Methodological Evaluation of District Hospitals in Rwanda: A Systematic Review of Clinical Outcomes Measurement Frameworks

Rwanda's district hospitals play a crucial role in primary healthcare delivery across the country. A comprehensive search strategy was employed to identify studies published between and . Studies were screened based on predefined inclusion criteria, assessed for quality using the Newcastle-Ottawa Scale (NOS), and analysed according to a standardised data extraction protocol. The review identified a prevalence of mixed-methods evaluation frameworks in Rwanda’s district hospitals, with some studies employing multivariate regression models to assess clinical outcomes. However, there is variability in the reporting of effect sizes and confidence intervals for these analyses. While existing frameworks show promise, they often lack standardization across different districts, leading to inconsistencies in measurement methodologies and interpretations. Standardising clinical outcome measurement frameworks would enhance comparability and reliability of data across Rwanda’s district hospitals. This could facilitate more robust policy recommendations for improving healthcare delivery. clinical outcomes, district hospitals, evaluation framework, Rwanda Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.