"background": "Community health centres are a cornerstone of primary care delivery in sub-Saharan Africa, yet rigorous evidence on their cost-effectiveness remains scarce. This limits evidence-based policy and resource allocation for strengthening these systems. ", "purpose and objectives": "This study aimed to develop and apply a novel quasi-experimental methodology to evaluate the cost-effectiveness of a national community health centre system, using Uganda as a case study. The primary objective was to estimate the incremental cost per disability-adjusted life year (DALY) averted by the system. ", "methodology": "We employed a quasi-experimental, propensity score-matched design, comparing intervention districts with matched control districts over time. Cost data were collected from financial records and ingredient costing. Health outcomes were modelled using routine health information system data and demographic surveys. Cost-effectiveness was estimated using a generalised linear model: \ (it) = \0 + \1 i + \2 t + \3 (i \ t) + {it\\ + \₈ₓ, where i denotes district and t time period, with robust standard errors clustered at the district level. ", "findings": "The community health centre system was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of US 320 per DALY averted (95% CI: 245 to 415). The intervention was associated with a statistically significant 18% reduction in under-five mortality rates in intervention districts compared to controls (p<0. 01). ", "conclusion": "The Ugandan community health centre system represents a cost-effective investment for improving population health. The study demonstrates the utility of robust quasi-experimental methods for health systems evaluation in resource-constrained settings. ", "recommendations": "Policymakers should prioritise sustained
Mwaka et al. (Sat,) studied this question.