District Hospital Trauma Survivor Mental Health Screening Prompt Payment Waiver Exposure and Post-Traumatic Stress Disorder Disclosure in Kenyan Referral Clinics: A Difference-in-Differences Analysis of Fee Exemption Rollout

Kenyan referral clinics have experimented with prompt payment waivers that remove user fees at the point of trauma care, on the assumption that financial relief increases survivors' willingness to disclose post-traumatic stress symptoms during routine mental health screening. The causal claim has not been tested. The design treats clinic-level waiver activation as the exposure, PTSD disclosure during structured screening as the outcome, and pre-rollout disclosure trends in not-yet-exposed clinics as the counterfactual. The protocol specifies parallel-trends diagnostics, event-study estimation, heterogeneity by injury severity and sex, and sensitivity analyses for differential attrition and screening-tool drift. It also addresses a measurement problem specific to the setting: disclosure is jointly produced by survivor willingness and clinician elicitation practice, so the estimand is the intention-to-treat effect of waiver exposure on disclosure under routine screening conditions. The contribution is a pre-specified, falsifiable design that converts a plausible policy intuition into an estimable quantity, and that names the conditions under which the waiver-disclosure relationship would fail to appear.