Abstract
{ "background": "Community health centres in sub-Saharan Africa face systemic risks that compromise service delivery and patient outcomes. Existing frameworks for risk management are often descriptive and lack rigorous, quantitative evaluation in operational settings.", "purpose and objectives": "This study aimed to empirically evaluate a novel, structured risk reduction framework (RRF) designed for community-level health systems. The primary objective was to measure its effect on a composite risk score across multiple operational domains.", "methodology": "We conducted a parallel-group, stratified randomised field trial involving 42 community health centres. Centres were allocated to implement the RRF or continue standard practice. The primary outcome was the change in a validated system risk score after the intervention period. Analysis used a linear mixed-effects model: $Y{ij} = \\beta0 + \\beta1 Ti + uj + \\epsilon{ij}$, where $Ti$ is treatment, $uj$ is a random intercept for district, and robust standard errors were calculated.", "findings": "Centres implementing the RRF demonstrated a significant reduction in system risk scores compared to control centres (adjusted mean difference: -12.4 points, 95% CI: -16.1 to -8.7, p<0.001). The greatest improvement was observed in the medication supply chain domain, where risk was reduced by approximately 32%.", "conclusion": "The structured risk reduction framework effectively lowered systemic risks in community health centres, indicating its utility as a practical management tool for strengthening health system resilience.", "recommendations": "Health policymakers should consider integrating core components of the RRF, particularly its supply chain modules, into national community health strategies. Further research should investigate cost-effectiveness and long-term sustainability.", "key words": "health systems strengthening, operational research, randomised trial, risk management, primary health care", "contribution statement": "This paper provides the first experimental evidence for a quantifiable risk reduction framework in a community health setting, introducing a replicable method for measuring