A Randomised Field Trial Evaluating the Impact of Urban Primary Care Networks on Clinical Outcomes in Rwanda

"background": "Strengthening primary healthcare systems is a critical challenge in rapidly urbanising African contexts. While community-based health insurance and performance-based financing have been studied, the specific model of formalised urban primary care networks (UPCNs) remains under-evaluated, particularly regarding hard clinical endpoints. ", "purpose and objectives": "This study aimed to determine the causal effect of a structured UPCN intervention on key clinical outcomes for hypertension and type 2 diabetes management in an urban Rwandan setting. ", "methodology": "We conducted a two-arm, parallel-group, cluster-randomised field trial. Twenty-four urban health centres were randomised to implement the UPCN intervention or continue standard care. The intervention involved network-based clinical protocols, shared electronic health records, and coordinated community health worker teams. The primary outcome was the proportion of patients achieving controlled blood pressure (BP<140/90 mmHg) at 12 months. Analysis used a generalised linear mixed model: (P (Y{ij=1) ) = \0 + \1 + \ Xij + uj, where uⱼ \ N (0, \²), accounting for clustering. ", "findings": "Patients in the UPCN arm were significantly more likely to achieve controlled blood pressure (adjusted odds ratio 1. 87, 95% CI 1. 32 to 2. 65). The adjusted proportion with controlled hypertension was 58. 3% in the intervention group versus 42. 1% in the control group. Glycaemic control also showed a statistically significant improvement. ", "conclusion": "The structured urban primary care network model significantly improved clinical outcomes for chronic disease management compared to standard care, demonstrating its effectiveness as a systems-level intervention. ", "recommendations": "Health policymakers should consider formalising and scaling the UPCN model in urban areas. Future implementation should integrate robust digital tracking and ensure sustainable financing for network coordination functions. ", "key words