In Nigeria, district hospitals play a pivotal role in healthcare delivery, but their operational effectiveness is often questioned. A randomized controlled trial was conducted across five districts to measure resource allocation, patient outcomes, and financial management practices. Data were collected over six months using standardised surveys and financial records analysis. The preliminary findings suggest that an optimised resource allocation strategy could lead to a 20% reduction in treatment costs without compromising patient care quality. This study highlights the potential for significant cost savings through strategic management practices, which can inform future district hospital system improvements. District health authorities should implement evidence-based financial and operational reforms guided by this research's findings. district hospitals, cost-effectiveness, randomized field trial, healthcare delivery Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.