District Hospital Trauma Mental Health Screening Cash-Based User Fee Exemption Verification Delays and Post-Traumatic Stress Disorder Assessment Dropout in Ugandan Clinics: A Regression Discontinuity Analysis of Eligibility Documentation Windows

Delays in verifying eligibility for cash-based user fee exemptions at Ugandan district hospitals may interrupt the clinical pathway between trauma presentation and post-traumatic stress disorder (PTSD) assessment. The design identifies the local average treatment effect of timely exemption confirmation on assessment completion for patients whose verification duration falls narrowly on either side of the window threshold. The paper specifies the estimand, the continuity and monotonicity assumptions, the bandwidth and polynomial order selection, and the threats to identification that arise from committee scheduling, documentation completeness and clinician discretion. It further proposes a companion difference-in-discontinuities specification to separate the effect of verification delay from seasonal and caseload confounding. The contribution is methodological: it converts an administrative artefact of cash-based exemption systems into a credible source of quasi-random variation, and it reframes PTSD assessment dropout not as a patient-level help-seeking failure but as a downstream consequence of how hospitals verify entitlement. The design is intended for application to routine hospital data and does not report empirical estimates.