Methodological Evaluation of District Hospitals Systems in Nigeria Using Difference-in-Differences Framework to Assess System Reliability

District hospitals in Nigeria play a crucial role in healthcare delivery, yet their reliability remains an area of concern. A difference-in-differences model was applied to analyse changes in service provision across selected districts before and after implementing quality improvement measures. The study utilised data from health facility records over two years. The analysis revealed an increase of 20% in the number of patient consultations per month post-improvement, indicating improved system reliability. The difference-in-differences model effectively measured changes in district hospital systems and demonstrated improvements through robust statistical methods. Future studies should focus on sustainability measures to ensure long-term effectiveness of quality improvement initiatives. District Hospitals, Difference-in-Differences, System Reliability, Quality Improvement Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.