Hospital Management Practices and Organizational Performance at the Moramanga District Referral Hospital Center, Madagascar
Abstract
Background: District referral hospitals in Madagascar operate under substantial resource and organizational constraints, yet evidence on their compliance with national management standards remains limited. This study examined hospital management practices and organizational performance at the Moramanga District Referral Hospital Center (DRHC). Methods: An evaluative, descriptive, cross-sectional study with a mixed-methods approach was conducted using retrospective data from 2022 to 2024. All staff members with at least six months of seniority were included. Data were collected through standards-based assessment grids and staff interviews, then analyzed according to the Donabedian model focusing on structure, process, and outcomes of care. Results: The final sample included 35 staff members. Only two of five governance bodies were operational, and the hospital employed 76 staff compared with the national standard of 84. Overall equipment coverage was 80.94%, but distribution varied considerably between departments. Six of eight reception standards and nine of twelve waste-management standards were met. Budget execution remained above 99% from 2022 to 2024, while total hospital revenue declined by 15.04% between 2021 and 2023. Bed occupancy fell from 20.6% in 2021 to 19.0% in 2023, and hospital utilization decreased from 0.80% to 0.52%. Conclusion: Despite strong budget execution and generally satisfactory equipment coverage, low governance functionality, shortages and imbalances in human resources, ageing infrastructure, and declining hospital utilization indicate persistent management challenges. Priority actions should strengthen governance and specialized staffing, improve maintenance and energy reliability, and align resource allocation with departmental needs. These findings may help hospital managers and policymakers improve service delivery in resource-constrained district hospitals.