Methodological Evaluation of District Hospital Systems in Ghana: A Randomized Field Trial on Efficiency Gains

District hospitals in Ghana are critical for providing essential healthcare services to rural populations. However, their efficiency varies significantly, impacting service quality and patient outcomes. A mixed-methods design was employed, including both quantitative data collection through surveys and interviews with healthcare providers and qualitative insights from focus group discussions. The study used a regression discontinuity design (RDD) to estimate treatment effects. The regression discontinuity analysis revealed that implementing additional training programmes for healthcare staff led to a statistically significant improvement in patient satisfaction scores by 15% (95% CI: [7%, 23%]). This study provides evidence on the effectiveness of targeted interventions aimed at enhancing district hospital efficiency. District health authorities should prioritise investment in staff training and development to improve service delivery and patient care quality. district hospitals, regression discontinuity design, healthcare efficiency, Ghana Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.