Methodological Evaluation of District Hospital Systems in Senegal: A Randomized Field Trial for Efficiency Gains

District hospitals in Senegal face challenges in delivering efficient healthcare services, leading to suboptimal patient outcomes and resource utilization. A mixed-methods approach was employed, including quantitative data collection via standardised health record audits and qualitative insights from clinician interviews. A two-stage cluster-randomized design was used to ensure representation across different districts. The analysis revealed that implementing a streamlined patient referral protocol resulted in a 20% reduction in unnecessary admissions (n = 500), demonstrating significant cost savings without compromising care quality. This randomized field trial provides robust evidence for the effectiveness of process interventions in improving hospital efficiency, offering practical recommendations for broader implementation. District health authorities should prioritise standardising referral processes and investing in training programmes to enhance staff competency, thereby optimising resource allocation and service delivery.