Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies

Andrew M Briggs; Joanne E Jordan; Saurab Sharma; James J Young; Jason Chua; Helen E Foster; Syed Atiqul Haq; Carmen Huckel Schneider; Anil Jain; Manjul Joshipura; Asgar Ali Kalla; Deborah Kopansky-Giles; Lyn March; Felipe J J Reis; Katherine Ann V Reyes; Enrique R Soriano; Helen Slater

doi:10.1093/heapol/czac061

Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies

Health Policy Plan. 2023 Feb 13;38(2):129-149. doi: 10.1093/heapol/czac061.

Authors

Andrew M Briggs^{1

2}, Joanne E Jordan³, Saurab Sharma^{4

5

6}, James J Young^{7

8}, Jason Chua⁹, Helen E Foster^{10

11}, Syed Atiqul Haq^{12

13}, Carmen Huckel Schneider¹⁴, Anil Jain¹⁵, Manjul Joshipura¹⁶, Asgar Ali Kalla¹⁷, Deborah Kopansky-Giles^{2

7

18}, Lyn March^{2

19

20}, Felipe J J Reis^{21

22

23}, Katherine Ann V Reyes^{24

25}, Enrique R Soriano^{26

27}, Helen Slater¹

Affiliations

¹ Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
² Global Alliance for Musculoskeletal Health (G-MUSC), Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia.
³ HealthSense (Aust) Pty Ltd, Malvern East, Victoria 3145, Australia.
⁴ Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal.
⁵ School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, 18 High St Kensington, New South Wales 2052, Australia.
⁶ Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, New South Wales 2031, Australia.
⁷ Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, Ontario M2H 3J1, Canada.
⁸ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
⁹ TBI Network, Faculty of Health and Environmental Sciences, Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland 1010, New Zealand.
¹⁰ Population Health Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom.
¹¹ Paediatric Global Musculoskeletal Task Force, Global Alliance for Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia.
¹² Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh.
¹³ Asia Pacific League of Associations for Rheumatology (APLAR), 1 Scotts Road #24-10, Shaw Center Singapore 228208, Singapore.
¹⁴ Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, 17 John Hopkins Drive, Camperdown, New South Wales 2050, Australia.
¹⁵ Department of Physical Medicine & Rehabilitation, Santokba Durlabhji Memorial Hospital, Bhawani Singh Marg Road, Rambagh Circle 302015, Jaipur, India.
¹⁶ AO Alliance Foundation, Clavadelerstrasse 8, Davos Platz 7270, Switzerland.
¹⁷ Department of Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
¹⁸ Department of Family & Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada.
¹⁹ Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Reserve Rd, St Leonards NSW 2065, Australia.
²⁰ Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia.
²¹ Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), R. Sen. Furtado, 121/125 - Maracanã, Rio de Janeiro - RJ, 20270-021, Brazil.
²² Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, 21044-020, Brazil.
²³ Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Bd de la Plaine 2, Ixelles 1050, Brussels, Belgium.
²⁴ Alliance for Improving Health Outcomes, Inc., West Ave, Quezon City 1104, Philippines.
²⁵ School of Public Health, Pamantasan ng Lungsod ng Maynila, Intramuros, Manila, 1002 Metro, Manila, Philippines.
²⁶ Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 CABA, Buenos Aires, Argentina.
²⁷ Pan-American League of Associations for Rheumatology (PANLAR), Wells Fargo Plaza, 333 SE 2nd Avenue Suite 2000 Mia, Florida 33131, United States of America.

Abstract

Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care.

Keywords: Low- and middle-income; health system; musculoskeletal; non-communicable; policy; qualitative.

MeSH terms

Delivery of Health Care
Developing Countries*
Health Policy
Humans
Noncommunicable Diseases* / prevention & control
Pain

Abstract

MeSH terms

Grants and funding