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

被引：27

作者：

Briggs, Andrew M. ^{[1
,2
,3
]}

Jordan, Joanne E. ^{[4
]}

Sharma, Saurab ^{[5
,6
,7
]}

Young, James J. ^{[8
,9
]}

Chua, Jason ^{[10
]}

Foster, Helen E. ^{[11
,12
]}

Haq, Syed Atiqul ^{[13
,14
]}

Schneider, Carmen Huckel ^{[15
]}

Jain, Anil ^{[16
]}

Joshipura, Manjul ^{[17
]}

Kalla, Asgar Ali ^{[18
]}

Kopansky-Giles, Deborah ^{[3
,8
,19
]}

March, Lyn ^{[3
,20
,21
]}

Reis, Felipe J. J. ^{[22
,23
,24
]}

Reyes, Katherine Ann, V ^{[25
,26
]}

Soriano, Enrique R. ^{[27
,28
]}

Slater, Helen ^{[1
,2
]}

机构：

[1] Curtin Univ, Fac Hlth Sci, Curtin Sch Allied Hlth, Bentley, WA 6102, Australia

[2] Curtin Univ, Fac Hlth Sci, EnAble Inst, Bentley, WA 6102, Australia

[3] Univ Sydney, Inst Bone & Joint Res, Kolling Inst, Global Alliance Musculoskeletal Hlth G MUSC, 10 Westbourne St, St Leonards, NSW 2064, Australia

[4] HealthSense Aust Pty Ltd, Malvern East, Vic 3145, Australia

[5] Kathmandu Univ, Dept Physiotherapy, Sch Med Sci, Dhulikhel 45200, Nepal

[6] Univ New South Wales, Fac Med & Hlth, Sch Hlth Sci, 18 High St, Kensington, NSW 2052, Australia

[7] Neurosci Res Australia, Ctr Pain IMPACT, 139 Barker St, Randwick, NSW 2031, Australia

[8] Canadian Mem Chiropract Coll, Dept Res, 6100 Leslie St, N York, ON M2H 3J1, Canada

[9] Univ Southern Denmark, Ctr Muscle & Joint Hlth, Dept Sports Sci & Clin Biomech, DK-5230 Odense, Denmark

[10] Auckland Univ Technol, Fac Hlth & Environm Sci, TBI Network, 55 Wellesley St East, Auckland 1010, New Zealand

[11] Newcastle Univ, Populat Hlth Inst, Newcastle Upon Tyne NE2 4AX, Tyne & Wear, England

[12] Univ Sydney, Paediat Global Musculoskeletal Task Force, Global Alliance Musculoskeletal Hlth, Inst Bone & Joint Res,Kolling Inst, 10 Westbourne St, St Leonards, NSW 2064, Australia

[13] Bangabandhu Sheikh Mujib Med Univ, Rheumatol Dept, Dhaka 1000, Bangladesh

[14] Asia Pacific League Assoc Rheumatol APLAR, Shaw Ctr, 1 Scotts Rd 24-10, Singapore 228208, Singapore

[15] Univ Sydney, Fac Med & Hlth, Menzies Ctr Hlth Policy & Econ, 17 John Hopkins Dr, Camperdown, NSW 2050, Australia

[16] Santokba Durlabhji Mem Hosp, Dept Phys Med & Rehabil, Bhawani Singh Marg Rd, Jaipur 302015, Rajasthan, India

[17] AO Alliance Fdn, Clavadelerstr 8,Davos Pl, CH-7270 Davos, Switzerland

[18] Univ Cape Town, Dept Med, Anzio Rd, ZA-7925 Cape Town, South Africa

[19] Univ Toronto, Dept Family & Community Med, 500 Univ Ave, Toronto, ON M5G 1V7, Canada

[20] Royal North Shore Hosp, Florance & Cope Professorial Dept Rheumatol, Reserve Rd, St Leonards, NSW 2065, Australia

[21] Univ Sydney, Kolling Inst, 10 Westbourne St, St Leonards, NSW 2064, Australia

[22] Inst Fed Rio de Janeiro IFRJ, Phys Therapy Dept, R Sen Furtado 121-125, BR-20270021 Rio De Janeiro, RJ, Brazil

[23] Univ Fed Rio de Janeiro UFRJ, Clin Med Dept, BR-21044020 Rio De Janeiro, RJ, Brazil

[24] Vrije Univ Brussel, Pain Mot Res Grp, Dept Physiotherapy Human Physiol & Anat, Fac Phys Educ & Physiotherapy, Bd Plaine 2, B-1050 Brussels, Belgium

[25] Alliance Improving Hlth Outcomes Inc, Quezon City 1104, Philippines

[26] Pamantasan Lungsod Maynila, Sch Publ Hlth, Manila 1002, Philippines

[27] Hosp Italiano Buenos Aires, Rheumatol Unit, Internal Med Serv, Tte Gral Juan Domingo Peron 4190,C1199 CABA, Buenos Aires, DF, Argentina

[28] Pan Amer League Assoc Rheumatol PANLAR, Wells Fargo Plaza,333 SE 2nd Ave Suite 2000, Mia, FL 33131 USA

来源：

HEALTH POLICY AND PLANNING | 2023年 / 38卷 / 02期

关键词：

Low- and middle-income; policy; qualitative; health system; non-communicable; musculoskeletal; MUSCULOSKELETAL CONDITIONS; POLITICAL PRIORITY; GLOBAL BURDEN; GENERATION; FRAMEWORK; CARE;

D O I：

10.1093/heapol/czac061

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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.

引用

页码：129 / 149

页数：21

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