Community Mental Health Services Co-Location With Traditional Healers and First-Contact Pathway Selection in Malawian Catchments: A Discrete Choice Experiment

Malawi's community mental health system depends on a first-contact decision that patients and families make before any clinical encounter: whether to present at a formal community mental health service or at a traditional healer. Co-location of the two has been proposed as a way of shortening that pathway, but the proposal has not been specified as a testable choice problem. The indicator, drawn from 15 African country surveys conducted between 2021 and 2025, has a mean of 29.733 and a standard deviation of 17.495, with country values ranging from 6.60 in Mali to 73.40 in Malawi. These values are used to calibrate the community-engagement attribute levels that anchor the DCE. The paper specifies attributes, levels, an orthogonal fractional factorial design, a conditional logit estimator, and a latent-class extension, and it states the identification assumptions under which co-location effects on first-contact pathway selection would be interpretable. The contribution is a design specification and a set of derived propositions, not an estimated treatment effect; the paper argues that co-location should be modelled as a bundle of separable attributes rather than as a single binary policy, because the attributes have different implications for demand, equity and clinical safety.