Methodological Assessment of District Hospitals Systems in Ethiopia Using Quasi-Experimental Design for Cost-Efficiency Analysis,Context

District hospitals in Ethiopia have played a crucial role in healthcare delivery, but their operational efficiency has not been systematically evaluated. A systematic literature review was employed to identify relevant studies published from onwards. Studies were screened based on predefined criteria, and data extraction was conducted by two independent reviewers. The quality of included studies was assessed using a standardised tool. The analysis revealed that the majority (75%) of district hospitals in Ethiopia operated with financial deficits, indicating poor cost management practices. Despite the challenges identified, the quasi-experimental design provided valuable insights into the operational inefficiencies and cost structures within these institutions. Efforts should be made to improve financial oversight and resource allocation strategies to enhance cost-effectiveness in district hospitals. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.