District hospitals in Ghana are critical for healthcare provision but often face challenges in efficiency. A randomized field trial will be conducted across selected district hospitals. Data on patient flow, resource utilization, and operational costs will be collected using standardised instruments. Efficiency scores will be calculated with an expected improvement of at least 15% based on preliminary data. The preliminary results suggest a direction for efficiency gains but do not provide definitive proportions or themes. Further analysis is needed to confirm the potential improvements in efficiency across all participating districts. Implementing evidence-based interventions and sharing best practices could enhance system performance. district hospitals, Ghana, randomization, healthcare efficiency Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.