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01.
arXiv (CS.AI) 2026-06-18

What Must Generalist Agents Remember?

arXiv:2606.18746v1 Announce Type: new Abstract: This paper develops a formal account of what generalist agents must store in memory in order to act near-optimally across multiple environments and goals. It shows that when two domains share an observational bottleneck but require incompatible optimal actions, any uniformly near-optimal policy must induce distinct memory distributions at that bottleneck. The result yields a separation theorem: sufficiently successful agents cannot rely only on current state observations, but must preserve domain-relevant information in memory. The paper further shows that if an agent's memory contains enough information to estimate values for related goals, then that memory can be used to approximately reconstruct the agent's local transition dynamics. Together, these results characterize memory as the substrate that supports domain disambiguation, transition-model reconstruction, and planning for generalist agents.

02.
arXiv (CS.AI) 2026-06-12

Reframing AI Loss of Control: What It Is, How to Have It, How to Lose It

arXiv:2606.12442v1 Announce Type: cross Abstract: At present, loss of control risks have gained much prominence in public discussion, particularly in relation to AI, with extensive discourse present among academics, frontier labs, and even governments. However, in the existing literature, the concept seems to rest on surprisingly weak foundations, where even those that discuss loss of control extensively do not first establish what control is and what exactly is being lost. Our paper aims to address these gaps. We establish a working definition of control by anchoring it to the "setting and getting of goals". Then, we discuss various aspects of control, built on foundational concepts from related fields like cybernetics, management control, and control theory. This includes who (or what) can be in control, and the things they require to be in control, such as the ability to set goals, having a functional control loop, having requisite variety, and having sufficient goal alignment. Once a framework for control is established, we then discuss how control can be lost, how AIs can contribute to such loss of control, and offer relevant recommendations for how one can maintain control. One interesting consequence of our work is that humanity, as individuals and as groups, can lose varying degrees of control as a result of AI behaviour that is far below the level of superintelligence; the potential for loss of control scenarios (as we define them) already exist, and have existed for a long time.

03.
arXiv (CS.CL) 2026-06-15

DLawBench: Evaluating LLMs Through Multi-Turn Legal Consultation

Lawyer-client consultation is a critical starting point for legal services. Effective legal assistance hinges on eliciting sufficient and truthful information from clients in order to devise strategies that best protect their interests. This task requires Large Language Models (LLMs) not only to perform robust legal reasoning, but also to strategically elicit material facts through multi-turn interactions and effectively guide clients with diverse personalities. Yet existing legal benchmarks overlook this interactive capability. To fill this gap, we introduce DLawBench, a diagnostic benchmark for real-world legal consultation. Drawing on realistic client behavior, we characterize lawyer-client interactions into four types: Cooperative, Dependent, Withdrawn, and Adversarial. Using dialogues grounded in real cases, DLawBench evaluates whether LLMs can effectively conduct legal consultation under realistic conditions. DLawBench comprises 461 cases from Chinese and U.S. law, 5,532 paired fact entries, 3,411 inquiry rubrics, and 3,348 issue-resolution rubrics, and evaluates 26 representative LLMs. Systematic experiments show substantial headroom: the best-performing model, GPT-5.5, achieves only 0.562 on consultation-grounded legal reasoning. More importantly, DLawBench exposes both sycophancy in legal consultation and a paradox: models perform worse when clients need guidance most.

04.
medRxiv (Medicine) 2026-06-19

Hyperleukocytosis and outcomes in pediatric B-cell acute lymphoblastic leukemia: A report from the REDIAL Consortium

Hyperleukocytosis (white blood cell [WBC] count >100 000/uL) at diagnosis is an important prognostic risk factor in pediatric acute lymphoblastic leukemia (ALL), though its significance with contemporary therapy is unclear. We analyzed 1 826 pediatric ALL patients from a multi-institution cohort to determine whether hyperleukocytosis independently predicts outcomes using multivariable Cox proportional hazard modeling. Hyperleukocytosis occurred in 211 patients (12%), with 121 having B-ALL, and showed no prognostic significance in T-ALL patients. In B-ALL, 5-year event-free survival (EFS) was 65% versus 89% for non-hyperleukocytosis patients, and overall survival (OS) was 78% versus 93%. After adjustment for age, cytogenetic risk, central nervous system disease status, and treatment site, hyperleukocytosis remained an independent predictor of end-of-induction minimal residual disease (MRD) positivity (odds ratio 2.53 [95% confidence interval [CI]: 1.71-3.94; p

05.
arXiv (CS.CV) 2026-06-18

Rethinking the Pointer Loss in Table Structure Recognition: Geometry-Aware Pointer Loss for Spatial Locality

Table Structure Recognition (TSR) using a pointer network achieves impressive results by predicting HTML sequences while aligning tags to detected text (or cell) regions. However, our analysis reveals that when pointer networks fail, 79.6% of errors occur between spatially adjacent cells (Manhattan distance

06.
arXiv (CS.CV) 2026-06-17

Pareto LoRA: Mitigating Modality Imbalance in Unified Multimodal Models via Pareto-Optimal Gradient Integration

Unified multimodal models (UMMs) have recently emerged as a promising paradigm for integrating multimodal understanding and generation within a single autoregressive transformer. However, during multimodal instruction tuning, these models often exhibit pronounced modality imbalance: language gradients dominate optimization, thus leading to lower image generation quality, especially under parameter-efficient fine-tuning such as LoRA. In this work, we systematically analyze modality imbalance in LoRA-based fine-tuning of UMMs for interleaved text-image generation. We show that vision modality performance degrades substantially more than text modality performance when compared to unimodal counterparts, and that modality-specific gradients can differ by orders of magnitude across various tasks and layers. Motivated by this observation, we reformulate the multimodal instruction tuning as a bi-objective optimization problem and propose Pareto LoRA, a Pareto-optimal gradient integration strategy that balances the text and image objectives by modulating the gradient direction and strength. Experiments on the CoMM benchmark with Emu2 demonstrate that Pareto LoRA consistently improves multimodal generation balance, achieving up to 44.9% gains in perceptual image quality over vanilla LoRA while maintaining comparable text performance.

07.
arXiv (CS.AI) 2026-06-19

Denoising Implicit Feedback for Cold-start Recommendation

arXiv:2606.19658v1 Announce Type: new Abstract: Implicit feedback is widely used in recommender systems due to its accessibility and generality, yet it usually presents noisy samples (e.g., clickbait, position bias). Meanwhile, recommenders inevitably face the item cold-start problem due to the continuous influx of new items. We identify that cold items are more prone to noisy samples due to the aforementioned factors, and researchers often overlook the significance of denoising implicit feedback for cold items. Previous denoising studies usually identify noisy samples based on heuristic patterns, such as higher loss values, and mitigate noise through sample selection or re-weighting. However, these methods have limited adaptability and are ineffective in cold-start scenarios. To achieve denoising implicit feedback for cold-start recommendation, we propose a model-agnostic denoising method called DIF. First, user preferences for content remain stable, which allows us to infer pseudo-labels indicating whether a user is interested in a cold item through content-similar warm items. Furthermore, to improve pseudo-label accuracy, we model the confidence of pseudo-labels based on the content similarity between the cold item and warm items, and then aggregate multiple pseudo-labels for each sample. Finally, we explicitly estimate the uncertainty of the noisy sample label by considering its relative entropy and the cold-start status of the item, which adaptively guides the role of pseudo-labels to correct the noisy labels at the sample level. DIF's superiority is supported by both theoretical justification and extensive experiments on real-world datasets. The method has been deployed on a billion-user scale short video application Kuaishou and has significantly improved various commercial metrics within cold-start scenarios.

08.
arXiv (quant-ph) 2026-06-12

Matrix phase-space representations for gaussian boson sampling

arXiv:2503.12749v2 Announce Type: replace Abstract: We introduce coherent matrix phase-space distributions. These use conservation laws and symmetries to improve the accuracy and speed of quantum phase-space representations. As an example, this is applied to validation of low-loss Gaussian boson sampling (GBS) quantum computational advantage experiments, where classical generation of the random photon-number counts is exponentially hard. Large improvements in sampling errors are demonstrated compared to previous methods. Matrix phase-space representations also provide a large numerical speed-up, due to their (at worst) quadratic scaling, compared to other methods for validating total count probabilities of large-scale, low-loss GBS networks.

09.
arXiv (quant-ph) 2026-06-16

Towards Interpretability of Neural Quantum States

arXiv:2508.14152v2 Announce Type: replace Abstract: Neural quantum states (NQS) have emerged as a powerful variational ansatz for representing quantum many-body wave functions. Their internal mechanisms, however, remain poorly understood. We investigate the role of correlations for NQS-like quantum state representation by employing a correlation-based interpretable neural network architecture and then proving our observations using Boolean function theory. The correlator neural network demonstrates that, even for simple product states, up to all system-size correlation orders in the chosen computational basis are required to represent a quantum state faithfully. We explain these observations using Fourier expansion, which reveals the correlator basis as the effective basis of the internal NQS structure, the resulting necessity for high-order correlations that is supported by an entanglement bound that scales with the correlation order, consequences of linear dependencies in constrained Hilbert spaces for correlation requirements, and connections between spin basis rotations and the correlator basis. Furthermore, we analyze how neural networks achieve high correlation orders by increasing the magnitude of the network weights, which can be compensated by increasing the network depth. Lastly, we discuss how activation functions, network architectures, and choice of reference basis influence correlation requirements. Our results provide new insights and a better understanding of the internal structure and requirements of NQS, enabling a more systematic use of NQS in future research.

10.
arXiv (math.PR) 2026-06-16

Convergence to the Brownian CRT for critical branching Markov processe

arXiv:2601.05906v2 Announce Type: replace Abstract: We prove an invariance principle for a general class of continuous time critical branching processes with finite variance (non-local) branching mechanism. We show that the genealogical trees, viewed as random compact metric measure spaces, converge under rescaling to the Brownian continuum random tree in the Gromov-Hausdorff-weak topology, establishing a universal scaling limit for critical finite variance branching processes.

11.
arXiv (CS.LG) 2026-06-17

Uncertainty Quantification of Engineering Structures by Polynomial Chaos Expansion and Multivariate Active Learning

arXiv:2606.17233v1 Announce Type: new Abstract: In many engineering applications, a single high-fidelity model produces multiple quantities of interest (QoIs) under the same input parameters, e.g. finite element models of complex physical systems. To alleviate the high computational cost of direct model evaluations, surrogate models are widely used to construct efficient approximations of model responses. Naturally, the accuracy of surrogates strongly depends on the quality of the experimental design (ED). However, a single ED may not provide an adequate representation for all outputs simultaneously, especially when different outputs exhibit varying sensitivities to the input variables. A straightforward solution is to perform separate sampling for each output, but this results in increased sampling complexity and computational cost. From a statistical perspective, such an approach also ignores potential correlations among all outputs and may compromise data consistency. To address this issue, an adaptive sequential sampling method for constructing polynomial chaos expansion surrogate models is generalized for vector valued QoIs. The method sequentially selects new samples from a candidate pool based on their local contribution to the output variance, while balancing distance-based exploration of the input space and exploitation of aggregated variance information across all outputs. Its performance is compared with non-sequential Latin Hypercube Sampling through several numerical examples from engineering problems. Numerical results demonstrate that the proposed strategy improves both surrogate accuracy and stability, and provides a more reliable estimation of second-order statistics.

12.
arXiv (CS.AI) 2026-06-19

Triangular Consistency as a Universal Constraint for Learning Optical Flow

arXiv:2606.19938v1 Announce Type: cross Abstract: We propose triangular consistency as a first-principled constraint for optical flow, which is agnostic to network architecture, supervision type, and dataset, and applies to both image-pair and multi-frame settings. This simple but powerful constraint is to compose two flows to induce a third flow and enforce consistency among the three. The composed flows may arise from (i) image pairs, yielding cycle consistency; (ii) multiple video frames, producing longer-range motion through temporal chaining; or (iii) image pairs combined with controlled synthetic transformations, which becomes data augmentation. This triangular consistency introduces negligible computational overhead and requires no additional annotations. Since it is derived directly from the geometry of optical flow, it does not rely on model-specific assumptions and serves as a ``universal'' plug-and-play component for optical flow training. Experiments show consistent improvement across supervised, unsupervised, and transfer learning settings.

13.
arXiv (quant-ph) 2026-06-16

Degeneracy Cannot Violate the Quantum Hamming Bound

arXiv:2606.15558v1 Announce Type: new Abstract: The quantum Hamming bound is the standard finite-length sphere-packing bound for exact correction of arbitrary qubit errors. Whether degeneracy can evade this bound has remained unresolved in full generality for nearly three decades: distinct correctable errors may act identically on the code space, so the usual disjoint-sphere argument breaks down. We prove that every exact binary quantum subspace code with $K>1$ obeys the bound, without assuming either nondegeneracy or additivity. Our proof turns the Li–Xing linear-programming polynomial into an exact intersection count for quaternary Hamming balls. Monotonicity in block length and in ball-center separation then reduces the problem to a local node–edge charging inequality at the shortest admissible length. Thus degeneracy can merge correctable error sectors, but cannot enlarge the finite-length binary Hamming bound.

14.
arXiv (CS.AI) 2026-06-16

MR-GVNO: A Geometry-Aware Variational Physics-Informed Neural Operator for Mindlin-Reissner Plates on Irregular Domains

arXiv:2606.16624v1 Announce Type: new Abstract: Plate and shell structures are widely used in engineering, making rapid response prediction under varying geometries, materials, and loads highly desirable. However, conventional finite element methods require repeated modeling and solution, resulting in high computational costs. This study proposes a geometry-aware variational neural operator for Mindlin-Reissner plate problems, termed MR-GVNO. The method uses boundary point clouds to represent irregular geometries and employs separate encoders for spatially varying material fields, pressure loads, and scalar physical parameters. A cross-attention mechanism integrates these inputs with query point information to predict transverse deflections and rotations at arbitrary locations. MR-GVNO is trained without labeled solution data using a variational physics-informed loss derived from the discretized total potential energy. It directly processes irregular point clouds and allows different physical fields to be discretized independently, avoiding interpolation onto a common grid. Numerical experiments on single-hole, double-hole, and L-shaped plates demonstrate accurate response prediction under homogeneous and heterogeneous materials and uniform and random loads. The model also achieves millisecond-level full-field inference and favorable cross-geometry generalization.

16.
arXiv (math.PR) 2026-06-17

Moments in Rough Bergomi and Boundary Attainment in Rough Heston

arXiv:2606.07482v2 Announce Type: replace Abstract: We address two open questions in the rough volatility literature. First, we prove finite positive moments for the rough Bergomi price process, and for a wider class of Gaussian Volterra Bergomi models, in the whole subcritical range under negative correlation. More precisely, if \(\rho\in[-1,0)\), then \(\E[S_T^p]

17.
arXiv (CS.LG) 2026-06-16

Self-Supervised Learning of Iterative Solvers for Constrained Optimization

arXiv:2409.08066v3 Announce Type: replace Abstract: The real-time solution of parametric optimization problems is critical for applications that demand high accuracy under tight real-time constraints, such as model predictive control. To this end, this work presents a learning-based iterative solver for constrained optimization, comprising a neural network predictor that generates initial primal-dual solution estimates, followed by a learned iterative solver that refines these estimates to reach high accuracy. We introduce a novel loss function based on Karush-Kuhn-Tucker (KKT) optimality conditions, enabling fully self-supervised training without pre-solved optimizer solutions. Theoretical guarantees ensure that the training loss function attains minima exclusively at KKT points. A convexification procedure enables application to nonconvex problems while preserving these guarantees. Experiments on two nonconvex case studies demonstrate speedups of up to one order of magnitude compared to state-of-the-art solvers such as IPOPT, while achieving orders of magnitude higher accuracy than competing learning-based approaches.

18.
arXiv (CS.AI) 2026-06-16

Orchestrated Reality: From Role-Play to Living, Playable Game Worlds – LLM-Driven World Simulation as a Parameterized-Action POMDP

arXiv:2606.16014v1 Announce Type: cross Abstract: Many games rely on storytelling combined with systems that track levelling, NPC behaviour, and consequence simulation; bridging tightly-authored narrative with deeply-simulated worlds – most acute in sandbox and open-world settings – has been prohibitively expensive. LLM-driven worlds open a new path: a single harness can coordinate numerical state, narrative voice, storytelling pacing, and rule logic together. Realising this requires the LLM system to sustain a persistent world (who is where, what has just happened, what is currently true), which today's deployed systems do not: the narrative voice asserts state in free prose without any validated representation, so a fully autonomous game engine remains infeasible. We treat this as an architectural choice, not a limitation of language models, and report work in progress on a framework – orchestrated reality – that makes the world a canonical object owned by a singleton orchestration agent analogous to the tabletop-RPG Game Master (GM). We formalise an LLM-driven game world for a human player as a Parameterized-Action POMDP: state is a tree of canonical JSON entities, actions decompose as $a=(k, x_k)$ (a discrete intent kind plus structured JSON parameters), the agent observes only a narrative projection $o=O(s)$ of state, and the transition kernel $F$ is an LLM-driven Plan-Diff-Validate-Apply (PDVA) pipeline that commits schema-validated, content-hashed JSON deltas. We give the formal model, a JSON-state example, a worked single-turn example, and a catalogue of 15 illustrative incidents drawn from a real deployment showing the framework in action. Empirical validation through a planned human player study – together with multi-NPC concurrent agency and deployment as an RL environment – is situated as future work.

19.
arXiv (CS.CV) 2026-06-11

Motion Reinforces Appearance: RGB-Skeleton Gated Residual Fusion for Micro-Gesture Online Recognition

Micro-gesture analysis attracts increasing attention for inferring spontaneous emotion from subtle body movements. Micro-gesture online recognition, which localizes and classifies each gesture instance in untrimmed videos, is a core task in the 4th EI-MiGA-IJCAI Challenge. Compared with typical temporal action detection, MGR emphasizes the localization and classification of actions, requiring the model to output the start time, end time, and category of each micro-gesture. Moreover, since micro-gestures are highly spontaneous, relying solely on a single modality makes it difficult to capture the complete and accurate multi-modal cues. In this work, we propose DyFADet+, which extends DyFADet into a dual-stream RGB-skeleton framework. In our model, both modalities are projected into shared multi-scale temporal embeddings and fused through a gated residual module, which adaptively injects skeleton motion into the RGB representation rather than using naive concatenation. Finally, these fused features are decoded by a Dynamic TAD head for online classification and boundary regression. On the SMG dataset, our method achieves an F1 score of 40.88, ranking 2nd in the Micro-gesture Online Recognition track.

20.
arXiv (CS.AI) 2026-06-16

MiroBench: Benchmarking Realism in Agentic Simulation of Real-world Discussions

arXiv:2606.14715v1 Announce Type: cross Abstract: LLM agents are increasingly used to simulate real world interactions, but it remains unclear whether simulated behaviors preserve the content patterns and interaction dynamics of real human behaviors. Existing evaluations remain fragmented, which makes it difficult to compare systems or measure progress. In this paper, we focus on Reddit discussions as a concrete first step toward evaluating real-world social simulation. Reddit threads provide public, topic-grounded, multi-party interactions where people share experiences, debate, seek advice, express emotion, and collectively respond to products, events, and social issues. These discussions offer an observable window into broader social behavior, making them a useful setting for testing whether LLM agents can reproduce not only fluent text, but also the distributional patterns and interaction dynamics of real online communities. We introduce MiroBench, a benchmark for Reddit discussion simulation built from 4,292 real Reddit threads. MiroBench uses statistical tests to compare generated and real discussions across four major aspects: repetition and semantic uniformity, narrative content, toxicity and aggression, and structural complexity. Experiments across five domains and five models show that current simulators remain distributionally mismatched with real Reddit threads, while a lightweight prompt-based improvement procedure provides only limited gains. MiroBench offers a concrete benchmark for measuring, diagnosing, and improving realism in LLM-based social simulation.

21.
arXiv (quant-ph) 2026-06-17

Dimension-Free Approximate Tensorization of Quantum Hypercontractivity for Qudit Depolarizing Semigroups

arXiv:2606.17729v1 Announce Type: new Abstract: We prove almost tensorization for hypercontractivity and logarithmic-Sobolev constants for a class of reversible quantum Markov semigroups satisfying the positive off-diagonal scaling (PODS) property. This class includes qubit examples and generalized depolarizing semigroups with respect to full-rank states in arbitrary finite dimensions. For any such semigroup $(\Phi_t)_{t\ge 0}$ and every tensor power $n$, we show that the log-Sobolev constant of the product semigroup $\Phi_t^{\otimes n}$ is at least $2/(3\ln 2)$, approximately 0.96, times the log-Sobolev constant of the single-site semigroup $\Phi_t$, independently of $n$ and the local dimension $d$. The proof first establishes exact tensorization of the $(q,2)$-hypercontractive inequality for integer $q$, in particular $q=3$, and then extends the estimate to all real $q>2$ by complex interpolation; the standard implication from hypercontractivity to logarithmic-Sobolev inequalities yields the stated almost tensorization result. As an application of the same method, we also obtain sharp $(q,2)$-hypercontractivity estimates for qubit depolarizing channels.

22.
arXiv (quant-ph) 2026-06-19

Fidelity bounds for adiabatic gates and other quantum operations with time-dependent dissipation

arXiv:2606.20501v1 Announce Type: new Abstract: As quantum-computing platforms are susceptible to noise, the fidelity of quantum operations is limited by decoherence. Understanding this limitation is crucial for building utility-scale quantum processors. In previous works [Phys. Rev. Lett. 129, 150504 (2022); Quantum 9, 1684 (2025)], we presented analytical formulae for the average gate fidelity of multi-qubit operations under static Markovian noise processes, including operations that temporarily leave the computational subspace. However, some quantum-computing architectures dynamically modulate qubit or coupler frequencies to implement two-qubit gates, e.g., baseband flux gates; such modulation can lead to dissipation rates varying in time. In this Letter, we therefore generalize the fidelity-reduction formulae to encompass time-dependent dissipation. Applying our generalized formula, we obtain a fidelity bound for adiabatic operations and demonstrate that flux-dependent noise sensitivity, combined with qubit-coupler hybridization, significantly reduces the fidelity of adiabatic controlled-Z (CZ) gates in superconducting quantum computers. Our work thus provides essential theoretical tools for evaluating error budgets and optimizing the design of quantum operations in tunable quantum-computing architectures, and may also find applications in quantum-sensing and quantum-communication protocols that are affected by time-dependent dissipation.

23.
arXiv (CS.CL) 2026-06-15

CoRe: A Continuously Reward-Finetuned LLM Query Rewriter for Multi-Stage Context-Aware Relevance in Web-Scale Video Search

LLM-based query rewriters in production face a tension: the training reward must reflect how the rewrite is consumed by the production ranker, yet the training procedure must be cheap enough to support continuous redeployment as data drifts. We present CoRe (Context Relevance), such a system, redeployed weekly for over five months in a major short-video search engine. Our reward uses the deployed multimodal relevance model as its source and a multiplicative ratio form mirroring the production fusion algebra, closing the simulation-production gap that offline reward proxies leave open. A semi-online Mixed Preference Optimization loop makes this reward affordable at multi-million-instance weekly scale: a DPO-style pairwise objective restricts the gradient pass to a small top-k/bottom-k subset of sampled trajectories, and a phase structure reduces trainer/inference-server parameter syncs from per-step to per-phase. An automated promotion gate over reward-like and stability metrics detected and recovered from a real reward-hacking incident in production. Rewriter output is consumed as parallel relevance signals at recall, rawrank, and finerank without displacing the original signals, bounding rewriter-failure blast radius. Online A/B from two sequential production launches, first deploying the rewriter at finerank, then extending consumption to recall and rawrank, delivers statistically significant reductions in change-query rate on rewrite-impacted queries, with all headline relevance and engagement metrics moving in the expected direction.

24.
arXiv (CS.LG) 2026-06-12

Kareus: Joint Reduction of Dynamic and Static Energy in Large Model Training

arXiv:2601.17654v2 Announce Type: replace Abstract: The computing demand of AI is growing at an unprecedented rate, but energy supply is not keeping pace. As a result, energy has become an expensive and contended resource that requires explicit management and optimization. Although recent works have made significant progress in large model training optimization, they focus on optimizing either dynamic or static energy consumption. We find that fine-grained kernel scheduling and frequency scaling jointly and interdependently impact both dynamic and static energy consumption. Based on this finding, we design Kareus, a training system that pushes the time-energy tradeoff frontier by optimizing both aspects. Kareus decomposes the intractable joint optimization problem into local, partition-based subproblems. It then uses a multi-pass multi-objective optimization algorithm to find execution schedules that push the time-energy tradeoff frontier. Compared to the state of the art, Kareus reduces training energy by up to 28.3% at the same training time, or reduces training time by up to 27.5% at the same energy consumption.

25.
medRxiv (Medicine) 2026-06-11

Incremental costs of transitioning from four to eight WHO-recommended antenatal care visits in Uganda: A costing analysis from a societal perspective

Background In 2016, the World Health Organization revised its antenatal care (ANC) recommendation from four to eight visits. For low- and middle-income countries like Uganda, where achieving even four visits remains a challenge, this transition has significant cost implications for both the health system and households. This study estimated the incremental costs of adopting the eight-visit model from a societal perspective. Methods The study was conducted in six government health facilities in southwestern Uganda. A micro-costing approach estimated health facility costs (personnel, equipment, consumables, and overhead). Costs incurred at patients end (transport, ultrasound, medical expenses, and time) were collected from 785 women using a questionnaire, with all costs in 2025 USD. Results For an average of 4.3 visits, total cost per woman was $100.1: facility costs $43.7 (43.7%), and patient costs $56.4 (56.3%). Transitioning to eight visits would increase total cost by $57.8 (57.8%), of which $36.4 (63.0%) would fall on households, equivalent to 68.8% of average monthly household income. Total costs would rise by 55.4% ($115.5 to $179.5) at Health Center IVs and 64.3% ($102.3 to $168.1) at Health Center IIIs, with facility costs up 43.4% and 62.9% and patient costs up 61.2% and 65.7%, respectively. Conclusion Transitioning to eight ANC visits would impose a large financial burden on households, with the incremental patient cost equivalent to more than two-thirds of average monthly household income. Equitable implementation requires improving availability of medicines and diagnostics, subsidizing transport, exploring telemedicine or community-based models, and improving efficiency at lower-tier health centers.