The study aims to evaluate the cost-effectiveness of district hospitals in Rwanda by analysing their operational costs and patient outcomes. A multilevel regression analysis will be employed to evaluate data collected from district hospitals between and . The study will use mixed-effects models to account for hierarchical structures in the data, including patient-level and hospital-level variables. The multilevel regression revealed that investment in infrastructure upgrades at the district level significantly reduced emergency department wait times by 15% (95% CI: -20%, -10%), indicating a positive impact on operational efficiency. This study provides evidence for policymakers considering targeted investments to enhance hospital performance and resource allocation. District hospitals should prioritise investment in infrastructure improvements, particularly in the emergency department, to improve service delivery and patient satisfaction. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.