Purpose: Health metrics have evolved with increasing sophistication, with the disability-adjusted life-year (DALY) emerged as a widely used metric. While DALYs vary between countries, the global disability weights (DWs) that are integral to the DALY ignore the potential impact of local factors on the burden of disease. This paper explores the variability in the DW for developmental dysplasia of the hip (DDH) in relation to to local health environments using select health system indicators. Methods: The DW for DDH was assessed using three methods: ordinal preference ranking with a fixed rankles, a time-trade-off approach and a Visual Analogue Scale. The correlation between select health system indicators and the DW for DDH per country was assessed with a piecewise linear regression. Results: The DW for DDH increases with decreasing income level of countries. The Human Development Index and the Gross Domestic Product per capita are both negatively correlated with (p<0.05) the DW for DDH per country. For the indicators surgical workforce, surgical procedures and hospital beds per 1000 population, there is a significant negative correlation in countries not meeting the minimum standard of that indicator (p<0.05), while for countries meeting that minimum standard, the correlation between DW for DDH and the respective indicator is not significantly different from zero. Conclusion: Consideration should be given to re-establishing the DWs for health entities in countries that do not meet the minimum standards of a functional health system. This would more accurately reflect the burden of disease from a functional perspective in LMICs, and perhaps allow for more informed priority setting within LMICs and for donors.