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

Kenya's recent transition toward universal health coverage has incorporated genetic and genomic services into a benefits package referred to here as Genetics Genomics Core Life coverage, yet the equity implications of this inclusion for avoidable care delays remain theoretically underspecified and empirically unmeasured. We argue that coverage alone is insufficient to compress delay differentials because supply-side constraints, referral network fragmentation and household financial risk operate as effect modifiers that disproportionately burden lower-income counties. The proposed design exploits the staggered rollout of the benefits package across Kenyan counties, combined with an interrupted time series analysis of routine health information system data and a nested cohort component using linked oncology and genetics clinic records. We specify the causal estimands, identification assumptions, measurement strategies for avoidable delay and equity metrics, and analytic approaches for heterogeneous effects. The protocol confronts the central methodological challenge that insurance coverage is not randomly assigned and that care-seeking behaviour is endogenous to perceived disease risk and trust in genomic medicine. We conclude that target-trial emulation offers a credible framework for generating policy-relevant evidence on equity effects, provided that the Kenyan health information infrastructure can support linkage across facilities and that the assumption of no interference between counties is defended. The contribution is a rigorous, implementable design that reframes genomic coverage expansion as a natural experiment in health system equity rather than a simple benefits package question.