In Rwanda, district hospitals play a crucial role in healthcare provision, yet their effectiveness remains under scrutiny. A mixed-method approach combining quantitative and qualitative data collection was employed to assess system performance and resource allocation. District hospitals in selected districts reported an average cost per patient treatment of $50 ± $10, indicating moderate efficiency levels. The quasi-experimental design revealed significant variations in service delivery across different regions. Further research is recommended to identify best practices and optimise resource allocation for improved healthcare outcomes.