Methodological Evaluation of District Hospitals Systems in Nigeria: A Randomized Field Trial on Clinical Outcomes

District hospitals in Nigeria are pivotal for healthcare delivery but often face challenges in clinical outcomes due to resource constraints and inadequate systems. A stratified cluster-randomized design was employed, with districts selected based on geographical and socio-economic criteria. Data collection involved standardised patient assessments across multiple hospitals in each district. In the intervention group (districts randomly assigned to receive improved healthcare services), a significant increase of 15% in patient recovery rates compared to the control group (no improvements) was observed. The randomized field trial demonstrated that targeted interventions can improve clinical outcomes in district hospitals, supporting evidence-based policy recommendations for resource allocation and system enhancement. District health authorities should prioritise investments in training staff, procurement of essential medical supplies, and infrastructure maintenance to enhance service delivery and patient care. district hospitals, randomized field trial, clinical outcomes, resource constraints Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.