The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

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The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants


JournalGlobal Health Research and Policy
Article typeJournal research article – Clinical research
Publication date – Jul – 2021
Authors – Andrew M. Briggs, Joanne E. Jordan, Deborah Kopansky-Giles, Saurab Sharma, Lyn March, Carmen Huckel Schneider, Swatee Mishrra, James J. Young , Helen Slater
Keywordsdisability, Global Health, Musculoskeletal, rehabilitation, Strategy, Systems strengthening
Open access – Yes
SpecialityHealth policy, Trauma and orthopaedic surgery
World region Global

Language – English
Submitted to the One Surgery Index on July 19, 2021 at 9:37 pm
Abstract:

Background
Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.

Methods
An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model.

Results
Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.

Conclusion
KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

OSI Number – 21174

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