This review examines quasi-experimental designs used to evaluate municipal water systems in Uganda over a decade. A comprehensive search strategy was employed using databases such as PubMed and Web of Science. Studies were included if they utilised quasi-experimental designs to analyse municipal water system performance. Quasi-experimental designs showed significant variability in their ability to detect efficiency gains, with some studies reporting gains up to 20% in treated areas compared to control zones. The review highlights the need for standardised methodologies and clear data collection protocols to enhance reliability of quasi-experimental findings on municipal water systems effectiveness. Future research should focus on harmonizing quasi-experimental designs, ensuring consistent measurement tools across studies, and incorporating robust statistical models to improve validity. Model estimation used $\hat{\theta}=argmin_{\theta}\sum_i\ell(y_i,f_\theta(x_i))+\lambda\lVert\theta\rVert_2^2$, with performance evaluated using out-of-sample error.