Community Health Worker Attrition and Trauma-Focused Therapy Dropout in Post-Conflict Northern Uganda: A Competing-Risks Analysis of Workforce Continuity Effects

Trauma-focused therapy programmes in post-conflict northern Uganda depend on community health workers (CHWs) to deliver and sustain treatment, yet CHW attrition and patient dropout are typically studied as separate problems. The framework specifies two mechanisms: a caseload-reassignment hazard, whereby departing CHWs transfer patients to workers with less trauma-specific training, and a trust-reconstruction hazard, whereby patients exposed to worker turnover withdraw from therapy. Using the DHS Program indicator 'Family planning messages at community meeting or event' (FP_EFPM_M_COM) across 15 African country surveys conducted between 2021 and 2025 (N = 15; mean = 29.733; SD = 17.495; range 6.60 in Mali to 73.40 in Malawi), the paper illustrates how community-embedded health communication varies across settings and why that variation matters for workforce continuity. The contribution is a formal competing-risks specification that makes CHW attrition an explicit covariate of therapy dropout, together with derived propositions and a measurement agenda. The framework implies that workforce continuity should be modelled as a time-varying exposure rather than a baseline programme characteristic, and that dropout analyses which ignore CHW turnover will overstate patient-level determinants of discontinuation.