Incorporating an economic approach to production in a health system model

As computational capacity increases, it becomes possible to model health systems in greater detail. Multi-disease health system models (HSMs) represent a new development, building on individual level epidemiological models of multiple diseases and capturing how healthcare delivery systems respond to population health needs. The Thanzi la Onse (TLO) model of Malawi is the first of its kind in these respects. In this article, we discuss how we have been bringing economic concepts into the TLO model, and how we are continuing to develop this line of research. This has involved incorporating more sophisticated approaches to account for the effects of the unavailability of healthcare workers, and we are working towards establishing the role of different forms of ownership of healthcare facilities and different management practices. Not only does this broad approach make the model more flexible as a tool for understanding the impact of resource constraints, it opens up the possibility of analysing considerably richer policy scenarios; for example establishing an estimate of the health gain that could be achieved through expanding the workforce or reducing healthcare worker absence.