Methodological Assessment of Quasi-Experimental Design in South African District Hospital Systems,: A Systematic Review from an African Perspective

District hospitals in South Africa have implemented various interventions aimed at improving patient outcomes and service delivery efficiency. A comprehensive search strategy was employed using databases such as PubMed, Scopus, and Web of Science. Studies published between and were included if they utilised quasi-experimental designs to measure yield improvements in patient care or service delivery efficiency. A key finding is that while some studies used appropriate control groups and randomization techniques, others lacked clear definitions of intervention effects and failed to account for confounding variables effectively. The review highlights the need for clearer methodological guidelines and robust statistical approaches in quasi-experimental designs applied to district hospital settings. Researchers are encouraged to employ standardised control groups, transparent data collection methods, and rigorous statistical analyses to ensure valid conclusions from quasi-experimental studies. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.