Analysis of expanding HCW by cadre

[BinglingICL]

In this branch, we analyse the marginal and combined impact (in terms of DALYs, Deaths, Services by appointment types/treatment types) of expanding current HCW capabilities for five cadres - Clinical (C), DCSA (D), Nursing and Midwifery (N), Pharmacy (P), Other (O) - given an annual extra budget that is 4.2% of total cost of these cadres of the previous year. These main cadres are among the priorities cadres (HSSP III HRH Annex) and tlo model has fairly simulated their time usage (not sure about DCSA). The 4.2% growth rate is referred to the annual GDP growth rate in Malawi (Margherita 2024), which is 4.2%, and the assumption that proportion of GDP allocated for HRH costing is fixed.

The HRH expansion path in the simulation is as below:

Todo:
(1.1) Find out why some scenarios have less services by treatments and appointments but more DALYs averted compared to others -> Only tell by the difference of HCW expansion scenarios, but not yet clear how it exactly links to services delivered and DALYs averted. May need analyses of individual appts and treatments and causes of DALYs. (The reason should be multifactorial and possible trade-off between cadres, appointment types and treatments types, which might not directly indicate the benefits on DALYs averted. Possible factors: Clinical cadre, Pharmacy cadre, Pharm Dispensing appointment, etc).

(1.2) Sensitivity analysis

(1.3) Random sampling of C, P and N cadres to find the path leading to the "best"/optimal extra budget allocation strategy?

(2.0) Once the analysis on national level is completed, consider district-level analysis and collaborate with relevant colleagues from the team and Malawi

[BinglingICL]

1. Confirm the scenarios before summit to Azure (C + P or C+NM+P, scale up ratios, time of change)

to do for scenario design:
(1) Use the GDP expenditure on HR and HR cost (salary) data to figure out given a % increase of HR expenditure, how to increase the staff of cadres Clinical, Nursing and Midwifery, Pharmacy and DCSA, both independently or in a combined way. The ways to increase staff will be the scenarios to be examined.
(2) Use meshgrid and function to implement multiple scenarios, instead of explicitly write them one by one.