Rwanda's district hospitals are pivotal in health care delivery but face challenges with adoption of evidence-based practices. A longitudinal study employing multilevel regression models to assess the stability and variability in practice adoption over time at both hospital (level-1) and district (level-2) levels, accounting for contextual factors. Findings indicate a significant increase in the adoption rate of antenatal care practices from baseline to follow-up, with a coefficient estimate of -0.56 (95% CI: -0.78 to -0.34). The multilevel regression analysis reveals that contextual factors significantly influence practice adoption rates. Facilitate continuous professional development and support for healthcare providers at district levels, incorporating robust monitoring systems. multilevel regression, longitudinal study, practice adoption, Rwanda, health care delivery Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.