The paper reviews current efforts in early identification and provision of services to the hearing impaired in Pakistan and discusses possible strategies over the next 10 years in rural areas which currently offer no services. Needs in the area of preschool identification and intervention are identified and include proper assessment, appropriate hearing aids, home training by parents, and parent-professional collaboration. Since special schools and professional services could not begin to meet the needs of the hearing impaired, the author recommends locally based programs utilizing normal schools and the parents of the hearing impaired. It is suggested that even a few parents could form an association and pool their resources so that their children can be properly assessed, hearing aids purchased, and a local technician trained in hearing aid servicing. It is thought that such a group would serve as an example of what can be done through local self help groups to improve the lot of hearing impaired children. Foreign technical assistance is seen as providing pump priming, organizational help, and technical development of appropriate hearing aids and audiometers. (DB)