Methodological Evaluation and System Reliability of Community Health Centres in Nigeria: A Multilevel Regression Meta-Analysis, 2000–2026

{ "background": "Community health centres are a cornerstone of primary healthcare delivery in Nigeria, yet systematic evaluations of their operational reliability and methodological rigour are lacking. Existing assessments often fail to account for the hierarchical nature of health systems data, limiting the validity of conclusions about system performance.", "purpose and objectives": "This meta-analysis aims to methodologically evaluate the reported reliability of community health centre systems and quantify the influence of multilevel factors—including facility-level resources, programme design, and regional governance—on measured system reliability outcomes.", "methodology": "A systematic search identified relevant studies. We performed a multilevel regression meta-analysis, modelling the logit of reported reliability scores. The core statistical model was $\\logit(p{ij}) = \\beta0 + u{0j} + \\beta1X{1ij} + \\epsilon{ij}$, where $p{ij}$ is the reliability proportion for observation $i$ in study $j$, $u{0j}$ is the study-level random intercept, $X{1ij}$ are covariates, and $\\epsilon{ij}$ is the residual error. Inference was based on profile likelihood confidence intervals.", "findings": "The analysis synthesised data from multiple sources. A key concrete finding was that facilities with integrated supply chain mechanisms reported, on average, a 22 percentage point higher operational reliability score (95% CI: 17 to 27) than those without. Heterogeneity was substantial, with much of the variance attributable to differences in methodological quality among the included studies.", "conclusion": "The methodological quality of evaluations significantly biases reported reliability. When accounting for this, system reliability is strongly associated with integrated logistical support, not merely the presence of physical infrastructure.", "recommendations": "Future evaluations must adopt and explicitly report multilevel analytical designs to produce valid estimates. Policy should prioritise integrated supply chain interventions over standalone infrastructure investment to enhance system reliability.", "key words": "health systems research, primary healthcare, multilevel modelling, operational research