall a successful and sustainable outcome even when more resources become available.