Purpose: This study aimed to describe the impact of a preschool hearing screening program in a low- and middle-income country (LMIC) in terms of referral outcomes and caregiver perspectives. Method: This study included two components. First, a review of outcomes from a large-scale community-based hearing screening program, facilitated by community health workers (CHWs), for preschool children who failed their hearing screening. Second, telephonic surveys were conducted with (a) 25 caregivers whose children attended follow-up appointments and were diagnosed with hearing loss and (b) 33 caregivers whose children did not attend follow-up appointments. Results: Over 21 months, 13,322 children underwent hearing screening, with an initial referral rate of 6% (809). Follow-up tests at preschools covered 86.2% (697) of children who failed the initial hearing screening, of whom 47.8% (387) presented with hearing loss and were referred for further evaluation. Among the 190 attending follow-up appointments, 54.8% (104) were diagnosed with hearing loss. Of these, 71.1% (74) had conductive hearing loss, 12.5% (13) had sensorineural hearing loss, and 13.5% (14) had mixed hearing loss. Caregivers strongly supported (96%) community-based hearing screening for preschool-aged children. Notably, attendance varied significantly between preschool rescreenings (86.2%) and health care facility follow-up appointments (49.1%). Caregivers highlighted barriers to attend hearing services including work commitments, long waiting times at health care facilities, miscommunication about referrals and appointments, relocations, and COVID-19 appointment cancellations. Conclusions: This study highlights the effectiveness of community-based hearing screenings in LMICs, led by CHWs. It emphasizes strong caregiver support and the importance of culturally relevant communication. Challenges in follow-up attendance persist, emphasizing the need for improved accessibility and communication within health care systems. Prioritizing caregiver concerns and promoting culturally sensitive education are essential for improving outcomes.