Affiliation:
1. Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore MD
2. Paul H. Nitze School of Advanced International Studies Johns Hopkins University Washington DC
Abstract
Background
Rheumatic heart disease (RHD) poses a high burden in low‐income countries, as well as among indigenous and other socioeconomically disadvantaged populations in high‐income countries. Despite its severity and preventability, RHD receives insufficient global attention and resources. We conducted a qualitative policy analysis to investigate the reasons for recent growth but ongoing inadequacy in global priority for addressing RHD.
Methods and Results
Drawing on social science scholarship, we conducted a thematic analysis, triangulating among peer‐reviewed literature, organizational documents, and 20 semistructured interviews with individuals involved in RHD research, clinical practice, and advocacy. The analysis indicates that RHD proponents face 3 linked challenges, all shaped by the nature of the issue. With respect to
leadership and governance
, the fact that RHD affects mostly poor populations in dispersed regions complicates efforts to coordinate activities among RHD proponents and to engage international organizations and donors. With respect to
solution definition
, the dearth of data on aspects of clinical management in low‐income settings, difficulties preventing and addressing the disease, and the fact that RHD intersects with several disease specialties have fueled proponent disagreements about how best to address the disease. With respect to
positioning
, a perception that RHD is largely a problem for low‐income countries and the ambiguity on its status as a noncommunicable disease have complicated efforts to convince policy makers to act.
Conclusions
To augment RHD global priority, proponents will need to establish more effective governance mechanisms to facilitate collective action, manage differences surrounding solutions, and identify positionings that resonate with policy makers and funders.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
20 articles.
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