The Administrator of a hospital, particularly of a teaching hospital, is faced with the task of organising increasingly complex and specialised, high technology institutions, under constant pressure to improve patient care and community services, training of health personnel, and to seek new knowledge, therapies and techniques. In addition, acute general hospitals are being forced to re-examine their goals and functions in the light of greater competition from other health and social services for scarce resources - and of changing environmental circumstances. These activities must be undertaken in the context of new theories of management with greater emphasis on the psycho-social aspects of organisation, decision-making processes and advances in information-processing techniques. To be equipped for this task the hospital administrator must also acquire new knowledge and skills. It was therefore frustrating to discover that no training courses for hospital administrators, medical or otherwise were available in this country and that there was a dearth of literature with specific reference to the Republic. Thus, it was as a measure of desperation that this thesis was embarked on, in order to satisfy a personal need to learn about the theory of administration and to meet the need for basic research into, and documentation of, hospital administration in South Africa. In view of the necessity to study virtually every aspect of the subject and the fact that so little research had been done on the management of South African hospitals, it was felt that hospital administration should be examined as a totality rather than selecting any single aspect of the subject. General Systems theory which views any open system as a whole, in constant interaction with its environment, provided an appropriate conceptual framework for the general study of hospital administration. The Groote Schuur Hospital Group provided a suitable model within which to l examine the application of general systems theory; for analysis of the environment, resources, organisation and products of a hospital; and upon which to base some general conclusions regarding the administration of hospitals, recommendations for change and for further research. This thesis which is presented in eight chapters with a short summary of the contents at the end of each chapter has examined one teaching hospital group as a whole system. No attempt has been made to study any aspect of hospital administration in great detail, but rather to identify areas where immediate changes can be implemented to improve the effective and efficient utilisation of resources, and those where further research is essential to find better ways of achieving these goals and meeting societal needs. In the words of Tenon - The hospital is the conscience of a civilisation whose worth, in the end will be measured not by articles of faith and lofty doctrines but by the way it nurtures life; succours distress, rights injustices and transforms misery, frailty and want into hope, dignity and sufficiency.

Introduction: This study sought to assess the roles and responsibilities performed by hospital boards in the public hospitals in the Limpopo Province since 2004. The rationale for embarking on the study is due to the fact that most public hospitals boards are characterized by role ambiguity resulting in squabbles and conflicts with health facility management, functionality crises or challenges, poor representation of communities being served, lack of personal commitment and will to the detriment of service delivery. Objectives: To determine the roles and responsibilities of the hospital boards in the Limpopo Province since 2004, to establish the main challenges that are experienced by public hospital board members which hinder good performance and to determine the qualification criteria for those appointed to be members of the hospital boards. Methodology: This is a qualitative study where the researcher interviewed board members of Tshilidzini Regional Hospital in the Vhembe District appointed in 2004 by the Provincial Member of Executive Council (MEC) for the Department of Health and Social Development in the Limpopo Province in terms of Northern Province Health Act of 1998. The study has been conducted from August to September 2008. Study Sample: The sample is a purposive one made up of 18 members from six district hospitals and 5 members from Tshilidzini Regional Hospital, all found in Vhembe district. The respondents were interviewed, using both open-ended and a closed-ended questionnaire. Data analysis and interpretation: As the study is a descriptive, the collected data was analyzed, taking into consideration the views and inputs as presented by different participants in the study. The researcher developed some themes or topics in accordance with the main focus areas of study and from what had been learnt via the literature reviews on the roles and responsibilities of hospital boards in the country and internationally. Results: The study found out that board members were not adequately performing the expected roles and responsibilities. Furthermore, the study shows numerous challenges and difficulties hindering board members in the execution of said roles and responsibilities that need to be addressed by the Department. The respondents also gave recommendations and inputs on the issue of criteria to consider when selecting community members interested to being hospital board members. Recommendations: A substantive recommendation is made for the Department of Health and Social Development in the Limpopo province including other provinces and the national Ministry of Health in South Africa to engage in a systematic review of the National Health Act, 61 of 2003. The study has evidence of the problems in the implementation of the Act which perhaps needs intervention through appropriate recruitment and appointment process, capacity building and clarification of roles and responsibilities. To address challenges pertaining to incentives for board members, it is further recommended that a policy needs to be developed. In order to enforce accountability, monitoring guidelines and reporting mechanisms should be developed in the form of regulations in the provinces. The appointed hospital board members should have background in financial management, financial accounting, strategic management, community development, human resource management, clinical matters, legal environment, quality assurance and risk management so that they can enhance good governance in a public hospital.

BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). South Africa has aligned itself with these MDGs. The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. There are a number of interventions in place to try and to achieve this goal; the provision of antenatal care is one of these interventions. Antenatal care provides the expectant mother early ongoing monitoring and risk assessment of her pregnancy. It is commonly considered fact that antenatal care improves maternal and perinatal outcomes. In spite of the provision of free maternal health services in South Africa, there are still a significant number of mothers who do not attend antenatal clinics before delivery. No formal study has been done to understand the magnitude of this problem in the Limpopo Province. In view of this, it was decided to conduct this study at the Van Velden Hospital (a rural district hospital in the Mopani District in the Limpopo Province) which has been admitting a significant number of unbooked mothers even after the introduction of free maternal health services in South Africa sixteen years ago. AIM: To compare the pregnancy outcomes (maternal and perinatal) between booked and unbooked mothers who delivered at Van Velden Hospital, a district hospital in the Limpopo Province in South Africa. METHODOLOGY: The setting of this study is the Maternity Unit at the Van Velden Hospital. A cross sectional study design was used. A retrospective record review was done and information for one year (2008/09) will be extracted from the records captured in the District Health Information System. No primary data was collected for this study. RESULTS: This is the first study that looked at broad issues pertaining to the influence of booking status on pregnancy outcomes (maternal and neonatal) at a district hospital in a rural district in the Limpopo Province and probably in South Africa. The study found a prevalence of 15.7% (range: 2.7% to 32.3%) among the study population during the 12 month study period. There were no significant differences in age, marital and employment status of the subjects. However, there were a significant number of teenage pregnancies (13.2%) among the study population, which is of concern. Interestingly, more white women were found not to book in comparison to the black women. There were no significant differences in parity, gravidity and miscarriages between the two groups. Overall, unbooked mothers were more likely to have a preterm baby. This implies antenatal booking can probably prevent preterm deliveries. This study also found unbooked mothers were more likely to have C/S than booked mothers. However, there was no significant difference between booked and unbooked mothers in terms of delivery complications. There was no significant difference between booked and unbooked mothers in terms of birth weight. Although, the babies of unbooked mothers had a significantly lower Apgar score (1 minute) than booked mothers, the difference became insignificant at 10 minutes. There was no maternal mortality during this period. All mothers were discharged home. Overall, perinatal mortality among the study population was 44/ 1000 births. This study found a significant risk of perinatal morbidity (preterm delivery and low Apgar score) among the unbooked mothers. CONCLUSION: This research was undertaken to develop a model that could be used by both the provincial and national governments to evaluate the prevalence and impact of booking status of pregnant women in rural district hospitals in South Africa.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management Johannesburg, 2011 / Introduction: South Africa is currently facing a quadruple burden of diseases: poverty related conditions, emerging chronic diseases, injuries and HIV/AIDS. Increasing burden of these diseases is having a detrimental impact on service delivery particularly in rural areas, where the majority of the population are dependent on public health system. Although numerous epidemiological studies had been done in the past to determine the prevalence of these conditions, only a few studies have attempted to quantify the effect of these diseases on health facilities such as admission rate, bed occupancy rate and resource utilisation. More data is required to develop a better understanding of their impact and to guide development of appropriate response strategies. Aim of the study: To `analyse trends of admissions and resource utilisation in adult medical wards of a rural district hospital in South Africa. Methodology: This was a descriptive cross-sectional, retrospective study involving an analysis of data from adult medical wards in the George Masebe Hospital (a district hospital in Limpopo Province) for six months in 2009. Results: The study found average number of admissions per month was 148, their length of stay varied from one day to more than a year. Their median age was 44 years. They were black, had no medical aid and unemployed and the majority of them were dependent on social welfare grant. The most common health problems diagnosed amongst the medical admissions were HIV related conditions such as gastro-enteritis, pneumonia, AIDS and tuberculosis as well as other chronic diseases such as diabetes mellitus. A striking discovery was the high incidence of mental illness amongst the admissions. The majority of them were discharged home. The crude death rate was 190 per 1000 admissions and the main cause of death was HIV related conditions. The average direct expenditure per month was R 1,040,579. The expenditure for salaries was the main expenditure (54%) followed by Allied health services (29%). The average expenditure per patient was R 7,039 (R 7,548 for female patients and R 6454 for male patients). v Conclusion: This was the first study on admission trends resource utilisation in this Hospital and in the Limpopo Province. The evidence from this study would hopefully steer the re-organisation of some of the Hospital services, more especially the establishment of a step-down ward facility within the Hospital. This study has recognised that the increased number of admissions in rural district hospitals often result from double burden of infectious and chronic diseases. More studies on the subject are needed to identify their impact on resource utilisation at these hospitals.

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Allied Health Professions. Bibliography: leaves 140-150.

This research focuses on the impact of Information Technology (IT) and the corresponding outcomes during an intense period of change and restructuring of the Singapore General Hospital (SGH), the premier public hospital in Singapore.

Thesis (Ph. D.)--University of Washington, 1991. / Vita. Includes bibliographical references (leaves [126]-138).

Thesis (M.H.A.)--University of Michigan, 1975.

Thesis (M.H.S.A.)--University of Michigan, 1981.

Thesis (M.H.S.A.)--University of Michigan, 1981.