"background": "Community health centres are a cornerstone of primary care delivery in many low-resource settings, yet rigorous quantitative evaluations of their systemic efficiency gains are limited. Existing assessments often lack robust counterfactuals, making causal attribution challenging. ", "purpose and objectives": "This case study aimed to develop and apply a quasi-experimental methodology to isolate and quantify the causal effect of a national community health centre strengthening programme on health system efficiency in Uganda. ", "methodology": "We employed a difference-in-differences model, comparing changes in key efficiency indicators (e. g. , outpatient cost per visit) between treatment facilities (n=127) and matched control facilities (n=127) before and after programme implementation. The core model is specified as: Y{it = \0 + \1 + \2 + \ (\) + \₈ₓ, where \ is the causal parameter of interest. Inference is based on cluster-robust standard errors at the facility level. ", "findings": "The intervention led to a statistically significant reduction in the average outpatient cost per visit of 18. 2% (95% CI: -22. 1% to -14. 3%, p<0. 01) in treatment centres relative to controls. This efficiency gain was primarily driven by improved supply chain management and task-shifting, as identified in supplementary qualitative fieldwork. ", "conclusion": "The community health centre model, when supported by a targeted strengthening programme, can produce substantial and measurable efficiency improvements within a constrained health budget. ", "recommendations": "Policy makers should integrate quasi-experimental evaluation designs, particularly difference-in-differences, into the rollout of health system interventions to rigorously monitor efficiency. Investment should prioritise integrated supply chain systems and supportive supervision for frontline health workers. ", "key words": "health systems, efficiency, difference-in-differences
Kato et al. (Sun,) studied this question.
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