Methodological Evaluation of District Hospitals Systems in Kenya: A Randomized Field Trial for Cost-Effectiveness Assessment

District hospitals in Kenya play a critical role in healthcare delivery, yet their operational efficiency varies significantly across different regions. This variability necessitates an evaluation of system methodologies to enhance service quality and cost-effectiveness. A stratified random sampling approach was employed to select districts for the study. Data collection included surveys among healthcare workers, financial records analysis, and feedback from patients. A mixed-methods design integrating quantitative and qualitative data was utilised to ensure comprehensive evaluation. The findings indicate that resource allocation discrepancies significantly impact patient care quality in some regions, with a notable proportion (30%) of facilities spending more than the recommended budget on essential supplies. The randomized field trial demonstrated that systematic adjustments in resource management and service delivery could improve cost-effectiveness without compromising service quality. District health authorities are advised to adopt evidence-based guidelines for resource allocation, implement regular performance reviews, and invest in training programmes for healthcare workers to enhance operational efficiency. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.