Large amounts of data are generated for Health Management Information Systems in low- and middle-income countries, but there is little or no evidence that locally generated data are systematically used for decision making at district level. Understanding how district administrators make decisions and reach consensus is key for identifying the best methods of decision making, in order to develop a decision making tool for use by this group. This systematic literature review seeks to understand how district administrators in low- and middle-income countries use local health systems data to make decisions and identify successful decision making processes; those reaching the best decision using available evidence and processes that work well. The key question it seeks to answer is: What are the steps involved in evidence based formal decision making for health systems at district level?