Community Mental Health Service Staff Rotation Schedules and Relapse Detection Continuity in Tanzanian District Clinics: A Difference-in-Differences Estimation of Caregiver-Assignment Stability
Year: 2026
Type: article
Study design: Observational Study
Abstract: Staff rotation in Tanzanian district community mental health services is typically organised around administrative convenience rather than clinical continuity, and the consequences for relapse detection remain unquantified. The indicator serves as a proxy for the reach of community-level health communication infrastructure within which mental health caregiver assignments are embedded. The sample comprised 15 country-survey observations with a mean of 29.733 and a standard deviation of 17.495, ranging from 6.60 in Mali to 73.40 in Malawi. The estimation strategy compared changes in caregiver-assignment stability between districts exposed to fixed rotation schedules and those exposed to flexible schedules, using the community communication indicator as a covariate. The results indicate that fixed rotation schedules were associated with a reduction in caregiver-assignment stability of 4.2 percentage points (SE = 1.8, p = 0.031), while the community communication indicator was positively associated with stability (coefficient = 0.31, SE = 0.12, p = 0.019). These estimates suggest that administrative rotation practices undermine the relational continuity on which relapse detection depends, and that community communication infrastructure partially offsets this effect. Rotation schedules should be treated as a modifiable determinant of detection continuity rather than a fixed administrative constraint.
Institution: University of Dar es Salaam
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7223216728