A Quasi-Experimental Evaluation of the Cost-Effectiveness of Community Health Centre Systems in Rwanda

Abstract

{ "background": "Community health centres (CHCs) are a cornerstone of primary healthcare delivery in many low-resource settings, yet robust evidence on their cost-effectiveness remains limited. This gap hinders optimal resource allocation and health system planning.", "purpose and objectives": "This study aimed to evaluate the cost-effectiveness of Rwanda's CHC system in delivering a package of essential maternal and child health services, using a quasi-experimental design to estimate causal effects on health outcomes relative to costs incurred.", "methodology": "We employed a difference-in-differences design, exploiting the phased rollout of CHC enhancements across districts. Cost data were collected from financial records, and health outcome data were extracted from district health information systems. Cost-effectiveness was modelled using a linear regression framework: $CEi = \\beta0 + \\beta1 \\text{Treatment}i + \\beta2 \\text{Time}i + \\beta3 (\\text{Treatment}i \\times \\text{Time}i) + \\epsiloni$, where $CE_i$ is the cost per disability-adjusted life year averted in district $i$. Inference was based on cluster-robust standard errors.", "findings": "The enhanced CHC system was associated with a 17% reduction in the cost per disability-adjusted life year averted compared to standard care (95% CI: 12% to 22%). This improvement was primarily driven by increased service utilisation for antenatal care and childhood immunisation, without a proportional increase in total economic costs.", "conclusion": "The Rwandan CHC model demonstrates significant cost-effectiveness in delivering key primary healthcare services. The findings suggest that strategic investment in integrated community-level health systems can yield substantial returns in health value.", "recommendations": "Policy makers should consider the phased enhancement of CHCs as a viable strategy for improving primary healthcare efficiency. Future research should investigate the long-term sustainability and equity impacts of this model.", "key words": "cost-effectiveness analysis, primary healthcare, difference-in