Evaluating the Impact of Urban Primary Care Networks on Clinical Outcomes in Rwanda: A Difference-in-Differences Analysis

"background": "Strengthening primary healthcare is a global priority for achieving universal health coverage. In Rwanda, the establishment of urban primary care networks (UPCNs) represents a major health system reform, but rigorous quantitative evidence of their impact on clinical outcomes is limited. ", "purpose and objectives": "This study aimed to quantify the causal effect of UPCN implementation on key clinical outcome indicators in urban settings. ", "methodology": "We employed a quasi-experimental difference-in-differences design, analysing longitudinal panel data from health facility records. The treatment group comprised facilities in districts where UPCNs were operationalised; matched control facilities were in districts awaiting implementation. The core model is Y{it = \0 + \1 (Treati \ Postt) + \ + \ +, where Y₈ₓ is the outcome for facility i at time t. Inference is based on cluster-robust standard errors at the facility level. ", "findings": "UPCN implementation was associated with a statistically significant 12. 4 percentage point increase (95% CI: 8. 1, 16. 7; p<0. 01) in the completion rate of the maternal antenatal care continuum. No significant effects were detected for childhood immunisation completeness or hypertension control within the study period. ", "conclusion": "The reform improved service integration and continuity for maternal care, but had heterogeneous effects across different clinical domains. ", "recommendations": "Policy should focus on adapting the network model to better support chronic disease management and childhood vaccination programmes. Further research should investigate the specific mechanisms driving the observed improvements in maternal care. ", "key words": "Primary health care, health systems reform, difference-in-differences, health policy evaluation, maternal health, Rwanda", "contribution statement": "This study provides the first quasi-experimental evidence on the clinical impact of Rwanda's urban primary care networks, introducing a novel facility-level matching strategy for