Seasonal Agricultural Labour Migration and Community Mental Health Service Contact Loss in Malawi: A Fixed-Effects Panel Estimation

Seasonal agricultural labour migration is a structural feature of rural livelihoods in Malawi, yet its consequences for continuity of community mental health care remain poorly specified. The framework treats contact loss as a function of migration-driven absence, of the timing of migration relative to scheduled review, and of the coverage of community health worker substitutes. It distinguishes between migration that removes the service user and migration that removes the household support that sustains attendance, and it shows why pooled cross-sectional comparisons confound these pathways with district-level service supply. The paper specifies a within-district estimator, derives the conditions under which district and year fixed effects absorb the principal confounders, and proposes a set of diagnostic tests for the most plausible violations, including reverse causation from symptom relapse to migration and differential attrition from the panel. No empirical estimates are reported; the contribution is a pre-specified estimation strategy and a set of testable propositions that can be applied to routine community mental health registers in Malawi and comparable settings. The framework implies that contact-loss estimates which ignore migration timing will understate the effect of seasonal absence on disengagement, and it identifies the design features that a credible evaluation of community mental health service continuity in labour-sending districts would require.