Equity Effects of Cell Biology Core Life Coverage on Avoidable Care Delays in Kenya: A Target-Trial Emulation

Health systems in low- and middle-income countries increasingly rely on diagnostic platforms that integrate cell biology core life services, yet the equity implications of expanding such coverage remain poorly theorised. Rather than reporting empirical estimates, the analysis specifies the observational analogue of a hypothetical randomised trial in which counties are assigned to accelerated or routine coverage strategies. The framework formalises avoidable delay as the interval between clinical suspicion and definitive diagnosis or treatment initiation, and it distinguishes between the average treatment effect and the equity-relevant effect on the socioeconomic gradient in delays. We argue that conventional adjustment for individual-level covariates is insufficient because coverage operates partly through system-level mechanisms, including referral network density and laboratory supply chains, that are themselves unequally distributed. The proposed design integrates difference-in-differences identification with non-parametric effect decomposition to separate individual from structural pathways. We conclude that target-trial emulation, when explicitly oriented toward distributional questions, can transform routine health administrative data into a credible basis for equity-focused health system learning in Kenya and comparable settings.