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

Kenya's health system faces persistent inequities in access to timely care, yet the contribution of forensic medicine services to these disparities remains unexamined. We argue that forensic medicine functions as a rate-limiting gateway for medico-legal cases, and its uneven geographic distribution produces systematic delays that disproportionately affect populations already disadvantaged by distance, poverty, and institutional capacity. The proposed design leverages the staggered rollout of county-level forensic units as a natural experiment, using observational health-system data to emulate a hypothetical randomised trial comparing time-to-definitive-care under different coverage regimes. We specify the causal estimands, identification assumptions, and analytic strategies, including inverse-probability weighting and doubly robust estimation, to address confounding and informative censoring. The protocol also incorporates equity-relevant effect modification by socioeconomic status, rural residence, and referral pathway. By articulating a rigorous counterfactual framework, the present analysis provides a template for evaluating forensic health-system interventions as determinants of equitable care access, and it identifies the data infrastructure investments required to support such evaluations in low-resource settings.