This study focuses on evaluating the operational efficiency of district hospitals in Ethiopia, aiming to identify best practices for improving service delivery and cost-effectiveness. The study employs a mixed-method approach combining quantitative data analysis with qualitative case studies. A quasi-experimental design is utilised to compare pre- and post-intervention cost-efficiency metrics across randomly selected districts, while in-depth interviews are conducted with healthcare managers to gather insights into operational practices and challenges. A notable finding is that implementing standardised resource allocation protocols led to a 15% reduction in overall costs without compromising patient satisfaction levels (95% CI: -20%, -10%). The study concludes that strategic interventions can significantly enhance cost-effectiveness in district hospitals, providing evidence for policymakers and healthcare administrators. Policy recommendations include the adoption of standardised resource allocation protocols across all districts to optimise efficiency and reduce costs. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.