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

Author

Dieter Wiek, Richard Brown, Andrew M Briggs, Saurab Sharma, James Waddell, Anthony D Woolf, Lyn March, Helen Slater, Enrique R Soriano, Kristina E Åkesson, Fiona M Blyth, Ali Mobasheri, Ben Horgan, Helen E Foster, Neil Betteridge, Joanne E Jordan, Anil Jain, Francesca Gimigliano, Nuzhat Ali, Margareta C Nordin, Shuichi Matsuda, Carmen Huckel Schneider, Sarika Parambath, James J Young, Deborah Kopansky-Giles, Swatee Mishrra, Joletta Belton, Demelash Debere, Karsten E Dreinhöfer, Laura Finucane, Scott Haldeman, Syed A Haq, Manjul Joshipura, Asgar A Kalla, Jakob Lothe, Lillian Mwaniki, Marilyn Pattison, Felipe J J Reis, and Heather Tick

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Despite 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.Methods Design: 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.Results Phase 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.Conclusion An 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.

Published
2021
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2. Health systems strengthening to arrest the global disability burden:Empirical development of prioritised components for a global strategy for improving musculoskeletal health

Author

Marilyn Pattison, Fiona M. Blyth, Anil Jain, Asgar Ali Kalla, Lillian Mwaniki, Joletta Belton, Dieter Wiek, Sarika Parambath, Neil Betteridge, Syed Atiqul Haq, Manjul Joshipura, Deborah Kopansky-Giles, Jakob Lothe, Richard Brown, Joanne Jordan, Laura Finucane, Francesca Gimigliano, Heather Tick, Ben Horgan, Andrew M. Briggs, Kristina Åkesson, Felipe J J Reis, Demelash Debere, James J. Young, Shuichi Matsuda, Helen E. Foster, Scott Haldeman, Saurab Sharma, Margareta Nordin, Karsten Dreinhöfer, Helen Slater, Carmen Huckel Schneider, Nuzhat Ali, Lyn March, Anthony D. Woolf, Enrique R. Soriano, Swatee Mishrra, James P. Waddell, Ali Mobasheri, Briggs, A. M., Huckel Schneider, C., Slater, H., Jordan, J. E., Parambath, S., Young, J. J., Sharma, S., Kopansky-Giles, D., Mishrra, S., Akesson, K. E., Ali, N., Belton, J., Betteridge, N., Blyth, F. M., Brown, R., Debere, D., Dreinhofer, K. E., Finucane, L., Foster, H. E., Gimigliano, F., Haldeman, S., Haq, S. A., Horgan, B., Jain, A., Joshipura, M., Kalla, A. A., Lothe, J., Matsuda, S., Mobasheri, A., Mwaniki, L., Nordin, M. C., Pattison, M., Reis, F. J. J., Soriano, E. R., Tick, H., Waddell, J., Wiek, D., Woolf, A. D., and March, L.

Subjects
Medicine (General), Economic growth, Guiding Principles, qualitative study, Infectious and parasitic diseases, RC109-216, cross-sectional survey, 03 medical and health sciences, R5-920, 0302 clinical medicine, Blueprint, Political science, health system, 030212 general & internal medicine, Health policy, Original Research, 030203 arthritis & rheumatology, Health Policy, Public Health, Environmental and Occupational Health, Health services research, Global strategy, health policy, health services research, Construct (philosophy), Inclusion (education), health systems, Qualitative research
Abstract

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.

Published
2021
Full Text
View/download PDF

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