The district hospitals are an integral part of the district health system (DHS) in South Africa fulfilling several important functions. Using data obtained from relevant published reports. The district hospital costs were allocated using the ‘ingredients approach’ that combined a top-down method and step-down sequence. The costs in the treatment of patients were grouped into six cost centres: buildings, drugs, equipment, materials, personnel and utilities. The unit costs were broadly grouped into two categories using the hospital departments (fixed and variable costs) and input use (direct and indirect costs). More than 30% of the total public expenditure on hospitals in the country was on district hospitals between 1996/97 and 1998/99. They had more beds per population (1.08/1000) than other public hospitals. The bed occupancy rates in these hospitals were generally very low varying between 57% and 75%. The average length of stay (ALOS) was within acceptable range in the hospital except in Osindisweni hospital. Personnel costs were more than 70% and drugs only 3% to 6% of the total costs. McCord hospital was the most expensive using total and unit costs. Harrismith hospital had the lowest total costs and Osindisweni hospital the lowest unit cost. Most of the costs were fixed or direct costs in all the hospitals. There is the need for the adoption of measures to ensure that the hospitals are efficiently run while maintaining access for vulnerable groups.

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BackgroundIn Trinidad and Tobago, the law on the mandatory use of seat belts was passed in 1995, but this law is hardly enforced. The objective of this study was to determine the frequency and predictors of seat belt use by motor vehicle drivers in the country.FindingsA cross-sectional study of 959 motor vehicle drivers using a self-administered questionnaire. Data analysis included Pearson Chi square test and multinomial logistic regression analysis in order to determine the possible predictors of seat belt use by the drivers in Trinidad and Tobago. A majority of the drivers sometimes (51.8%) or always (31.6%) use a seat belt. About 16.7%, 29% and 54.2% of the drivers perceived that the other drivers use their seat belts more frequently, with the same frequency and less frequently respectively compared to themselves. The main reason for not using seat belt by the drivers was given as frequent stops (40.7%) and the main motivation to use seat belt by the drivers was given as stiffer penalties for non-compliance with the seat belt law (44.5%). The predictors of seat belt use were male driver, no formal or lower level of education, driving for less than 10 years, and the perception that the other drivers use seat belts with the same or higher frequency compared to the respondents.ConclusionOnly a small proportion of the drivers in Trinidad and Tobago always use a seat belt when driving. There is the need to enforce the seat belt legislation in the country.

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There were 51,880 road traffic accidents recorded in Durban Municipality in 1998, 46.4% being same direction accidents. Most of the casualties (38.8%) were from the vehicle/ pedestrian accidents. Casualties per 100 accidents were highest with vehicle/pedestrian accidents (97.5) and only 9.5 in same direction accidents. Fatalities occurred in 1% of the road traffic accidents and made up 5.1% of all casualties. The total costs of road traffic accidents in 1998 were US$151 million, which was 13.1% of the budget of the municipality for 2002/2003. Damage only accidents cost about US$83.6 million and comprised 55.4% of the total accident costs. Fatal accidents cost US$25.9 million and 17.2% of the total costs. Serious and slight accidents cost about US$42 million and 27.4% of the total costs. Slight accidents cost about US$20.16 million and 13.3% of the total costs. There is an urgent need for measures to reduce the number of pedestrian casualties and fatalities of road traffic accidents.