Skip to main content

Table 4 Accelerators for the development and implementation of a global MSK strategy

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

Accelerator

Description

Illustrative quotes

Leveraging multi-sectoral partnerships and cooperation to facilitate sustainable and scalable change

A multi-sectoral approach that supports engagement and education of the community (people, patients, organisations, governments) and the establishment of partnerships between government and non-government agencies (including existing regional societies) to address prevention and management of MSK health is needed. Additionally, consideration of cultural differences in how health is conceptualised is necessary.

To achieve the necessary scale of change, this strategic approach must extend beyond the healthcare sector and intentionally and explicitly involve multiple other sectors of the community and across government ministries.

“I think there has been general momentum in the last 5 to 10 years for existing rheumatology or musculoskeletal associations to communicate much more clearly with each other to think about working together, to think about a much more collective approach. Certainly, that is a direction that EULAR has really taken very seriously and we now have improving relationships. We’ve, for some number of years, had strong relations with American colleagues, but I have to say we’ve worked very hard to build strong relationships with the Asia-Pacific League, with PANLAR and, especially in the last short number of years, with AFLAR to really seek that. Obviously, there are low- and middle-income countries in all of the regions, but we’ve already started to look at building consensus.” (ID15)

“I think it needs to be targeted, anything we do needs to be targeted at all levels. I think targeting at governmental levels is one, but I think civil society, public health agencies, employers, but also community awareness and community help. So, I think any campaign would need to be targeted at all levels in order to be effective.” (ID7)

Intentional alignment with existing global or international strategies and initiatives

An MSK global strategy needs to align with, and link into existing global strategies and initiatives that are relevant to a lifecourse approach. There is a need to focus on health and participation that extends beyond MSK health (e.g. healthy ageing, NCD prevention and control, obesity management, rehabilitation, physical activity, work), including SDG-3, and be formulated in a way that can align with existing national strategies.

"I guess you’ve got to go back to make sure that you’re connecting with the Clinical Consortium on Health Outcomes at the WHO and you’ve got to be knowing that the Integrated Care for Older People (ICOPE) is evidence-based. So, you’ve got specific plans and programs already happening." (ID23)

“… I also think that there needs to be a willingness to link our strategy with existing strategies outside of musculoskeletal health as well, because there are so many crossovers. Obesity is probably one that comes to top of mind and obesity is an issue with cardiovascular health and cancer and many others as well. So, we need to make our strategy, it needs to have the ability to overlap and co-exist with other strategies …” (ID12)

Identify essential, evidence-based standards or actions to enable lower-resourced settings to initiate action on MSK health

A strategy should identify the minimum (essential), evidence-based actions and standards for effective prevention and management of MSK health conditions, pain care and injury care. Depending on resourcing, priorities and context of each individual country, there may be options for advanced (desirable) standards or care considerations.

This framework would provide guidance on ‘what’ essential care to provide, allowing countries to decide ‘how’ best to deliver the care in their unique contexts.

“The concept of this being a universal thing is difficult. Things that are relevant to Australia, Canada, United States and Great Britain are largely irrelevant, I think, in some low- and middle-income countries, other than the philosophy of care. So, I think the emphasis should be more on the philosophy of care in terms of what’s important and what isn’t important, as opposed to the mechanics of care, if I can use that term.” (ID26)

“One thing I think from a simple rehabilitation perspective is to create sort of packages of rehabilitation interventions that should be done for the management of musculoskeletal conditions. Like a minimal level of assistance that should be provided in Universal Health Coverage for musculoskeletal conditions and a sort of recipe of the minimal amount.” (ID29)

Increase public and government awareness of MSK health, the impacts of MSK-related disability and that effective management is possible

In order for multi-sectoral reform initiatives to be effective and sustainable, there is a need to increase and improve the awareness among society, policymakers and global organisations in relation to:

the importance of MSK health;

the socioeconomic impacts of MSK-related disability on people and broader communities;

the management of MSK conditions and that effective care is possible, supported by data and actions/solutions.

“I think one thing is to follow the route that all major global health problems have taken, that is to raise awareness, show data, show the impact of the problem and, at the same time, propose a solution. So, I think it’s a package that we need to present to the international community, to the decision-makers, politicians and global health agencies” (ID19)

“From a personal perspective I think we need to move musculoskeletal health away from a somewhat ethereal area of rheumatism, perceived to be a disease of the older population, to something that is actually amenable to modern molecular, digital, AI-driven interventions that can really change lives and that can really inform policy, that can keep people working, that can keep people with their families for longer.” (ID15)

Co-design objectives and performance indicators relevant to desired outcomes and implementation

A global strategy needs to be accompanied by an action plan that articulates specific objectives and performance indicators that are co-designed by the global community through thorough consultation. Objectives and indicators must be acceptable and feasible to guide implementation activity, resourcing and monitoring, including evaluation of implementation. This is relevant at the global level and to support development at the country level.

That would be the starting point to actually lay out what the expectations are within the strategy and having the supporting action plan to actually then understand what needs to happen. And then the measurement as well of that, a system, so it’s not just an action plan that sits on the shelf and never comes to fruition, but actually having systems in place where that’s then measured in a timely way.” (ID17)

“… but I thought that what you hadn’t sorted out was what it was you were trying to reduce. So, to me, the aim of a musculoskeletal strategy is to reduce fractures, to reduce hip replacements, to improve WOMACs, to reduce VAS scores for back pain.” (ID9)

Language translation is essential for improving access and uptake

To support dissemination and uptake of a global strategy for MSK health, investment in translation beyond the six official UN languages is important, to ensure that all countries have access to global guidance.

“So, I think that language barrier is an important issue, especially when I think about global strategies. When translations are provided they are in French and Spanish. Other languages, like Brazilian Portuguese, Portuguese from Portugal, German and Italian, are not covered … So when we plan or develop a strategy with global impact we need to overcome this language barrier, providing the most translations that we can, like Japanese and Arabic. So, we need to overcome and also provide strategies that are inclusive and not only in English and assuming that everybody can read in English.” (ID28)

Provide guidance on MSK health care in the context of pandemics (e.g. COVID-19)

A contemporary global strategy for MSK health needs to consider the impact of COVID-19 (and potentially future pandemics) on access to MSK healthcare services and the likely impact on COVID-19 on MSK health. In this context, providing guidance on how countries can manage MSK health in the context of a pandemic is important; e.g. guidance on self-management, guidance on access to rehabilitation services.

“...then because of COVID there are so many restrictions to, for example, physical exercise and things like that so we encourage people to do the online exercise and online self-management. So, it’s very important to have that aspect and also self-care and self-management, not always prescribed by physiotherapists or doctors, it’s more like how they can adopt healthy behaviour to promote mobility and decrease the pain and cope with pain.” (ID24).

So, because of the COVID situation, actually government is trying to narrow down what is an essential service for babies, essential for adults and essential for the older adults.” (ID24)

  1. AFLAR African League of Associations for Rheumatology, EULAR European Alliance of Associations for Rheumatology, LMICs low- and middle-income countries, ICOPE Integrated Care for Older People, MSK musculoskeletal, NCDs noncommunicable diseases, PANLAR Pan-American League of Associations for Rheumatology, SDG Sustainable Development Goal, VAS visual analogue scale, WHO World Health Organization, WOMAC Western Ontario and McMaster Universities Osteoarthritis Index