Ugandan municipal water systems have faced significant challenges in cost-effectiveness over recent years. A comprehensive search strategy was employed using databases such as PubMed and Google Scholar. Studies were screened based on predefined inclusion criteria related to methodology and impact assessment in municipal water systems in Uganda. Quasi-experimental designs showed a mixed performance, with some studies demonstrating significant cost savings but others failing to replicate these results consistently across different contexts. The review highlights the need for more robust methodological frameworks to ensure reliable and valid assessments of municipal water systems' cost-effectiveness in Uganda. Researchers are advised to adopt validated statistical models and establish clear criteria for data interpretation to enhance the reliability of their findings. The empirical specification follows $Y=\beta_0+\beta^\top X+\varepsilon$, and inference is reported with uncertainty-aware statistical criteria.