Rwanda's district hospitals play a critical role in healthcare delivery, yet their systems' effectiveness is not well understood. A randomized field trial was conducted across ten districts, with a sample size of 50 hospitals. Data collection included surveys and observational assessments, using mixed-methods approach for comprehensive evaluation. The analysis revealed that only 38% of the sampled district hospitals adopted recommended health interventions within the first year post-intervention. Despite initial optimism, there is a significant gap in the adoption rates of new health interventions by Rwanda’s district hospitals. Policy-makers should prioritise strengthening healthcare infrastructure and professional training to enhance intervention uptake. district hospital systems, adoption rates, randomized field trial, Rwanda Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.