This research evaluates the implementation of procurement audits in Rwandan hospital logistics, focusing on their role in enhancing operational efficiency and transparency. Employing a mixed-methods approach, the study integrates quantitative analysis of archival data and qualitative insights from interviews with key stakeholders across public and private hospitals. Major findings reveal a statistically significant improvement in procurement efficiency metrics, including a 25% reduction in procurement cycle time (from 60 to 45 days, p < 0.01), a 50% decrease in stock-out rates, and a 20% reduction in procurement costs. Additionally, the study identifies critical barriers, such as limited financial resources (reported by 35% of hospitals) and inadequate staff training (30%), impacting audit efficacy. The findings underscore the transformative impact of audits on supply chain efficiency, reducing expired stock by 25% and improving supplier performance by 20%. Recommendations include increased funding, enhanced staff training, standardized audit protocols, and integration of advanced technologies. These measures aim to strengthen procurement practices and ensure sustainable improvements in Rwanda’s healthcare sector.