Rwanda has implemented district hospitals as a cornerstone of its healthcare system to improve access and quality of care in rural areas. A mixed-methods approach combining quantitative data from surveys with qualitative insights from interviews was employed. The quasi-experimental design utilised pre- and post-intervention data to assess changes in protocol implementation. District hospitals demonstrated varying degrees of adoption, with a significant proportion (37%) showing substantial improvement in following established health protocols after the intervention period. The study concludes that while there are challenges in achieving full protocol adherence, the quasi-experimental design effectively measures these rates and identifies key areas for improvement. Further research should focus on enhancing training programmes and monitoring systems to ensure consistent adoption of health protocols across all district hospitals. quasi-experimental design, healthcare system evaluation, protocol adoption, Rwanda Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.