Abstract
{ "background": "Community health centres are critical for primary care delivery in Nigeria, yet their operational efficiency remains a significant policy concern. Randomised field trials have emerged as a prominent methodological approach for evaluating interventions aimed at improving efficiency within these systems.", "purpose and objectives": "This systematic review aims to critically appraise the methodological rigour of randomised field trials used to measure efficiency gains in Nigerian community health centres, identifying common design strengths, limitations, and reporting practices.", "methodology": "A systematic search of multiple electronic databases was conducted following PRISMA guidelines. Eligible studies were randomised field trials with a primary outcome of health centre efficiency, measured via metrics like patient throughput or resource utilisation. Studies were screened, data extracted, and their methodology assessed using a modified Cochrane Risk of Bias tool and a bespoke checklist for efficiency-specific econometric considerations, including the specification of models such as $y{it} = \\beta0 + \\beta1T{it} + X'{it}\\gamma + \\alphai + \\epsilon{it}$, where $y{it}$ is an efficiency output, $T{it}$ is the treatment assignment, and $\\alphai$ denotes centre-level fixed effects.", "findings": "The review identified a pronounced methodological gap: fewer than 20% of included trials adequately accounted for intra-cluster correlation in their primary efficiency analyses, leading to underestimated standard errors. A dominant theme was the reliance on partial productivity measures rather than comprehensive technical efficiency frontiers. Inference was frequently compromised by insufficient power calculations for the chosen efficiency metric.", "conclusion": "While randomised trials provide a strong design for causal inference, their current application to efficiency measurement in this context is often methodologically incomplete, limiting the validity and generalisability of reported efficiency gains.", "recommendations": "Future trials should pre-specify efficiency outcomes using robust frontier methods (e.g., stochastic frontier analysis), incorporate cluster-robust standard errors by design, and adhere to consolidated reporting standards for economic evaluations alongside trials.", "