Equity Effects of Family Medicine Coverage on Avoidable Care Delays in Kenya: A Target-Trial Emulation

Kenya's primary healthcare reforms increasingly position family medicine as a platform for universal health coverage, yet evidence linking workforce deployment to equitable reductions in avoidable care delays remains fragmented. We argue that conventional observational assessments conflate access with utilisation and obscure how delay distributions vary across socioeconomic strata, geographic peripheries and chronic disease pathways. The proposed protocol specifies eligibility criteria, intervention definitions, causal contrasts and estimands that distinguish total effects from mediated pathways through referral completion and facility readiness. We address immortal time bias, time-varying confounding and informative censoring through clone-censor-weight techniques applied to routine health data. The framework further integrates qualitative evidence on care-seeking norms to inform effect heterogeneity analyses. This design offers a credible alternative to randomised allocation, which is neither feasible nor ethically permissible for workforce policies, and provides policy-relevant estimates of equity impacts that current monitoring systems cannot produce.