District hospitals in Ethiopia play a crucial role in healthcare delivery but face significant challenges related to cost-effectiveness. A systematic literature review was conducted to assess the existing evidence on district hospitals in Ethiopia. The analysis included randomized field trials to measure cost-effectiveness. Randomized field trial results indicate that district hospital systems have a median cost per patient treated of $50, with variability across different regions (e.g., Addis Ababa and Tigray). The study highlights the importance of standardising KPIs for district hospitals to ensure consistent performance evaluation. District health authorities should prioritise investment in infrastructure and training programmes to enhance system efficiency and patient outcomes. Standardised reporting of cost-effectiveness metrics is recommended to facilitate benchmarking across regions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.