Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

• Published in: BMJ global health Vol. 6; no. 6; p. e006045
• Main Authors: Briggs, Andrew M, Huckel Schneider, Carmen, Slater, Helen, Jordan, Joanne E, Parambath, Sarika, Young, James J, Sharma, Saurab, Kopansky-Giles, Deborah, Mishrra, Swatee, Akesson, Kristina E, Ali, Nuzhat, Belton, Joletta, Betteridge, Neil, Blyth, Fiona M, Brown, Richard, Debere, Demelash, Dreinhöfer, Karsten E, Finucane, Laura, Foster, Helen E, Gimigliano, Francesca, Haldeman, Scott, Haq, Syed A, Horgan, Ben, Jain, Anil, Joshipura, Manjul, Kalla, Asgar A, Lothe, Jakob, Matsuda, Shuichi, Mobasheri, Ali, Mwaniki, Lillian, Nordin, Margareta C, Pattison, Marilyn, Reis, Felipe J J, Soriano, Enrique R, Tick, Heather, Waddell, James, Wiek, Dieter, Woolf, Anthony D, March, Lyn
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Advocacy; Clinical Medicine; Cross-sectional studies; cross-sectional survey; Disease prevention; Expenditures; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Global health; Health care policy; Health policy; Health Sciences; health services research; health systems; Hälsovetenskap; Klinisk medicin; Leadership; Low income groups; Medical and Health Sciences; Medicin och hälsovetenskap; Original Research; Orthopedics; Ortopedi; Pain; Public Health, Global Health, Social Medicine and Epidemiology; Qualitative research; qualitative study; Rehabilitation; Trauma; cross-sectional survey; health services research; qualitative study; health systems; health policy
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2021-006045

IntroductionDespite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.MethodsDesign: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1–2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.ResultsPhase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.ConclusionAn empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.