BMJ Global Health最新文献

{"title":"Economic burden of typhoid among hospitalised children in Kenya.","authors":"Prashant Mandaliya, Stacey Orangi, Isaac Waluke, Franklin Okech, Felix Masiye, Obinna Onwujekwe, Lumbwe Chola, Edwine Barasa","doi":"10.1136/bmjgh-2025-023131","DOIUrl":"10.1136/bmjgh-2025-023131","url":null,"abstract":"<p><p>Typhoid remains endemic in many low and middle-income countries, with the highest incidence reported in children under 15 years. No published study has estimated the cost of hospitalised paediatric typhoid cases in Kenya. This analysis estimated the direct medical, direct non-medical and indirect costs from the healthcare provider and societal perspectives and assessed the proportion of households that would experience catastrophic health expenditure (CHE) due to the disease.Patient-level data on hospitalised children with typhoid were drawn from 16 public hospitals that are part of the Clinical Information Network (CIN) in Kenya. A cost-of-illness analysis was conducted. Resource quantities were extracted from CIN data and unit costs were obtained from price lists, surveys and expert interviews. All costs were converted to 2025 KES and USD. A simulation-based CHE analysis was conducted. One-way sensitivity analysis varied hospital bed, staff, non-medical and indirect costs.Median cost per unique admission was US$79.68 from the provider and US$96.95 from the societal perspective. Staff costs accounted for up to 55% of societal costs while hospital-bed costs accounted for up to 15%. Productivity loss represented 12% of societal costs. Staff time was the most influential parameter in the sensitivity analysis, increasing median costs by up to 89% from the provider and 74% from the societal perspective. CHE incidence rose as the share paid out-of-pocket increased and house wealth declined, with rural households in the lowest wealth quintile most affected. At full out-of-pocket payment, up to 23.6% of rural and 26.5% of urban households from the poorest wealth quintile could face CHE.Typhoid imposes a substantial economic burden among hospitalised children in Kenya, driven mainly by staff and hospital-bed costs. The findings of this study can guide policymakers in reducing strain on health services and the financial burden on families.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It's time to put plastics on the health security agenda: a call to action for Indonesia and Australia.","authors":"Sekar Aqila Salsabilla, Andy Fefta Wijaya, Fadillah Amin, Sujarwoto Sujarwoto, Laura Downey","doi":"10.1136/bmjgh-2025-023316","DOIUrl":"10.1136/bmjgh-2025-023316","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where and why malaria persists in heterogeneous transmission settings: insights from routine health facility data.","authors":"Camille Morlighem, Corentin Visée, Chibuzor Christopher Nnanatu, Mame Wodji Tine, Aminata Niang Diène, Catherine Linard","doi":"10.1136/bmjgh-2025-023003","DOIUrl":"10.1136/bmjgh-2025-023003","url":null,"abstract":"<p><strong>Background: </strong>Malaria distribution in sub-Saharan Africa is becoming increasingly spatially heterogeneous. Pre-elimination areas, high-transmission settings and urban areas with increasing transmission may all coexist within the same country. Effective intervention planning requires identifying high-risk areas and their drivers-an area in which geospatial models can provide valuable insights. Yet these models often assume stationary risk factors across transmission levels and frequently rely on prevalence survey data, which are unreliable in low-transmission settings. This study uses routine public-sector health facility data (ie, DHIS2) to model malaria incidence in Senegal from 2017 to 2021, accounting for transmission levels, and introduces novel fine-scale estimates of reported malaria incidence derived from dasymetric disaggregation.</p><p><strong>Methods: </strong>Health facility catchment populations were estimated using a probabilistic approach, allowing individuals to attend multiple facilities based on relative travel time. Malaria incidence per catchment was modelled using high-resolution environmental and socioeconomic covariates within a Bayesian hierarchical modelling framework. Separate models were fitted by season and endemicity-urbanisation level to assess the heterogeneity of risk factors. We adapted dasymetric disaggregation methods from population mapping to redistribute facility-level cases to 1 km pixels.</p><p><strong>Results: </strong>Estimated malaria incidence increased from 60 cases per 1000 people in 2017 to 71 cases in 2021. Key risk factors varied across endemicity-urbanisation levels; some factors were uniquely associated with low (eg, distance to roads), moderate (eg, cropland) and high-transmission settings (eg, flooded vegetation). Fine-scale maps represent malaria cases that the public-sector health system routinely reports, rather than the total malaria burden, and revealed potential underdiagnosis in remote areas.</p><p><strong>Conclusions: </strong>Our findings emphasise the importance of considering endemicity levels when evaluating malaria risk factors in heterogeneous transmission contexts. As health system data quality continues to improve, this approach offers a scalable alternative for mapping reported malaria incidence, supporting better targeted interventions and the identification of underdiagnosed areas.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The arms industry as a commercial determinant of health in the Middle East: a call for research.","authors":"Jihad Makhoul, Nason Maani, Dima El Hajj, Salsabil Abou Arabi, Razan Masry","doi":"10.1136/bmjgh-2025-022837","DOIUrl":"10.1136/bmjgh-2025-022837","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping research priorities related to maternal and infant nutritional health in the context of climate change in Pakistan: a mixed-methods study.","authors":"Sadiq Bhanbhro, Zahid A Memon, Wardah Ahmed, Fizza Ansar, Gulfishan Tahir, Nadia Agha, Sally-Fowler Davis, Hora Soltani","doi":"10.1136/bmjgh-2026-023722","DOIUrl":"10.1136/bmjgh-2026-023722","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify research priorities for maternal and infant nutrition in the context of climate change in Sindh, Pakistan, using an eco-social framework to examine structural, environmental and gendered inequalities.</p><p><strong>Setting: </strong>The study was conducted from March to May 2024 in Sindh province of Pakistan. Survey respondents were drawn from across Sindh province, while the priority-setting workshop and a focus group discussion were conducted with both male and female participants in Karachi and Matiari District, respectively.</p><p><strong>Participants: </strong>In total, 127 participants were engaged, including community members, doctors, female health workers, nurses, nutritionists, climate experts, advocates and researchers from across Sindh province of Pakistan.</p><p><strong>Results: </strong>Among survey respondents, 89% expressed extreme or very high concern about the impact of climate change on maternal and infant nutritional health. Across the survey and workshop, 'lack of awareness of proper nutrition' emerged as the top nutritional priority, while 'dehydration, weakness and exhaustion' ranked highest among maternal health concerns. Infant health priorities differed slightly: survey respondents prioritised 'heat exposure and low birth weight', whereas workshop participants highlighted 'heat waves and infant hospital admissions'. Participants also identified climate-resilient nutritional interventions and addressing the nutritional needs of pregnant women as critical research priorities. Focus group findings from Matiari District highlighted structural drivers of vulnerability, including flood-related displacement, disrupted agriculture, gendered labour burdens and limited social protection.</p><p><strong>Conclusion: </strong>Awareness and concerns about the increasing impacts of climate change and associated extreme weather events, including floods, extreme heat and changing weather patterns affecting food production, are increasing. However, understanding how these intersect with the everyday realities of affected people, places and communities remains significant for developing meaningful and equitable responses.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the Moments that Matter parenting programme on caregiving practices, family violence, mental health and early child development in Kenya: a cluster-randomised controlled trial.","authors":"Joshua Jeong, Juliet K McCann, Alexandria Ree Hadd, Wilson Ochuka, Michael Ochieng","doi":"10.1136/bmjgh-2025-023335","DOIUrl":"10.1136/bmjgh-2025-023335","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, parenting interventions have been shown to improve caregiving practices and child development. However, rigorous evidence from sub-Saharan Africa remains limited, particularly for programmes that leverage multiple community-based delivery platforms. We evaluated the effectiveness of the Moments that Matter (MTM) parenting programme delivered by community volunteers in partnership with faith leaders on child development and caregiving-related outcomes in Kenya.</p><p><strong>Methods: </strong>We conducted a cluster-randomised controlled trial in two counties in western Kenya. Villages were randomly assigned to the MTM parenting programme or a standard-of-care waitlist control, stratified by county. Eligible participants were primary caregivers of children aged 0-18 months. The intervention consisted of monthly group sessions and home visits delivered over 18 months. Caregivers were surveyed at baseline and endline. The primary outcome was child development measured using the Caregiver Reported Early Development Instruments. Intervention effects were estimated using mixed-effects models with a difference-in-differences, intention-to-treat approach.</p><p><strong>Results: </strong>Between February and March 2023, 595 caregiver-child dyads in 46 villages were enrolled and randomly assigned to the intervention (n=310) or control (n=285). At endline, there were no overall intervention effects on child development outcomes. Moderate-to-large effects were observed across multiple secondary outcomes, including caregiver stimulation, harsh discipline, caregiver mental health, social support, intimate partner violence victimisation, child dietary diversity, and male caregiver engagement, as reported by female primary caregivers. Exploratory subgroup analyses revealed treatment heterogeneity by county, with small significant improvements in child language and socioemotional development in one county but null effects in the other.</p><p><strong>Conclusions: </strong>A multicomponent parenting programme delivered in partnership between community volunteers and faith leaders improved multiple caregiving and family well-being outcomes but did not lead to overall improvements in child development. Findings highlight the potential of integrating multiple community-based platforms for delivering parenting programmes, while underscoring the need for implementation research to enhance impacts on child development at scale.</p><p><strong>Trial registration number: </strong>NCT05796934.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peru's front-of-package warning label policy and changes in the healthfulness of the food supply: a pre-post observational study.","authors":"Jonathan Lara-Arevalo, Lorena Saavedra-Garcia, Francisco Diez-Canseco, Natalia Rebolledo, Donna R Miles, Bridget Hollingsworth, J Jaime Miranda, Lindsey Smith Taillie","doi":"10.1136/bmjgh-2025-020809","DOIUrl":"10.1136/bmjgh-2025-020809","url":null,"abstract":"<p><strong>Introduction: </strong>In 2019, Peru implemented the first phase of a front-of-package warning label (FOPWL) policy requiring packaged foods and beverages exceeding thresholds for total sugars, sodium, saturated fats or containing trans fats to display warning labels. While intended to inform consumers, such policies may also incentivise product reformulation. This study assessed differences in the proportion and nutrient content of regulated ('high in') products in the Peruvian food supply after FOPWL policy implementation.</p><p><strong>Methods: </strong>Product-level nutritional information was collected from packaged foods and beverages during two periods: pre-implementation (T0: March-June 2019; n=2481) and post implementation (T1: March 2020-February 2021; n=3018). The proportion of products exceeding thresholds for nutrients of concern (sugars, sodium and saturated fats) and shifts in nutrient distributions across quartiles were compared pre-implementation and post implementation of the law in repeated cross-sectional samples and a longitudinal subsample (products collected in both periods, n=1694). Generalized estimating equations and logistic regression assessed differences in the proportion of 'high in' products, while quantile regression evaluated shifts in nutrient distributions.</p><p><strong>Results: </strong>In cross-sectional analyses over T1-T0 period, the proportion of 'high in' products declined by 6 percentage points (61% to 55%) among foods and by 11 percentage points (31% to 19%) among beverages. Relative reductions were observed in products 'high in' sugars (10% among foods; 37% among beverages), sodium (16% among foods) and saturated fats (7% among foods). Reductions varied across product categories and were greatest in those where thresholds were set below the prepolicy 75th percentile of baseline nutrient distributions. Longitudinal results were largely consistent with cross-sectional findings.</p><p><strong>Conclusion: </strong>Peru's first FOPWL policy phase was associated with reductions in the proportion of products 'high in' nutrients of concern, suggesting reformulation occurred across diverse product categories. These findings highlight the potential of mandatory FOPWL policies to improve the nutritional quality of the food supply and support efforts to reduce diet-related diseases.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the conceptualisation, contributing factors and interventions of moral distress among healthcare providers in Africa: a scoping review.","authors":"Joyline Jepkosgei, Dorothy Oluoch, Jacinta Nzinga, Kate McNeil, Yingxi Zhao, Sassy Molyneux","doi":"10.1136/bmjgh-2025-023358","DOIUrl":"10.1136/bmjgh-2025-023358","url":null,"abstract":"<p><strong>Introduction: </strong>Moral distress is the psychological discomfort experienced by healthcare providers when prevented from acting on their ethical values. Although extensively studied in high-income settings, it remains relatively unexplored in Africa, where chronic resource limitations and systemic constraints shape clinical practice. This scoping review mapped African literature examining how moral distress is conceptualised and discussed, its drivers and interventions implemented to address it with a particular focus on the balance between individual and organisational perspectives.</p><p><strong>Methods: </strong>A systematic search of databases identified papers on moral distress and related concepts among healthcare providers in Africa. Data extracted included: publication year, geographical focus, study design, participants, healthcare setting, conceptual framing, definitions, factors contributing to moral distress and descriptions of interventions and their evaluations. The results were analysed thematically considering individual and organisational perspectives.</p><p><strong>Results: </strong>30 papers published between 1999 and 2025 across 11 African countries were included. Of these, 14 were qualitative, 10 quantitative, 2 mixed methods, 1 review, 2 commentaries and 1 book chapter. Moral distress was commonly framed as an individual psychological burden, yet its primary drivers were identified as organisational including staff shortages, excessive workloads, inadequate resources and limited institutional support. Quantitative papers explicitly referred to 'moral distress', while qualitative papers generally described ethical and moral challenges more widely. Reported interventions were mainly proposed: counselling, debriefing, ethics committees and better staffing were recommended but rarely implemented or evaluated. In practice, healthcare workers relied on informal coping strategies such as peer support, prayer and improvisation.</p><p><strong>Conclusion: </strong>Moral distress is increasingly explored in the literature on African health systems but remains inconsistently defined and inadequately addressed at the organisational level. Despite widespread acknowledgement of its organisational and systemic origins, responsibility for managing its effects falls largely on individuals. This review supports a systems-level understanding of moral distress and highlights the need for organisational and policy change processes. Future research should move beyond description to identifying and evaluating team-based and organisational strategies that effectively reduce or manage moral distress.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising screening for recurrent tuberculosis: a microsimulation-based study.","authors":"Emily A Kendall, Samyra R Cox, Abhay Kadam, Aye Hnin Moe, Gayatri Lele, Nikhil Gupte, Madhusudan Barthwal, Mandar S Paradkar, Mithun K Mitra, Hojoon Sohn, Shreeya Wasunkar, Ryan R Thompson, Amita Gupta, Sanjay Gaikwad, Jonathan E Golub, Vidya Mave","doi":"10.1136/bmjgh-2026-024146","DOIUrl":"https://doi.org/10.1136/bmjgh-2026-024146","url":null,"abstract":"<p><strong>Background: </strong>People recently treated for tuberculosis (TB) (TB survivors) face substantial risk of recurrence. The optimal implementation and expected impact of active case-finding are uncertain.</p><p><strong>Methods: </strong>We developed an individual-level stochastic simulation model of TB recurrence among recently treated people in India, informed by empirical data on the cumulative incidence and timing of TB recurrence, the extent and durations of symptoms and bacteriological positivity and screening-related costs. We modelled post-treatment symptom screening at quarterly or semiannual intervals, with or without universal near-point-of-care bacteriological testing at the first screening encounter. We estimated months of symptomatic TB and of potentially infectious (bacteriologically positive, regardless of symptom status) TB averted over a 2-year period after treatment, along with corresponding screening programme costs, estimated as medians and 95% uncertainty ranges across simulations.</p><p><strong>Results: </strong>Symptomatic TB recurred within 2 years post-treatment in 10% (8%-12%) of recent TB survivors and undiagnosed prevalence peaked in month 2 (1-3). Symptom screening 6, 12 and 18 months post-treatment (as per Indian guidelines) averted 16% (8%-32%) of symptomatic and 8% (5%-17%) of infectious time. An 'early' screening schedule (3, 6 and 9 months post-treatment) increased case detection and health impact (26% (15%-43%) of symptomatic and 16% (9%-27%) of infectious time averted). Adding 'universal bacteriologic testing' at the 3-month encounter doubled the impact on transmission potential (34% (21%-55%) of symptomatic and 37% (22%-62%) of infectious time averted). In this context, 'early' symptom screening cost $190 ($100-$350) per case detected, and adding universal bacteriological testing cost an additional $520 ($240-$1070) per case incrementally detected by the screening programme.</p><p><strong>Conclusions: </strong>Screening for recurrent TB in high-risk settings such as India could reduce morbidity and time spent with potentially infectious TB. Concentrating screening within the first year has greatest yield. Symptom-based screening is most affordable, but testing for asymptomatic recurrence could further reduce transmission potential.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health impacts of expanding the health workforce across cadres under an incremental budget in Malawi.","authors":"Bingling She, Sakshi Mohan, Rachel E Murray-Waston, Sangeeta Bhatia, Martin Chalkley, Tim Colbourn, Joseph H Collins, Emilia Connolly, Eva Janoušková, Dominic Nkhoma, Paul Revill, Asif U Tamuri, Pakwanja Desiree Twea, Tara D Mangal, Joseph Mfutso-Bengo, Timothy B Hallett, Margherita Molaro","doi":"10.1136/bmjgh-2025-022167","DOIUrl":"10.1136/bmjgh-2025-022167","url":null,"abstract":"<p><p>Like many others, Malawi's healthcare 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 healthcare 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' <i>Thanzi La Onse</i> (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.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 8","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}