An estimation of the health-cost of unfilled medical positions in Malawi: A Thanzi La Onse Mathematical Modelling study

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Abstract Background Malawi’s healthcare system faces strain due to an insufficient number of healthcare workers (HCWs). The number of HCWs currently employed falls below the Malawian government’s own facility-based staffing standards, which are known as the establishment target . While vacancy rates from this target have been estimated, the health consequences of this workforce gap on the population have not. Methods This study quantifies the health-cost of unfilled establishment HCW positions using the Thanzi La Onse (TLO) model, an “all diseases – whole healthcare system” individual-based model, which self-consistently accounts for the dynamics between health system constraints and population health. We constructed two staffing scenarios: one ( Current) in which the currently employed staff are represented, and another ( Target) where all positions planned under the establishment target are filled. Using the TLO model, we then estimate the health impact of filling all establishment positions as the difference in the Disability-Adjusted Life Years (DALYs) incurred between the two scenarios. Results Our results indicate that fulfilling Target positions could reduce the health losses by 13.6% (43.1 million DALYs averted, 95% CI: 40.8–48.6) over the projection period. The largest proportional reductions are for DALYs caused by HIV/AIDS (41%), tuberculosis (26%), and malaria (24%) compared to the Current provision. Conclusions The analysis shows the potential health benefits associated with increasing the fulfilment of establishment positions in Malawi and offers key quantifications for policymakers as they strive to achieve Universal Health Coverage. Author Summary Malawi’s current healthcare workforce is significantly smaller in number than the establishment targets set out by the Ministry of Health. Our research uses an individual-based epidemiological and healthcare system model, Thanzi La Onse , to examine the consequences of filling all the target healthcare worker positions. We find that the healthcare system could reduce the overall disease burden by an extra 43.1 million DALYs (13.6% reduction) between 2023 and 2040, with the greatest reductions in the burden of AIDS, tuberculosis, and malaria. This modelling approach accounts for other barriers to healthcare delivery, such as healthcare-seeking habits, consumables and equipment supply, diagnostic accuracy, and treatment efficacy. Our findings, therefore, show that in Malawi’s healthcare system, every unfilled healthcare worker post represents an important lost opportunity for population health gains.

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