{ "background": "Community health centres in Nigeria face systemic risks that compromise service delivery and patient safety. Existing risk management approaches are often ad hoc and lack a standardised, evidence-based methodology suitable for low-resource settings.", "purpose and objectives": "This study aimed to evaluate the efficacy of a novel, structured methodological framework for operational risk reduction in Nigerian community health centres. The primary objective was to quantify the framework's impact on a composite risk score.", "methodology": "We conducted a parallel-group, randomised field trial. Sixty centres were randomly allocated to implement the new framework (intervention) or continue with existing practices (control). The framework comprised risk mapping, root-cause analysis, and iterative protocol adaptation. The primary outcome was the change in a validated risk audit score after six months. Analysis used a linear mixed-effects model: $\\Delta Score{ij} = \\beta0 + \\beta1 Treatment{ij} + uj + \\epsilon{ij}$, where $u_j$ is a random intercept for geographical cluster, with robust standard errors.", "findings": "Centres using the novel framework demonstrated a significantly greater reduction in mean risk score compared to controls (adjusted mean difference: -12.4 points, 95% CI: -16.1 to -8.7, p<0.001). This represents a 24% relative improvement. The most substantial risk reductions were observed in medication storage and patient referral logistics.", "conclusion": "The implemented methodological framework is an effective tool for systematically reducing operational risks in resource-constrained community health settings.", "recommendations": "Health policymakers should consider integrating this structured framework into national community health guidelines. Further research should assess long-term sustainability and cost-effectiveness.", "key words": "operational risk, health systems, randomised trial, patient safety, implementation science", "contribution statement": "This paper provides the first experimental evidence for a standardised, context-adapted risk reduction methodology in sub-Saharan African primary care, demonstrating its significant effect size