Methodological Evaluation of District Hospitals Systems in Uganda Using Multilevel Regression Analysis for Cost-Effectiveness Studies

District hospitals in Uganda are critical for providing essential healthcare services to rural populations. However, their effectiveness and cost-effectiveness have not been systematically evaluated. The study employed multilevel regression analysis to evaluate the performance and costs of district hospitals across different regions. Data were collected from administrative records and patient surveys. Our findings indicate that there is a significant variation in hospital efficiency, with some districts achieving higher cost-effectiveness ratios (CER) than others, suggesting areas for improvement. The multilevel regression approach provided valuable insights into the variability of district hospitals' performance and costs. Future research should explore potential interventions to enhance their effectiveness. District health authorities are advised to focus on improving efficiency in high-performing districts, while implementing targeted strategies in low-performing areas. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.