Malawian health centres deploy dental therapists and dental hygienists under supervision arrangements whose ratio thresholds remain unstandardised, and the consequences for restorative task delegation are poorly understood. Because no primary facility-level data were available for this run, the study is framed as a multilevel analytical design applied to a real secondary indicator: the DHS Program indicator 'Current users most recent supply or information from a government health center' (FP_SRCM_W_GHC), comprising 150 country-survey observations from 36 African countries between 1990 and 2025, with a mean of 25.261 and a standard deviation of 18.895. The paper specifies a two-level model in which country-survey observations are nested within countries, derives the supervision-ratio threshold as a team-composition parameter, and interprets the DHS indicator as a proxy for public-sector supply-side contact that conditions delegation. The contribution is a formalised threshold framework linking hygienist-therapist ratios to restorative delegation, together with an explicit statement of the data that would be required to estimate it. The analysis does not report empirical estimates of the threshold; it reports the design, the identification conditions, and the boundary conditions under which the threshold claim could be tested.
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Mwale et al. (2026) studied this question.
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