District hospitals in Rwanda face challenges such as resource allocation inefficiencies and inadequate healthcare delivery. A systematic literature review employing multilevel regression models to analyse data from various Rwandan district hospitals. The study aimed at understanding the impact of systemic factors on healthcare delivery and patient outcomes. Multilevel regression analysis revealed a significant reduction in risk (p < 0.05) for complications related to resource management when effective governance structures were implemented, suggesting that robust managerial frameworks can mitigate operational risks. This study underscores the importance of systematic intervention strategies and governance reforms in district hospitals to enhance service delivery and patient safety. District hospital managers should prioritise implementing governance models for improved resource allocation and risk mitigation. Continuous monitoring and evaluation are recommended to sustain these improvements. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.