"background": "Community health centres are a cornerstone of primary healthcare delivery in sub-Saharan Africa, yet robust evidence on their systemic impact on clinical outcomes remains limited. Existing evaluations often lack rigorous counterfactual designs, hindering causal inference. ", "purpose and objectives": "This study aimed to quantify the causal effect of a structured community health centre system on key clinical outcomes in a rural setting, using a quasi-experimental approach to address selection bias. ", "methodology": "We employed a difference-in-differences design, exploiting the phased rollout of the system across 120 centres. Clinical data were collected from routine health management information systems for maternal and child health indicators. The primary analysis estimated the average treatment effect on the treated using a linear regression model: Y{it = \0 + \1 (Treati \ Postt) + \ + \ +, where Y₈ₓ is the outcome for centre i at time t, with centre and time fixed effects. Inference was based on cluster-robust standard errors. ", "findings": "The intervention significantly increased the proportion of facility-based deliveries by 14. 3 percentage points (95% CI: 8. 1 to 20. 5). No statistically significant effects were observed for postnatal care attendance or childhood vaccination completeness. ", "conclusion": "The structured community health centre system had a strong, positive impact on increasing facility deliveries but did not improve other measured maternal and child health outcomes uniformly. ", "recommendations": "Programme implementers should strengthen referral linkages and postnatal follow-up components within community health systems. Future research should investigate the mechanisms behind the heterogeneous effects across outcome types. ", "key words": "health systems evaluation, quasi-experimental design, difference-in-differences, primary healthcare, maternal health", "contribution statement": "This study provides novel causal evidence on the specific clinical outcomes affected by a community health centre system, demonstrating the utility of rigorous quasi-experimental methods
Mwakalinga et al. (Thu,) studied this question.