The board has overall responsibility for the performance of the hospital . Non-profit hospitals, particularly in Sub-Saharan Africa, continue to face governance challenges. Questions remain unanswered regarding the effectiveness of the board in influencing attainment of hospital performance goals. The research purpose was to evaluate the impact of the board on performance of nonprofit hospitals. The study focused on mission hospitals operating under Christian Health Association of Malawi (CHAM). Specifically, the study reviewed the relationship between strategy goal attainment with finance management, quality service management, resource mobilization and regulatory compliance. Mixed method was utilized. Primary data was sourced from 21 sampled hospitals using a survey questionnaire for management and board representatives. A total of 105 participants were purposively sampled to participate in the survey comprised of 42 board members and 63 management team members. Qualitative data was sourced through an interview guide targeting governance experts from CHAM. SPSS and thematic analysis were employed to analyze quantitative and qualitative data, respectively. Multiple regression analysis results for board respondents confirmed a positive association between strategy goal attainment
with board oversight on finance management (β = .297, t = 2.631, P = .013), quality service delivery (β =.329, t= 2.839, P = 0.032) and regulatory compliance ( β = .449, t= 3.839, P = 0.001). Results from correlation analysis (r = 0.391, p = 0.007) demonstrated a positive association between strategy goal attainment and resource mobilization. However, findings showed that strategy goal attainment had no statistically positive significance link with resource mobilization (β = -0.100, t = -.747, P = 0.460) from the board respondents as well as management respondents (β = -.021, t= 1.188, P= .851). While multiple regression results from Management respondents revealed a similar trend of positive significant effect between finance management, quality service management with strategy goal attainment, regulatory compliance revealed to have no effect on strategy attainment. This was attributed to the failure of most CHAM hospitals to recruit adequate staff to meet their required needs and challenges to attract qualified staff for clinical care and administration positions.
It is recommended that the board should have a strategic fit of its competency and skills with the strategy to provide effective direction and oversight to management towards implementation of hospitals strategy goals. The board strategic control role is an important function that supports positive performance towards implementation of strategic goals and objectives in the hospital setup.