Nurse Shortages by PempheroM · Pull Request #1749 · UCL/TLOmodel

PempheroM · 2025-11-13T11:40:09Z

Analyses for nurse shortages. Issue #1747

…emphero/nurses_scenario

BinglingICL · 2025-12-01T10:15:17Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+        self.initial_population_size = 200
+        self._scenarios = self._get_scenarios()
+        self.number_of_draws = len(self._scenarios)
+        self.number_of_draws = 2


Line 29 is repeating line 28, so line 29 can be dropped, I think.

src/scripts/nurses_analyses/nurses_scenario_analyses.py

BinglingICL · 2025-12-01T10:29:43Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+                    {
+                        "HealthSystem": {
+                            'ResourceFile_HR_scaling_by_level_and_officer_type': "default",
+                            'mode_appt_constraints_postSwitch': 2,


All scenarios use Mode 2 since 2025; so line 61 is enough.

This applies to all scenarios.

BinglingICL · 2025-12-01T10:35:30Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+                    self._default_of_all_scenarios(),
+                    {
+                        "HealthSystem": {
+                            'ResourceFile_HR_scaling_by_level_and_officer_type': "default",


I think it is not here is implement the change of nursing cadre capabilities. It should be in the class ConstantRescalingHRCapabilities in the health system module to read the updated capabilities, and then schedule the expansion event every year from a start year to an end year (normally the simulation end) in the health system module.

This applies to all scenarios.

If I understand you correctly, you want use to change the expansion every year. Aren't we just supposed to change yearly_HR_scaling_mode for that? Or are you suggesting that we have to re-write class ConstantRescalingHRCapabilities for yearly scaling?

Hi Wati, we are supposed to change year_HR_scaling_by_level_and_officer_type parameter here, such as set it to be 2025, so that the event of ConstantRescalingHRCapabilities will be scheduled on the first day in the year of 2025, meaning the expansion will happen on that day and the scaled up staff capabilities will remain onwards till the end of simulation

My comment above meant that 'ResourceFile_HR_scaling_by_level_and_officer_type' is not a health system module parameter, so we cannot modify it. Instead, we should modify 'HR_scaling_by_level_and_officer_type_mode' parameter, such as set it to be "default" or "custom" (the csv file that store the values of scaling up factors).

The parameter name of yearly_HR_scaling_mode is quite similar and can be misleading, but it is related to a default historial HRH growth from 2020 to 2024, which is not relevant to our nursing expansion from 2025 here.

BinglingICL · 2025-12-01T10:37:37Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+                        "HealthSystem": {
+                            'ResourceFile_HR_scaling_by_level_and_officer_type': "default",
+                            'mode_appt_constraints_postSwitch': 2,
+                            "use_funded_or_actual_staffing": "actual",


This parameter is to be untouched I think. All HRH capabilities change will be implemented by changing the values in the csv files in ResourceFile_HR_scaling_by_level_and_officer_type folder.

This applies to all scenarios.

I think we did this. You will notice that we changed the csv value files in the ResourceFile_HR_scaling_by_level_and_officer_type folder for scenarios Improved Staffing Doubled Establishment, Worse Case. These are associated with csv files custom_doubling.csv and custom_worse.csv respectively. Is this what you mean? Or do you mean we should delete all lines where we set ResourceFile_HR_scaling_by_level_and_officer_type?

Hi Pemphero, here I meant to not modifying use_funded_or_actual_staffing parameter in this script, which is not necessary. So all relevant lines on this should be dropped.

It is good that we have already the csv files to modify the nursing staffing. To implement such changes, we just need to modify the HR_scaling_by_level_and_officer_type_mode as mentioned in my response to Wati.

If we remove use_funded_or_actual_staffing , how best are we going to represent the scenarios where in the baseline scenario we are using the actual (filled positions) and in the improved scenario, we are using the funded_plus (staff establishment)?

Hi Pemphero, sorry for my possible misunderstanding, but may I confirm: in your improved scenario, you will only have the nursing cadre to achieve the establishment level? Considering that all other cadres remain as current levels across all scenarios.

If so, you do not need to modify use_funded_or_actual_staffing here but to calculate the corresponding scale-up factor and store it in the csv file in the ResourceFile_HR_scaling_by_level_and_officer_type folder, and then modify the HR_scaling_by_level_and_officer_type_mode parameter.

It would be good that we have a clear diagram for all nursing expansion scenarios, specifying the expansion time/period along the simulation timeline. And we could have further discussions on this if anything unclear. (I am attaching one example from my work, which is yearly expansion from 2025 to 2034; not a one-time scaling-up at the beginning of 2025 though.)

Hi Bingling and Pemphero,
The attached document contains the scenarios for this study. Of course, its not final.

For Improved Staffing scenario or scaling factor, I went through Tara's paper. Was thinking we could use a linear establishment filling for the scaling factor as seen below. The only challenge would be that we need to find number of filled nursing posts in the baseline year (N0) and approved nursing establishment (E) as seen below. It would also be easy to get a formula for the worst case from this. This is something we would try to find.

Improved Staffing (Nurses Only): Establishment Filling

Let:

N0 = number of filled nursing posts in the baseline year (maybe 2024)

E = approved nursing establishment

T = target year (2030)

y = current simulation year, where y ∈ {2025, 2026, …, 2030}

We assume linear filling of vacant nursing posts:

N_y = N0 + ((E - N0) / (T - 2024)) * (y - 2024)

The nurse scaling factor applied in year y is:

SF_y = N_y / N0

BinglingICL · 2025-12-01T10:41:19Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+                    }
+                ),
+
+            "Improved Staffing":


Is this scenario to scale up all cadres to meet the establishment level? If so, we need to calculate the correspondeing scaling up factors to be saved in a csv file in the folder ResourceFile_HR_scaling_by_level_and_officer_type.

It seems to me that this scenario consists of two parts: one is to expand nurse cadre, and the other is to expand other cadres. I think these two parts may need to be explicitly separated in the scenario definitions. By which I mean, the main variable in the problem is to change the nursing capabilities, and basing on that, consider what capability levels of other cadres are to be specified across the scenarios.

In our previous discussions, we decided to keep all other cadres constant and use historical growth (i.e., Only nurses change. Other cadres remain constant)

BinglingICL · 2025-12-04T11:29:44Z

src/scripts/nurses_analyses/nurses_scenario_analyses.py

+                        "HealthSystem": {
+                            'ResourceFile_HR_scaling_by_level_and_officer_type': "default",
+                            'mode_appt_constraints_postSwitch': 2,
+                            "use_funded_or_actual_staffing": "funded_plus",


So in this scenario, if you want to scale up the nursing staff to the establishment level in the year of 2025: we do not use "use_funded_or_actual_staffing": "funded_plus", which will not work; instead, we create a csv file to store the scale-up factor (e.g. established nursing count/2024 nursing count) that will enable such expansion and set HR_scaling_by_level_and_officer_type_mode to the csv file name.

This applies to the next scenario where you want to increase nursing count to doubling establishment.

src/scripts/nurses_analyses/nurses_scenario_analyses.py

…emphero/nurses_scenario

thewati · 2026-02-04T07:57:59Z

Hi @BinglingICL and @tbhallett,
We tried to implement the changes discussed in the last meeting on Monday. This is ready for a quick review.

scenario file

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PempheroM assigned thewati, BinglingICL and PempheroM Nov 13, 2025

thewati and others added 9 commits November 13, 2025 13:43

Merge branch 'master' into pemphero/nurses_scenario

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…emphero/nurses_scenario

BinglingICL reviewed Dec 1, 2025

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PempheroM and others added 9 commits December 8, 2025 11:15

addressing comments

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thewati added 7 commits February 3, 2026 10:52

Merge branch 'master' into pemphero/nurses_scenario

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…emphero/nurses_scenario

setup analyses for qs

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PempheroM commented Nov 13, 2025

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BinglingICL Dec 4, 2025 • edited Loading Uh oh! There was an error while loading. Please reload this page.

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Improved Staffing (Nurses Only): Establishment Filling

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thewati commented Feb 4, 2026

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BinglingICL Dec 4, 2025 •

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