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If someone is assigned to the Course Creator role, they can create courses. It's important to understand that while the permissions for the Course Creator role are fairly limited (see the Course Creator's Guide for details), once a Course Creator adds a course to the system, they are automatically assigned the role of Instructor in this course. This therefore grants them the permission to modify the course settings and add activities to it (see the Instructor's Guide for details).
To learn more about Instructors or how to assign roles at the course level, see the Managing Instructors and Students documentation.
Assigning Site Administrators
The procedure for assigning Site Administrators is /wiki/spaces/Healthcare/pages/34849271.
When The System Administrator creates a new site, they must assign at least 1 Site Administrator to that site if they want to delegate some of the administrative duties. Once a Site Administrator has been assigned to the site, that Site Administrator can assign other Site Administrators.