Summary The recent World Report on Hearing published by the WHO addresses made clear that hearing care is still not sufficiently accessible for those who need it. Especially in low- and middle income countries, hearing diagnostic and rehabilitation tools are lacking or hardly available. Implementing neonatal hearing screening (NHS) is one of the major challenges. In many countries NHS has been successfully implemented, leading to timely diagnosis and treatment of pediatric hearing loss. However, in many countries or regions NHS is not fully established, even within Europe. One of the problems in starting up an NHS programme is the lack of appropriate follow-up in the initial phase. It is often difficult to provide adequate diagnostic equipment and trained audiologists in a country with little experience in treating hearing loss at very young age. But, if proper follow-up is missing, is it worth the effort of starting up a screening programme? And is it ethically justifiable? This leads to the question at what moment a pediatric cochlear implementation programme should be introduced: before, during or after implementing NHS? Another important question is who should be responsible for introducing new hearing care programmes within a country, such as NHS and pediatric cochlear implantation. Professionals abroad can transfer the necessary experience, but involvement of local professionals and institutions is essential when aiming for a sustainable care system. In the end, the hearing care provided should be preferably fully independent and self-containing. Within this presentation an overview is given of European and world-wide provision of pediatric hearing care, with the main focus on hearing screening and cochlear implementation. We will discuss relevant opportunities and challenges in making pediatric hearing care accessible and sustainable, partly based on the experiences within the EUSCREEN study that was performed within 2017 and 2021. The WHO calls for action, but are we as hearing-care providers sufficiently aware of what kind of action is expected and what we can contribute ourselves? This session will not provide the definitive answers, but attempts to highlight necessary steps that lead to accessible and sustainable hearing care around the world within the field of pediatric cochlear implantation.