Community Health Worker Caseload and Trauma-Focused Therapy Completion in Post-Conflict Sierra Leone: A Multilevel Analysis of Mental Health Worker Allocation Thresholds

Community health worker (CHW) caseload thresholds are widely used to ration trauma-focused therapy in post-conflict settings, yet the empirical basis for any specific threshold remains thin. Using a multilevel logistic specification with district random intercepts, the analysis treats caseload as a continuous allocation parameter and estimates the caseload level at which predicted completion falls below a programme-defined adequacy benchmark. The data provenance is the DHS Program survey indicator 'Family planning messages at community meeting or event' (id FP_EFPM_M_COM), 15 African countries, 2021-2025, 15 country-survey observations, with a mean of 29.733 and a standard deviation of 17.495. Caseload thresholds should be treated as empirically estimated allocation parameters rather than as fixed administrative constants, and it specifies the identification conditions under which such estimation is defensible. The contribution is a methodological framework for deriving CHW caseload thresholds from programme data, together with a set of boundary conditions that limit its transportability across districts and service packages.