District hospitals in Ethiopia face challenges in maintaining efficiency due to varying resource availability and operational practices. A mixed-method approach was employed, combining quantitative data from cost-benefit analysis and qualitative interviews with healthcare professionals to assess system performance. Resource reallocation led to a 15% reduction in patient wait times (p < 0.05) and an increase in outpatient services by 20%, indicating potential for efficiency gains. The randomized field trial demonstrated that targeted resource allocation and operational improvements can significantly enhance the efficiency of district hospital systems in Ethiopia. District health authorities should prioritise regular performance evaluations and implement evidence-based interventions to sustain these efficiency gains. district hospitals, efficiency measurement, resource allocation, mixed-methods approach Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.