A Quasi-Experimental Evaluation of Cost-Effectiveness in Nigerian Community Health Centre Systems

"background": "Community health centres are a cornerstone of primary care delivery in many African nations, yet rigorous economic evaluations of their systems are scarce. Existing studies often lack robust counterfactuals, limiting causal inference on cost-effectiveness. ", "purpose and objectives": "This study aimed to evaluate the cost-effectiveness of an enhanced service delivery model within community health centre systems, using a quasi-experimental design to estimate the incremental cost per disability-adjusted life year (DALY) averted. ", "methodology": "A quasi-experimental difference-in-differences design was employed, comparing 24 intervention centres with 26 matched control centres. Cost data were collected from financial records, and effectiveness was measured via DALYs averted from key maternal and child health outcomes. The primary analysis estimated the average treatment effect on the treated using a generalised linear model: \ (it) = \0 + \1 (\) + \ X{it + \₈ₓ, with cluster-robust standard errors to account for centre-level correlation. ", "findings": "The enhanced model was associated with a 17% reduction in DALYs (95% CI: 12 to 22) relative to controls. The incremental cost-effectiveness ratio was estimated at ₦4, 850 per DALY averted, with the uncertainty analysis indicating a 78% probability of being cost-effective at a willingness-to-pay threshold of one times the national gross domestic product per capita. ", "conclusion": "The intervention demonstrated cost-effectiveness within this context, suggesting that targeted enhancements to service delivery models can improve health economic outcomes in resource-constrained primary care systems. ", "recommendations": "Policymakers should consider scaling the enhanced model, with prioritisation given to areas with baseline service deficits. Future evaluations should incorporate longer-term fiscal sustainability analysis. ", "key words": "health economics, primary health care, difference-in-differences,