Rwanda's healthcare system is undergoing reforms to enhance service delivery at district hospitals, which play a crucial role in rural areas. The study employed multilevel regression models to analyse data from multiple sources including patient records and hospital administrative databases. Data revealed significant variation in clinical outcomes across different districts, with a notable improvement observed in the implementation of evidence-based guidelines (EBGs). Multilevel regression analysis provided insights into how district-level interventions can impact healthcare quality and patient care outcomes. District hospitals should prioritise EBGs adoption to further improve clinical outcomes. Continuous training for staff is recommended to ensure consistent application of these guidelines. district hospitals, Rwanda, multilevel regression analysis, clinical outcomes, evidence-based guidelines Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.