District hospitals in Ethiopia face challenges in delivering efficient healthcare services. A mixed-methods approach combining quantitative data analysis with qualitative interviews was employed to assess system performance over two years. District hospitals showed an average improvement in patient throughput by 15% after implementing targeted efficiency measures, although variability existed across different regions. The randomized field trial demonstrated the effectiveness of specific interventions in enhancing hospital efficiency, with notable improvements observed in some districts. Further studies should focus on sustainability and scalability of these interventions to ensure long-term benefits for district hospitals. district hospitals, Ethiopia, efficiency gains, randomized field trial Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.