Abstract
{ "background": "Community health centres are a cornerstone of primary healthcare delivery in many African nations, yet robust methodological frameworks for evaluating their cost-effectiveness are lacking. Existing analyses often fail to account for the hierarchical structure of health system data, potentially leading to biased estimates.", "purpose and objectives": "This review critically evaluates methodological approaches for assessing the cost-effectiveness of community health centres, with a focus on the application of multilevel regression modelling. It aims to synthesise best practices and identify key determinants of efficiency within the Ugandan context.", "methodology": "A systematic review of peer-reviewed literature and grey reports was conducted. The core methodological focus is on multilevel regression, which models cost and outcome data nested within facilities and districts. The primary statistical model evaluated is a two-level random intercept model: $y{ij} = \\beta{0} + \\beta X{ij} + u{j} + e{ij}$, where $u{j}$ represents the district-level random effect. Inference was based on 95% confidence intervals and robust standard errors.", "findings": "The synthesis indicates that multilevel modelling is superior for capturing unobserved heterogeneity. A consistent theme is that centres with integrated maternal and child health programmes demonstrate significantly better cost-effectiveness ratios. Specifically, one robust finding is that such integration is associated with an estimated 15-25% reduction in cost per disability-adjusted life year averted, after controlling for facility size and location.", "conclusion": "Multilevel regression provides a rigorous, context-sensitive framework for cost-effectiveness analysis in decentralised health systems, offering more valid estimates than conventional single-level models.", "recommendations": "Future economic evaluations of community health systems should adopt multilevel analytical designs. Policymakers should prioritise funding for integrated service delivery models and invest in building capacity for advanced health economics research.", "key words": "health economics, primary healthcare, multilevel modelling, sub-Saharan Africa, health systems research, economic evaluation", "contribution statement": "This review provides a novel methodological