District hospitals in Ghana play a crucial role in healthcare delivery, yet their impact on clinical outcomes is not well understood. A comprehensive search strategy was employed using databases such as PubMed and Cochrane Library. Studies were included if they met specific criteria regarding study design, sample size, and clinical outcomes measurement. The review identified a significant proportion (34%) of studies employing randomization techniques to measure clinical outcomes, with mixed results indicating the need for more standardised methodologies. While randomized trials are increasingly used in assessing district hospital performance, there is room for improvement in methodological consistency and reporting standards. Standardised protocols should be developed and implemented across Ghana's district hospitals to ensure reliable clinical outcome measurements. district hospitals, clinical outcomes, randomization, methodology review Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.