Community Mental Health Services Supervision Visit Frequency and Diagnostic Reclassification Rates in Botswanan Clinics: A Difference-in-Differences Analysis of Supervision Redistricting

Botswana's community mental health services rely on supervisory visits from psychiatric nurses to guide diagnostic practice in primary care clinics, yet the frequency of these visits varies across districts and has never been systematically evaluated against diagnostic reclassification rates. The protocol specifies a two-period design comparing clinics whose supervision frequency increases against those whose frequency remains unchanged, with diagnostic reclassification rates as the primary outcome. The analysis is framed around the hypothesis that more frequent supervision reduces diagnostic reclassification by improving diagnostic stability and adherence to clinical guidelines. The paper also reports descriptive statistics from the Demographic and Health Surveys Program indicator 'Family planning messages at community meeting or event' across 15 African countries (2021-2025), with a mean of 29.733 and a standard deviation of 17.495, to illustrate the broader context of community health messaging in the region. The protocol contributes a replicable evaluation framework for supervision policy in resource-constrained mental health systems, and it identifies key threats to validity including differential attrition and secular trends in diagnostic practice. The paper concludes with implications for the design of supervision redistricting in Botswana and comparable settings.