"background": "Community health centres are a cornerstone of primary healthcare delivery in sub-Saharan Africa, yet robust evidence quantifying their impact on population-level health risk is limited. Existing evaluations often lack rigorous counterfactual comparisons. ", "purpose and objectives": "This study aimed to estimate the causal effect of enhanced community health centre systems on composite health risk scores in a rural population, using a quasi-experimental design to address selection bias. ", "methodology": "We employed a difference-in-differences design, exploiting the phased rollout of an integrated health centre strengthening programme across 120 villages. Household panel data were collected from 2, 400 adults. The primary outcome was a validated composite health risk score (0-100). The core econometric model was: Y{it = \0 + \1 (Treati \ Postt) + \ Xit + \ + \ +, where \ and \ₜ are individual and time fixed effects. Inference was based on cluster-robust standard errors. ", "findings": "Exposure to the strengthened health centre system was associated with a significant reduction in mean health risk score by 7. 3 points (95% CI: -10. 1, -4. 5). The largest risk reductions were observed in infectious disease and maternal-child health domains. ", "conclusion": "The findings provide causal evidence that enhanced community health centres can effectively reduce population health risks. The quasi-experimental approach offers a viable methodology for impact evaluation in real-world, non-randomised programme implementation contexts. ", "recommendations": "Policy should prioritise sustained investment in integrated community health systems. Future programme evaluations should incorporate quasi-experimental designs with longitudinal data to strengthen causal inference. ", "key words": "health systems evaluation, quasi-experimental design, difference-in-differences, primary healthcare, causal inference, sub-Saharan Africa", "contribution statement": "This study provides novel causal evidence on the
Mwakyusa et al. (Tue,) studied this question.