Abstract
The introduction of one of the control process management tools in the biggest South African Universitary hospital, after over 15 years from the introduction of the management in the Italian public health organization, have allowed the team to perform a critical revision of the budget tool condition in Italy. The context analysis in the African country shows remarkable differences in comparison with our country. First of all, the ten percent less of personnel costs on the total hospital costs, requiring a different management tool from the one of the Italian model. The parallelism of the implementing process, instead, shows repeated lacks overlapping with the European ones. Commitments not clear and not keep as promise, lack of programming in the implementing process, lack of organic management approach as request of the clinical governance are the main results of the study.