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Background: Childhood hearing loss is a global health concern. Despite the proven benefits of neonatal hearing screening (NHS), it is not yet mandated in South Africa. The lack of awareness of hearing loss and absence of NHS leads to delayed diagnosis and adverse developmental outcomes for affected children. Aim: The study aimed to assess the availability of NHS services across primary healthcare (PHC) facilities in the City of Cape Town (CCT). Setting: Surveys were conducted with 26 PHC facilities in the CCT metropolitan areas that offer mother and child healthcare services. Methods: Surveys gathered data through online and telephone methods. The surveys aimed to assess the availability and nature of NHS services, care pathways and training of healthcare professionals regarding NHS. Results: None of the facilities used objective screening methods to screen hearing or have standardised care pathways for at-risk babies. Instead, they relied on parental concerns, with the use of the Road to Health book. None of the respondents reported having received hearing screening training, and the majority of participants (62%) lacked confidence in their knowledge of ear and hearing care. Conclusion: The absence of NHS services highlights the need for standardised protocols and increased awareness among healthcare workers and caregivers. Implementing NHS services could facilitate earlier diagnosis and intervention of hearing loss for infants in the Western Cape. Contribution: This study’s findings could guide efforts to improving access to NHS access at PHC level in Cape Town, ultimately providing early hearing screening services to infants.