"background": "Community health centres are critical nodes in Nigeria's primary healthcare system, yet persistent inefficiencies in resource allocation and service delivery constrain their performance. A robust methodological framework for quantifying operational efficiency and identifying determinants of improvement is lacking. ", "purpose and objectives": "This case study aims to methodologically evaluate the operational systems of community health centres and measure efficiency gains using a multilevel modelling approach. The objective is to identify facility- and community-level factors that significantly influence technical efficiency. ", "methodology": "We employed a two-stage analytical design. First, data envelopment analysis calculated technical efficiency scores for a purposive sample of 127 centres. Second, a multilevel linear regression model identified determinants of efficiency. The core statistical model was Efficiency{ij = \0j + \1Xij + \2Zj + uj + eij, where i and j denote facilities and districts, with robust standard errors clustered at the district level. ", "findings": "The multilevel analysis revealed that drug supply chain integrity and staff skill-mix were the most significant facility-level predictors of efficiency. A one-standard-deviation improvement in supply chain metrics was associated with a 15. 2% increase in technical efficiency (95% CI: 11. 8% to 18. 6%). District-level health funding allocation showed no statistically significant effect. ", "conclusion": "The study demonstrates that operational efficiency is predominantly driven by manageable, facility-specific factors rather than broader budgetary inputs. The applied methodology provides a replicable framework for systemic evaluation. ", "recommendations": "Health policy should prioritise interventions that strengthen logistical systems and human resource management at the individual facility level. Routine efficiency audits using this multilevel model are recommended for targeted resource allocation. ", "key words": "health systems efficiency, multilevel modelling, primary healthcare, resource allocation, health policy evaluation", "contribution statement": "This study provides a novel methodological application
Okonkwo et al. (Thu,) studied this question.