{ "background": "Community health centres are a cornerstone of primary healthcare delivery in many African nations, yet systematic evidence on the methodological rigour and reliability of field trials evaluating their systems remains limited. A synthesis of existing randomised field trial evidence is required to assess the robustness of current evaluation approaches.", "purpose and objectives": "This meta-analysis aims to methodologically evaluate the design and reporting quality of randomised field trials assessing community health centre systems in Ghana and to quantitatively synthesise evidence on system reliability metrics.", "methodology": "We conducted a systematic search of multiple electronic databases for published and grey literature. Included studies were randomised field trials reporting on system reliability outcomes (e.g., equipment functionality, supply chain integrity, protocol adherence). Methodological quality was appraised using a modified Cochrane Risk of Bias tool. A random-effects meta-analysis was performed to pool reliability estimates, with heterogeneity assessed using the $I^2$ statistic. The primary model was $\\thetai = \\mu + \\epsiloni + \\deltai$, where $\\thetai$ is the observed effect, $\\mu$ the true effect, $\\epsiloni$ the within-study error, and $\\deltai$ the study heterogeneity.", "findings": "The analysis incorporated data from trials. Methodological appraisal revealed significant heterogeneity in trial design and reporting standards. The pooled estimate for overall system reliability was 0.72 (95% CI: 0.68 to 0.76), indicating moderate reliability, but with substantial study heterogeneity ($I^2 = 78\\%$, p<0.01).", "conclusion": "While aggregated data suggest moderate system reliability, the high heterogeneity and methodological inconsistencies across trials undermine the strength of this conclusion. The evidence base is fragmented and requires more standardised evaluation frameworks.", "recommendations": "Future field trials should adopt a core outcome set for system reliability and improve reporting of randomisation procedures and implementation contexts. National health research guidelines should incorporate standardised methodological checklists for system evaluations.", "key