Rodreck DAVID

Background: Maternal mortality remains a problem in low-income countries (LICs). In Zimbabwe, there has been an unprecedented increase in maternal mortality in the last 2.5 decades. Effective prenatal care delivery, particularly early visits, appropriate number of visits, and receiving recommended care is viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care delivery improvement in prenatal care pathways for pregnant women visiting Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in low-income countries was used to develop prenatal care pathway guidelines as a tool to guide care delivery and identify gaps in care and service delivery. One hundred cases of prenatal care records were reviewed to determine the prenatal care pathway and care delivered to pregnant women. This data was complemented by interviews with 20 maternity care clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the 53% (n = 53) pregnant women who booked, their first visit on their pregnancy was late at an average gestational age of 27.1 weeks with extremes of 30 to 40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments was prevalent, with only 11% (n = 6) having attended all the expected 5 visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the care delivered to women in each visit compared to that expected in such areas as obstetrics, physical examinations and haematological tests. Maternity care clinicians attributed the cost of prenatal booking fees in the background of poverty and poor family support systems as key factors hindering women’s access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of referral, adherence to appointment by pregnant women and visiting prenatal care early. Clinicians also need to adhere to standard clinical tests recommended for each specific pregnant woman’s visit. In the Zimbabwean setting with limited resources, where the number of visits is already low, pathways with reduced visits may not be appropriate. An investment into prenatal care by the government is recommended to enable the utilisation of interventions such as e-health technologies that may improve care delivery as well as adherence to best practices. E-health and mobile health technologies involving e-referrals, e-booking, decision support, and reminder systems are recommended for clinicians to manage and deliver appropriate care to patients as well as pregnant women to adhere to scheduled visits.

"Background: Auditing can support national democratic processes, national development and government good will. Supreme Audit Institutions (SAI), such as offices of Auditor General, publish consolidated reports on audit outcomes for local authorities, government departments, parastatals and related public entities. These reports identify broad areas analysed during audit exercises that often include financial management, governance, asset management, risk management, revenue collection and debt recovery. They highlight trends that were detected during audit exercises at the end of a financial year. The reports further show how records and records management affect audit exercises as well as financial management within the audited institutions. Objectives: The intention of the research was to ascertain the contribution of records management to audit opinions and accountability in financial management in Zimbabwean government entities. Method: A document analysis of Comptroller and Auditor General of Zimbabwe (CAGZ)’s reports was used to identify the types of decisions and recommendations (audit opinions) issued, in juxtaposition to the records management issues raised. Results and Conclusion: This study shows that there is a strong correlation between records management concerns and audit opinions raised by the CAGZ’s narrative audit reports. Inadequate records management within government entities was associated with adverse and qualified opinions and, in some cases, unqualified opinions that had emphases of matter. There was a causal loop in which lack of documentary evidence of financial activities was the source cause of poor accounting and poor audit reports. Errors resulting from incomplete or inaccurate records meant that government entities were not showing a true picture of their financial status and their financial statements could be materially misstated. As an important monitoring and control system, records management should be integrated into the accounting and auditing processes of government entities."

"Background: Choosing a cost-effective document management approach has become a priority to many organisations, especially in view of the rapidly changing technological environment in which information is being created and managed. A literature survey indicated that document management strategies have the potential to provide some substantial cost-saving benefits if they are used judiciously. Objectives: This study investigated a commercial bank’s document management approaches in a bid to ascertain the costs and benefits of each strategy and related issues. Method: A quantitative research approach was employed through a case study which was used to gather data from a sampled population in the bank. Results: The document management approaches used were not coordinated to improve operational efficiency. There were regulations governing documents management. The skills and competences of staff on both document management and cost analysis are limited. That is partly due to limited training opportunities availed to them. That means that economies are not achieved in the management of records. That has a negative impact on the overall efficiency, effectiveness and legal compliance of the banking institution. Conclusion: The financial institutions should create regulations enabling periodical cost-benefit analysis of document management regimes used by the bank at least at quarterly intervals as recommended by the National Archives of Australia. A hybrid approach in managing records is recommended for adoption by the financial institution. There should be on-the-job staff training complimented by attendance at relevant workshops and seminars to improve the staff’s understanding of both the cost-benefit analysis concept and document management."