@article{She:2026,
author = {She, B and Mohan, S and Murray-Waston, RE and Bhatia, S and Chalkley, M and Colbourn, T and Collins, JH and Connolly, E and Janouková, E and Nkhoma, D and Revill, P and Tamuri, AU and Twea, PD and Mangal, TD and Mfutso-Bengo, J and Hallett, TB and Molaro, M},
journal = {BMJ Global Health},
title = {Health impacts of expanding the health workforce across cadres under an incremental budget in Malawi},
year = {2026}
}

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TY  - JOUR
AB  - Like many others, Malawi’s health care system faces significant health workforce shortages largely due to budget constraints that limit training, recruitment and retention of staff. A crucial question is how to best allocate a limited incremental budget to expand different health care workers (HCW) cadres so that the potential health gains are maximised, which is more important now than ever considering recent withdrawal and reduction in donor funding. This research aims to provide a practical answer to this question. We designed a range of budget allocation scenarios for HCW expansion across cadres and used the “all diseases – whole healthcare system” Thanzi La Onse (TLO) model to estimate the resulting population health outcomes. We find that, indeed, how to allocate the incremental budget among cadres is an important determinant of the potential health impact. Concentrating all of the budget on expanding a single cadre – such as Clinical, Pharmacy, or Nursing and Midwifery - is not the most effective use of the resources, even when that cadre currently faces the greatest staffing shortages. Similarly, allocating the budget in a manner that mirrors the current distribution of spending and results in a uniform expansion across cadres does not generate the greatest possible gains. Instead, an allocation that uplifts staffing for multiple cadres, accounting for the additional time and costs required to meet the future healthcare needs, yields the greatest benefits. We conclude that, in the context of complex interplay between demography, epidemiology, treatment scope and effectiveness, and health resource constraints, human resources for health (HRH) bottlenecks in achieving health gains are multifactorial and a needs-based, balanced mix of cadres and skills is required for future HRH expansion. As such, health system models such as the TLO that capture this interplay can make potential contributions to strengthening HRH planning.
AU  - She,B
AU  - Mohan,S
AU  - Murray-Waston,RE
AU  - Bhatia,S
AU  - Chalkley,M
AU  - Colbourn,T
AU  - Collins,JH
AU  - Connolly,E
AU  - Janouková,E
AU  - Nkhoma,D
AU  - Revill,P
AU  - Tamuri,AU
AU  - Twea,PD
AU  - Mangal,TD
AU  - Mfutso-Bengo,J
AU  - Hallett,TB
AU  - Molaro,M
PY  - 2026///
SN  - 2059-7908
TI  - Health impacts of expanding the health workforce across cadres under an incremental budget in Malawi
T2  - BMJ Global Health
ER  - 

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