Methodological Evaluation of District Hospitals Systems in Rwanda Using Quasi-Experimental Design for Efficiency Gains

District hospitals in Rwanda are pivotal to healthcare delivery but face challenges in efficiency. A systematic literature review will be conducted, focusing on methodologies used in evaluating district hospitals' operational efficiencies. The study will employ meta-analysis to aggregate findings from various studies. Findings suggest that while some districts have implemented successful efficiency improvement measures, the variability across regions necessitates a standardised approach for broader application. The review concludes with an analysis of existing methodologies and recommendations for district hospital systems in Rwanda to enhance operational efficiency. Recommendation includes the adoption of a unified data collection framework and standardised performance metrics to facilitate better monitoring and improvement strategies. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.