{ "background": "Community health centres are a cornerstone of primary healthcare delivery in many African nations, yet rigorous methodological evaluations of their systems and cost-effectiveness remain limited. This creates a significant evidence gap for health systems planning and resource allocation. ", "purpose and objectives": "This review aims to critically appraise the methodological approaches used in randomised field trials assessing community health centre systems in Tanzania, and to synthesise evidence on their cost-effectiveness from these studies. ", "methodology": "We conducted a systematic methodological review of published and grey literature reporting on randomised controlled trials (RCTs) of community health centre interventions. A cost-effectiveness analysis was synthesised from trial data using a decision-analytic model. The primary outcome was cost per disability-adjusted life year (DALY) averted, estimated via the model = (CI - CC) / (EI - EC), where C and E denote costs and effects for intervention (I) and control (C) groups. Uncertainty was characterised using 95% confidence intervals derived from probabilistic sensitivity analysis. ", "findings": "Methodological quality of trials was variable, with common limitations in blinding and attrition reporting. Synthesised evidence indicates that integrated service delivery models were significantly more cost-effective than vertical programmes, with a median incremental cost-effectiveness ratio of US\110 per DALY averted (95% CI: \85–\150). A key theme was the critical influence of community health worker training and supply chain integrity on outcomes. ", "conclusion": "Randomised field trials provide crucial, but methodologically inconsistent, evidence on health centre systems. When synthesised, this evidence strongly supports the cost-effectiveness of integrated service models within the Tanzanian context. ", "recommendations": "Future RCTs should adopt more standardised methodological protocols for cost and outcome measurement. Policymakers should prioritise funding for integrated service delivery and strengthen the training and logistical support for community health workers. ", "key words": "health systems research,
Khamis et al. (Sun,) studied this question.