Methodological Evaluation of District Hospitals Systems in Ghana: A Randomized Field Trial for Measuring Cost-Effectiveness

District hospitals in Ghana play a critical role in healthcare delivery, yet their operational efficiency varies significantly. A systematic review was conducted to identify and analyse existing methods used for evaluating district hospitals' performance. Quantitative synthesis techniques were employed to combine data from multiple studies, ensuring robustness and validity of findings. The analysis revealed that the most effective methodological approach involved a mixed-methods design combining quantitative cost data with qualitative patient feedback surveys. This study concluded that integrating both types of data significantly improved the accuracy and applicability of cost-effectiveness evaluations for district hospitals in Ghana, providing actionable insights for policy makers. Policy makers should consider adopting a mixed-methods approach to evaluate district hospital systems, prioritising methods that yield comprehensive and reliable outcomes. district hospitals, cost-effectiveness, methodological evaluation, randomized field trial Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.