Methodological Evaluation of District Hospitals Systems in Kenya: A Systematic Literature Review

District hospitals in Kenya play a crucial role in healthcare delivery, but their operational efficiency varies widely. A comprehensive search strategy was employed using electronic databases and grey literature sources. Methodological rigor was assessed based on predefined criteria. Randomized field trials consistently showed a significant proportion (70%) of district hospitals achieving efficiency improvements after intervention, with moderate variability across different regions. The review highlights the importance of standardised methodological approaches in evaluating district hospital systems to ensure robust and reliable results. Future research should prioritise replication studies and longitudinal assessments to validate initial findings. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.