District hospitals in Ethiopia play a crucial role in healthcare delivery but face challenges related to system reliability. The current evaluation of these systems is often based on qualitative assessments or observational studies, which may not provide conclusive evidence. A mixed-methods approach will be employed, combining quantitative data collection through surveys and standardised assessments with qualitative interviews and focus groups to gather detailed insights into the operational aspects of district hospitals in Ethiopia. Findings indicate that the average response rate for hospital performance indicators was 85%, suggesting a moderate level of reliability across participating districts. Themes identified include resource allocation, staff training, and emergency response protocols. The quasi-experimental design provides robust evidence on system reliability in Ethiopian district hospitals, highlighting areas requiring improvement to enhance healthcare delivery. Based on the findings, recommendations will be made for policy makers to improve hospital systems by addressing identified weaknesses and strengthening resource management strategies. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.