District hospitals in Tanzania play a crucial role in healthcare delivery, yet their reliability remains under scrutiny. Panel data analysis was employed to assess system performance across multiple districts over time. The average reliability score across all hospitals was 75%, with significant variability between regions. Despite challenges, the panel data approach provides a robust framework for monitoring and enhancing district hospital systems in Tanzania. Further research should focus on implementing targeted interventions to improve system reliability in underserved areas. district hospitals, reliability assessment, panel data analysis, healthcare systems, Tanzania Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.