Methodological Evaluation of Community Health Centre Systems in Rwanda: Quasi-Experimental Approach to Assessing Cost-Effectiveness

Community health centers (CHCs) play a crucial role in Rwanda's healthcare system, aiming to improve access and quality of care for underserved populations. A mixed-methods approach combining quantitative data from financial records and qualitative insights from interviews and surveys was employed. The primary analysis used regression discontinuity design (RDD) to estimate the impact of CHC implementation on healthcare utilization and costs per beneficiary. CHCs showed a significant reduction in outpatient visits cost by $20 per patient, with an estimated average cost-effectiveness ratio of 1:3 across all evaluated districts, indicating that for every dollar spent on CHCs, there was a return of three dollars in terms of healthcare costs and quality. The quasi-experimental design provided robust evidence supporting the efficacy of CHC systems in Rwanda, highlighting their potential to scale up as part of broader health system reforms. Further studies should explore longer-term impacts and sustainability of CHCs while considering scalability across different regions with varying healthcare needs. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.