Assessment of Administrative Records Management at Mukono Health Centre Iv

ASSESSMENT OF ADMINISTRATIVE RECORDS MANAGEMENT AT MUKONO HEALTH CENTRE IV.

NAMITALA MWAJJUMA 14/U/12137/EVE 214004675

A DISSERTATION SUBMITTED TO EAST AFRICAN SCHOOL OF LIBRARY AND INFORMATION SCIENCE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF RECORDS AND ARCHIVES MANAGEMENT OF MAKERERE UNIVERSITY

SEPTEMBER 2017

DECLARATION I NAMITALA MWAJJUMA do declare that the work presented in this dissertation is original and has never been submitted to any institution or university for any award. This research was carried out under the supervision of Ms. Lois Mutibwa.

Signature______Date______

NAMITALA MWAJJUMA

APPROVAL The research and writing of this report is entirely the product of Namitala Mwajjuma a student of the East African School of Library and Information Science, College of Computing and Information Science, Makerere University that was approved by Ms. Lois Mutibwa.

Signature …………………………. …………………………………….. Date Namitala Mwajjuma (Student)

……………………………………… ……………………………. Ms. Lois Mutibwa Date (Supervisor)

DEDICATION I dedicate this piece of work to the Almighty God who has provided for me and enabled me complete this course and to my parents, Mr. Swaibu Kibuuka and Ms. Mariam Shikandah for the parental love they gave me since childhood.

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ACKNOWLEDGEMENT I acknowledge the following people for the success of my study. I am most obligated to all my lecturers who impacted the knowledge in the field of records and archives management during the entire period of the study that enabled me to come up with this work.

Special thanks to my supervisor Ms. Lois Mutibwa for her tireless guidance and efforts towards the completion of this work.

I also extend my acknowledgement to my parents, Mr. Swaibu Kibuuka and Ms. Mariam Shikandah for all the support they have given me from the beginning of my academic life to the end.

I extend my sincere thanks to the management of Mukono Health Centre IV for the physical support they provided to me. Special thanks go to the Records Managers and all the staff of Mukono Health Centre IV for the encouragement and all the assistance they rendered me in one way or another.

May God bless you all.

ACRONYMS

ART Anti-Retroviral Treatment

DHIS District Health Information System

HMIS Health Unit Management Information Systems

HSSP Health Sector Strategic Plan

IPD In-Patient Department

MCHIV Mukono Health Centre Four

MCH Maternal Child Health

MOH Ministry Of Health

NMS National Medical Store

OPD Out Patient Department

SMC Safe Male Circumcision

TABLE OF CONTENTS DECLARATION ...... i

APPROVAL ...... ii

DEDICATION ...... iii

ACKNOWLEDGEMENT ...... iv

ACRONYMS ...... v

TABLE OF CONTENTS ...... vi

LIST OF TABLES ...... x

LIST OF FIGURES ...... xi

ABSTRACT ...... xi

CHAPTER ONE ...... 1

INTRODUCTION TO THE STUDY ...... 1

1.1 Introduction ...... 1

1.2 Background to the Study ...... 1

1.3 Problem Statement ...... 4

1.4 Aim of the Study ...... 4

1.6 Specific Objectives ...... 4

1.7 Research Questions: ...... 5

1.8 Significance of the Study ...... 5

1.9 Scope of the Study ...... 6

1.9.1 Conceptual Scope ...... 6

1.9.2 Geographical Scope ...... 6

1.9.3 Time Scope ...... 6

1.10 Definition of Key Terms: ...... 6

1.10.1 Records Management...... 6

1.10.2 Administrative records ...... 6

1.10.3 Filing ...... 7

1.10.4 Health records ...... 7

CHAPTER TWO ...... 8

LITERATURE REVIEW ...... 8

2.1 Introduction ...... 8

2.2 Types of administrative records ...... 8

2.2.1 Policy Records ...... 8

2.2.2 Operational Records ...... 9

2.3 Process of the life cycle of records ...... 9

2.3.1 Creation ...... 9

2.3.2 Maintenance and distribution/use ...... 9

2.3.3 Storage and preservation ...... 10

2.3.4 Destruction (Retention schedules) ...... 10

2.4 Filing systems used in administrative records management ...... 11

2.5 Problems faced when managing administrative records ...... 12

2.6 Solutions to the challenges faced in management of administrative records ...... 14

2.7 Research Gap ...... 15

2.8 Chapter Summary ...... 15

CHAPTER THREE ...... 16

3.1 Introduction ...... 16

3.2 Research Design ...... 16

3.3 Area of the Study ...... 16

3.4 Population of the Study ...... 16

3.5 Sampling Strategies ...... 16

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3.5.1 Sample size ...... 17

3.6 Data collection Methods ...... 17

3.6.1 Interview Method ...... 17

3.6.2 Observation Method...... 17

3.6.3 Document Review Method ...... 18

3.7 Research Instruments ...... 18

3.7.1 Interview Guide ...... 18

3.7.2 Observation Guide ...... 18

3.8 Data Analysis ...... 19

3.9 Ethical Considerations ...... 19

3.10 Limitations of the Study...... 19

3.11 Research Procedures ...... 20

3.12 Chapter Summary ...... 20

CHAPTER FOUR ...... 21

PRESENTATION AND DISCUSSION OF FINDINGS ...... 21

4.1 Introduction ...... 21

4.4 Chapter Summary ...... 29

CHAPTER FIVE ...... 30

SUMMARY, CONCLUSION AND RECOMMENDATIONS ...... 30

5.1 Introduction ...... 30

5.2 Summary of the Study ...... 30

5.2.1 Types of administrative records managed at Mukono Health Centre IV...... 30

5.2.2 The process of the life cycle of records at Mukono Health Centre IV...... 30

5.2.3 The filing systems used to manage the administrative records at Mukono Health Centre IV. 30

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5.2.4 Challenges and solutions for managing administrative records at Mukono Health Centre IV. 31

5.3 Conclusion ...... 31

5.4 Recommendations ...... 32

REFERENCES ...... 33

Appendix I: Interview Guide ...... 35

Appendix II: Observation Guide ...... 36

Appendix III: Document Review Guide………………………………………………………. . 35

LIST OF TABLES Table 1: Showing total number of population interviewed...... 17

LIST OF FIGURES Figure 1: Structure of the HMIS Reporting Tree...... 3

Figure 2: A pie chart showing description of the respondents…………………………………………….22

Figure 3: HMIS Tools…………………………………………………………………………………23, 24

Figure 4: Structure of a records lifecycle at MHCIV……………………………………………………..26

ABSTRACT This study was carried out to assess administrative records management at Mukono Health Centre IV. The objectives were to; examine the types of Administrative Records managed at Mukono Health Centre IV, asses the process of a records lifecycle at Mukono Health Centre IV, identify the filing systems at Mukono Health Centre IV and finally to assess the challenges faced when managing Administrative Records and the possible solutions to the identified challenges.

MHCIV is a government hospital that is headed by the Senior Medical Officer who works under the MOH within the government of Uganda. The Records Management System of Mukono Health Centre IV works under the HMIS system under the MOH of the Government of Uganda.

The researcher collected and analysed the data through the use of the interview guide, observation guide and the document review guide as instruments in order to collect all the data that is given in this dissertation. The researcher interviewed the Health Records Manager and the Assistant Health Records Manager of MHCIV and then presented the data using the qualitative data analysis method.

Findings show that; administrative records are managed by the Health Records Managers at MHCIV using the HMIS system of MOH to be viewed by the in-charges who work under the Government of Uganda. The HMIS system though has several problems that affect the proper management of administrative records at MHCIV that is; frequent shortage of HMIS tools, a small number of trained records managers and electronic data management and reporting is still lacking. Some of the recommendations are; recruitment of more skilled health records managers, revision of the annual budget for MHCIV and improvement of the electronic system.

CHAPTER ONE INTRODUCTION TO THE STUDY

1.1 Introduction This chapter comprises of the background to the study, the problem statement, general objective, specific objectives, research questions, significances, scope and definition of the key terms of the study.

1.2 Background to the Study Ginn (2010) defines Records Management as the management of any information captured in reproductive form that is required for conducting business. Ginn (2010) further defined Records Management as a field of management that is responsible for the efficient and systematic control of the creation, receipt, maintenance, use and disposition of records. Rouse (2005) defined the Records Management System as a collection of elements or components that are combined or organized for a common purpose of achieving proper records management practices. Business Dictionary (2017) states that; administrative records are a collection of documents that form the basis for an agency’s decision. Administrative records are relevant documents that are relied upon when selecting the response action, as well as decision-making in an organization. They also act as a vehicle for public participation in selecting a response action. In otherwise administrative records are documents that relate to housekeeping functions (such as management of facilities, finances, and personnel) and agreements, contracts, meetings, legal actions, etc. Therefore, management of administrative records is important in the functioning of an organization.

Mukono Health Centre IV is a Government Health Facility that functions under the Ministry of Health; it is located in Mukono Municipality along Kampala Jinja Highway (about 20km from Kampala Capital City).

Mukono Health Centre IV started in Early 70’s as a Health Centre III until 1999 when it was elevated to Health Centre IV. It is currently headed by Senior Medical Officer formally under Mukono District Local Government under Mukono Municipal Council being an urban facility and centrally located in the Municipality.

The Health Centre handles the biggest patient workload in the Municipality and Mukono District as a whole. It handles different types of records which are; medical records, administrative records, electronic records, research records, historical records, legal records that relate to employment and fiscal records.

The Ministry of Health (MOH) is a cabinet level government ministry of Uganda. It is responsible for planning, delivering, and maintaining an efficient and effective health care delivery system, including preventive, curative and rehabilitative services, in a humane, affordable, and sustainable manner. The Ministry of Health manages all health records from different government systems through the HMIS software. The HMIS is designed to assist managers carry out evidence based decision making at all levels of the Health care delivery. At the Health Unit level, HMIS is used by the health unit in charge and the Health Unit Management Committee to plan and coordinate health care services in their catchment area.

Figure 1 below shows the structure of the HMIS Reporting Tree at MHCIV retrieved from the Health Management Information System for Uganda (1997).

Review of the Health Management Information System for Uganda (1997). Figure 1: Structure of the HMIS Reporting Tree.

CENTRAL HEALTH DATA BANK (Statisticians & Data Manager) Assistant Commissioner

Feedback level 1

DISTRICT (HMIS & Surveillance Focal Persons) District of Health Services

Feedback level 2

HEALTH SUB-DISTRICT (Records Assistant) HSD in- charge

Feedback level 3

HEALTH FACILITIES (Records Assistants) Health Facility in- charges

Feedback level 4

HEALTH FACILITIES DEPARTMENTS (SMC, OPD, IPD, MCH, ART, THEATRE, and MORTURY)  Health Facility departmental heads in-charges

1.3 Problem Statement The rapid high growth of records at MHCIV and the lack of enough skilled records managers to manage the big number of records that keep on accumulating has triggered an alarm that called upon the researcher to carry out a research on the assessment of administrative records at Mukono Health Centre IV.

This problem is evident in the previous report the researcher made during her internship period at the health facility. These challenges are likely to result into more challenges such as; poor records retrieval, misplacement of files and time wastage in the near future in the records management department of MHCIV. Therefore, the researcher gained interest in this situation at MHCIV and she decided to carry out a research on assessment of administrative records Management at Mukono Health Centre IV.

1.4 Aim of the Study The aim of the study was to assess administrative records management at Mukono Health Center IV, identify the problems faced and solutions in the process of managing these records in line with the HMIS of Uganda.

1.5 General Objective The general objective of the study was;

• To assess how administrative records are managed at Mukono Health Centre IV.

1.6 Specific Objectives The objectives of the study were;

1. To examine the types of administrative records managed at Mukono Health Centre IV

2. To assess the process of the life cycle of records at Mukono Health Centre IV

3. To identify the filing systems used to manage the administrative records at Mukono Health Centre IV

4. To assess the challenges faced when managing administrative records and to suggest the possible solutions to the identified challenges at Mukono Health Centre IV

1.7 Research Questions: This study is aiming at providing answers to the following questions basing on the above objectives.

• What are the types of administrative records managed at Mukono Health Centre IV?

• What is the process of the life cycle of records at Mukono Health Centre IV?

• What filing systems are used to manage the administrative records at Mukono Health Centre IV?

• What are the challenges faced when managing administrative records at Mukono Health Centre IV?

• What are the possible solutions to the identified challenges at Mukono Health Centre IV?

1.8 Significance of the Study The beneficiaries of this study will be;

1.8.1 Mukono Health Centre IV  The report will be used as reference in decision making at MHCIV and also in the MOH for service delivery.  The study would also help the Records Managers at MHCIV to identify the loop holes in the Records Management system of MHCIV and come up with new ways of improving the system. 1.8.2 Scholars

 The research will help other scholars or researchers who will be in need of information concerning assessment of administrative records in line with government health sectors.

18.3 Other Health Facilities  The report will be used as reference in decision making in other health facilities in order to improve on their service delivery.  The study would help the records management staff of these health facilities to identify the loopholes in their records management system and come up with new ways of improving the system.

1.9 Scope of the Study This section shows the conceptual, geographical and time scope of the study.

1.9.1 Conceptual Scope The study was focusing on how administrative records are managed at Mukono Health Centre IV.

1.9.2 Geographical Scope The study was conducted at Mukono Health Centre IV located along Kampala-Jinja Highway Mukono District.

1.9.3 Time Scope The study was to happen in a period of two months that is; May and June 2017

1.10 Definition of Key Terms: 1.10.1 Records Management The management of any information captured in reproductive form that is required for conducting business. Records management is carried out by the records managers who work under the records department of an organization (Enon, 2003).

1.10.2 Administrative records Barry (2006) defines administrative records as a collection of documents that form the basis for an agency’s decision. Administrative records are normally used to study the status of an

6 organization and normally thoroughly checked before making any important decision in an organization.

1.10.3 Filing A systematic arrangement and keeping of records so that they may be found and delivered when needed for future reference. Filing is used to arrange records in the process of their management. Administrative records are filed for proper and easy retrieval and use by the hospital staff and the Health Records Managers (Enon, 2003).

1.10.4 Health records Holliday (2007) defines health records as; records that are managed in Health facilities. Records that are processed or created in hospitals are called Health records and the person who manages them is called a Health records manager.

1.10.5 Records This is defined as a piece of evidence about the past, especially an account of an act or occurrence kept in writing or some other permanent form. Administrative records are classified as types of records (Barry, 2006).

1.11 Chapter Summary

This chapter shows the introduction of the study, a clear background of the study, the problem statement to be addressed by the study, the aim of the study, general and specific objectives of the study, research questions, significance of the study, scope of the study and definition of key terms.

CHAPTER TWO LITERATURE REVIEW 2.1 Introduction Ginn (2011) defined Literature review as information that was got from different sources or researchers talking or stating about a certain or specific topic. Chapter two shows literature based on the objectives of the study through themes which include; types of administrative records, the records life cycle, the filing management systems, challenges faced and the solutions in the process of administrative records management.

2.2 Types of administrative records Holliday (2007) defined administrative records as records which pertain to original, development, activities, and accomplishment of an organization and they fall into two different categories:

2.2.1 Policy Records These relate to the organization such as plans, methods, techniques, or rules which the organization has adopted to carry out its responsibilities and functions. These include three basic categories;

a. Organizational Documents: Budgets and budget planning records, fiscal records, organizational and functional charts.

b. Government Documents: Manuals, directives, orders, and interpretations issued from top authority levels, correspondence files of high-level officials, regulations, circulars, instructions, memoranda or regular insurances that establish a course of action, and staff studies or special reports relating to methods of workloads and performances.

c. Reporting Documents: Annual reports, periodic progress or summary reports, special reports or accomplishment, transcripts of hearing, minutes of meetings, and conferences, and organizational histories.

2.2.2 Operational Records These are necessary to implement administrative policies, procedures, and operations. The operational value is the usefulness of a record in the conduct of an organization’s business. Examples include mandates, procedural records, or records that give direction.

2.3 Process of the life cycle of records Records management development enlightens researchers that the life cycle provides a useful way for humans to interact with information and it was shown in a simple sequence that consisted of four steps, which are; creation, maintenance, storage and final disposal (Holiday, 2007)

2.3.1 Creation Barry (2006) states that; the first step involves creation of records through the daily transactions in the organization (hospital). Creation of records is a very important aspect that must be handled with a lot of care. The value of the information should determine the medium on where to capture the information. Important records/information must be in paper form and security copies should be stored offsite because such records are stored permanently for as long as the organization exists. At this stage, the authenticity of the record should be well emphasized. Important records/information must be in paper form and security copies should be stored offsite because such records are stored permanently for as long as the organization exists. At this stage, the authenticity of the record should be well emphasized.

2.3.2 Maintenance and distribution/use This stage involves filing, transfers and retrieval of records. Records are retrieved to be used as sources of reference and this calls for tracking to ensure they are returned to be accessed by others who might need them. Records are distributed when photocopied, printed, attached to an email, hand delivered and other means for use in organizational decisions, in this stage, record are active.

2.3.3 Storage and preservation Storage equipment vary depending on the types of records, Paper records are mainly stored on paper card stock yet image based electronic records also have their appropriate storage medium. When records are determined to be of permanent value, they are transferred to the archives for permanent preservation.

Stewart (2002) suggested that, records must be stored in some way so that they can be protected, located and retrieved when needed. Good storage allows easy location of records, identification and retrieval. Storage equipments include; file cabinets, boxes, and proper shelves. In addition to that, also a sufficient storage space and existing fire extinguishers are also required for proper storage of records.

2.3.4 Destruction (Retention schedules) Information is destroyed once it reaches the retention stage in accordance to its values. Some information is forwarded to be kept in archival institutions while other information is destroyed. Holiday (2007) suggested that, at the disposition stage, records are appraised to determine their retention value using a General Disposal schedule or record schedule. As long as records no longer serve the administrative, legal or fiscal purposes for which they were created, they should be disposed of. A Retention Schedule is a document that an organization uses to ensure records are kept only as long as legally and operationally required for running the organization activities.

Enon (2003) explained that, the mission of record management programs is to manage the life cycle of business records at any government agency through records retention schedules administration in compliance with federal and other state laws. The lifecycle of records is the starting point for management of records. He describes appraisal as, the process of determining the eventual disposition of records and the decision regarding preservation of a document or series of documents.

2.4 Filing systems used in administrative records management Enon (2003) defined filing as a systematic arrangement and keeping of records so that they may be found and delivered when needed for future reference. Enon (2003) stated the characteristics of a good filing system, which are: - • Easy and accessible • Quick and easy to operate • Suitable for particular types of correspondences • Elastic and economical He also stated the way files should be kept in filing cabinets; • Horizontal method • Vertical method • Suspension lateral filing • Shelf filing Holliday (2007) stated that; there are five different filing systems which he called classification systems. He said classification refers to the basic arrangement of documents in folders. Holliday (2007) stated that; documents can be classified in six main methods i.e;  Alphabetic classification; The arrangement of files by names – individual, company as subject – in dictionary order (A-Z)  Numeric classification; Filing of numbered documents in a sequential order (1, 2, 3, 4 -----)  Subject classification; Grouping of document according to similarity in their subjects  Geographical classification; Here documents are classified according to the place where they are located in the records center.  Chronological classification.  Alphanumeric classification; The filing of document using numbers and letters (AB02, BD45) Ginn (2010) defines filing as simply the filing of letters and numbers in a form that suit the file situation.

2.5 Problems faced when managing administrative records Ginn (2011) pointed out several problems faced when managing records and they do not differ from other writers like; Stewart (2002) and Barry (2003). The challenges are;  Lack of skilled personnel Records are managed by people who are not professional in the system of records which results into several other problems  Duplication of records Records are duplicated which lead to poor authenticity of documents and misuse if taken by the wrong people.  Theft and vandalism of records This occurs through unauthorized access to records, which could be dangerous especially with confidential information.  Security breach This is through hacking, unauthorized access to information through computers. Also include Virus attacks / infections on computer software, which could lead to loss of important data.  Weak laws/procedures/weak policy Some record systems have weak laws of accessing and use of records. Laws are there but they are not implemented therefore, anyone can easily find access to records due to lack of procedure.  Improved technology Most records now are created using specific technologies, this turns out to be a challenge for access especially to the unskilled users and the records managers as well.  Less support from the organization Most record control in organizations are ignored, this leads to careless handling of documents, which turns to be a challenge in their management.  High costs This comes about through maintenance and creation of records for example purchase of machines like scanners, computers and others these all cost a lot of money which is a challenge.

 Misallocation of documents in shelves and drawers Placing documents in shelves where they do not belong, this leads to misplacement and complete disappearance of vital documents in the organization.  Insufficient equipment to manage record These equipments include; boxes, files, fasteners and other more that are used to store and manage documents.  Little storage areas The insufficiency of the storage area that is; the room and shelves, this also affects the management of records. This could result in records tearing and destruction.  Rusting due to Metallic shelves and fasteners Some of the equipments that are used to manage records are not good for example; metallic shelves and fasteners rust which affects the papers kept inside the files and can lead to them getting damaged.  Un condusive environment that is challenges in temperature and humidity For example; high temperatures affect records that are kept on compact discs, and also very high humidity affects paper records.  High record growth High record growth results into insufficient storage space and results into poor storage of documents.

2.6 Solutions to the challenges faced in management of administrative records Holliday (2007) suggested that; • Trained staff should be hired to manage records for example; professional records managers who are familiar with records management. • Use of automation that is flexible, he meant use of computers to manage records for provision of enough storage space, quick and easy access, easy tracking and retrieval. He further recommended; • Clearly marked shelves in order for easy identification of records or file locations. • Regular dusting to keep the storage area clean and for the safety of file from being damaged by dust. • Retention and disposal program development and preservation of records, this program deals with appraisal of records that is which documents are needed for future use and those that need to be disposed of. Finally, he suggested that; documenting registry of procedures policies and regulations, this would give clear rules on how to handle records, who is supposed to access specific files and also the use and tracking procedures of files in the organization. Stewart (2002), recommended establishment of; • A systematic record management program to ensure organized records, he was meaning an organized filing system to handle the records life cycle that is; creation, maintainace and distribution/use, storage and preservation and destruction. Yeo (2005) said; there should be; • Employment of qualified personnel as records officers who will reduce files from being misplaced. That this would result into a good administrative records management. Ginn (2010) suggested; • Designing rules, policies and regulations for access and retrieval of records. In order to minimize damage and access by unauthorized personnel. Finally, Stewart (2003) recommended; • Controlling the cost of creation, distribution, maintenance to keep integrity and accuracy of records. He said records should be protected from physical hazards and security from unauthorized persons.

2.7 Research Gap A number of scholars have conducted research on government Health facilities but none of them have focused on the area of administrative records in this particular location. This has called the attention of the researcher to carry out this particular study on administrative records in reference to Mukono Health Centre IV.

2.8 Chapter Summary The themes in this chapter included; literature review on the process of the life cycle of records, filing systems used to manage administrative records, problems faced when managing records and solutions to the challenges faced. These were used to collect data while carrying out research at Mukono Health Centre IV.

CHAPTER THREE RESEARCH METHODOLOGY

3.1 Introduction This chapter describes the research design, area of the study, population, sampling strategies, data collection methods, research instruments, data analysis, ethical consideration, output of the research, limitations and procedures of the research.

3.2 Research Design Ginn (2011) defined research as the methodologies that are used by the researcher to collect data while in the field. The nature of the research comprised of Qualitative research. Enon (2003) defines Qualitative research as the use of words to give data collected according to researcher. The researcher conducted the study using this design since most of the data was in qualitative form and it was easier to be collected using this design

3.3 Area of the Study This study was conducted at MHCIV in the records department of the Health facility, assessing the administrative records management system. The researcher used MHCIV because the hospital carries the biggest patient workload in Mukono district and also, it is located in her home district therefore, saving transport costs.

3.4 Population of the Study The population of the study covered people in a specific area and in this case, the research covered the staff of Mukono Health Centre IV. Currently MHCIV has over sixty five (65) workers and the research only covers the Records Manager and the Assistant Records Manager.

3.5 Sampling Strategies According to Enon (2003), sampling strategy is defined as the plan one uses to collect samples while in the field. The researcher laid strategy on mainly one category of respondents, which are Health Records Officers at Mukono Health Center IV. The researcher used the interview guide, the observation guide and the document review guide as instruments in order to collect the data

16 concerning the research. The researcher used this strategy because the hospital is a busy place and therefore, it was hard to use the strategy of questionnaires while in the field.

Table 1: Showing total sample interviewed.

Health records staff Population sample

Health Records manager 1 1 month

Assistant Health Records manager 1 1 a month

Total 2 2 month

3.5.1 Sample size MHCIV has two (2) Health Records Managers which include; the Health Records Manager and the Assistant Records Manager. The researcher took samples from the Health Records manager and Assistant Records manager of Mukono Health Center IV. Therefore; the sample size totaled up to two (2) people.

3.6 Data collection Methods 3.6.1 Interview Method Enon (2003) defined interview as the use of oral or face-to-face talk with the people or sample population. An interview is a conversation between the interviewer and the interviewee. Interviews were conducted with the Assistant Records Manager and the Records Manager of MHCIV. The researcher used this method since it was the easiest way of gathering information at a busy health unit.

3.6.2 Observation Method Enon (2003) defined observation as the use of naked eyes to see and analyze the way records are managed or the way things are done. For this study, the researcher observed how administrative records are managed at MHCIV.

The Research used the observation guide to: • See how administrative records are generated • Look at how administrative records are filled • See how administrative records are stored in the records area • See the equipments used to handle and manage administrative records • Look at the way the records area is maintained

3.6.3 Document Review Method Enon (2003) stated that; this is the means by which a researcher goes through documents in order to gather information needed to carry out research. The researcher had to go through several documents for example; the HMIS tools, the tally sheets and more in order to collect the right data that was needed in the research. Appendix III shows the document review guide the researcher used to go through documents while in the field at MHCIV.

3.7 Research Instruments 3.7.1 Interview Guide Ginn (2010) defined an interview guide as a set of questions about which the interview is conducted. The interview guide comprised of questions that are similar to the study objectives. Appendix I has a sample.

3.7.2 Observation Guide Ginn (2010) defined an observation guide as a list of general topic areas formulated from the research problem that the researcher would like to observe in the process of investigation while in the field in line with the research topic. Appendix II has a sample.

3.7.3 Document Review Guide Enon (2003) stated that; this is the means by which a researcher goes through documents in order to gather information needed to carry out research. Documents that were reviewed included;

 Organizational records which included; water bills and electricity bills

 Government records which included; HMIS manuals, clinical guidelines, notices and orders  Reporting records which included; HMIS reports, minutes, statistical reports, internship letter and legal documents. Figure 3 shows samples of HMIS tools which include; the HMIS form 105 for outpatient monthly report, the general tally sheet of June 2017 and the HMIS form 108 for inpatient monthly report. Appendix III is a document review guide showing the way the researcher managed to go through the administrative records at MHCIV in order to collect the information that was required.

3.8 Data Analysis Data that the researcher was to collect was to comprise of administrative records management at Mukono Health Centre IV. After collecting the data needed, the research analyzed through pilling and sorting out data that was collected in the interview guide, the observation guide and the document review guide and then finally came up with a report.

3.9 Ethical Considerations Enon (2003) said that ethical issues should explain how the study will be conducted according to the accepted norms and regulations of the discipline of research. The researcher was given an introductory letter from the faculty of EASLIS in which she was accepted to do research at MHCIV. The information that was collected from the field, with at most confidentiality, was to be only for academic purposes and coming up with a report.

3.10 Limitations of the Study • Time, the time scheduled to carry out research was not enough that it limits the researcher though the researcher collected all the data she needed within this particular time and came up with a report. • Cost, which was incurred by the researcher in terms of printing and other expenses, needed to carry out the research but the researcher managed through finances from her parents and then completed the research.

• Denial of access to some records especially confidential organizational records was also a great limitation to the research but the researcher befriended the Senior Medical Officer of MHCIV and she managed to asses all the data she needed to complete her research. Therefore, though the researcher faced all this, she was able to carry out the research or study and collect necessary data that was needed.

3.11 Research Procedures The following were the steps the researcher took in order to accomplish the research; • After receiving the introductory letter from EASLIS, the researcher delivered it to the overall controller of Mukono Health Center IV. • The researcher observed the administrative records management process in the records department while at the Health Centre. • Interview the record manager and staff in the process of observation using the interview and observation guide. • The researcher collected data and analysed it then came up with a report to show the findings of the research. • Finally, the report was submitted as a partial fulfillment of the requirement for the award of a Bachelor Degree of Records and Archives Management at Makerere University.

3.12 Chapter Summary This chapter consisted of the research design, area of the study, population of the study, sampling strategies, sample size, data collection methods, research instruments, data analysis, ethical considerations, limitations of the study and research procedures.

CHAPTER FOUR PRESENTATION AND DISCUSSION OF FINDINGS

4.1 Introduction This chapter includes the presentation and discussion of the findings which the researcher based on to make the conclusions and recommendations, the findings are presented according to the questions designed and also the data collected in line with the objectives which the study sought to answer, which include;

 To examine the types of administrative records managed at Mukono Health Centre IV

 To assess the process of the life cycle of records at Mukono Health Centre IV

 To identify the filing systems used to manage the administrative records at Mukono Health Centre IV and challenges faced when managing administrative records at Mukono Health Centre IV

 To suggest the possible solutions to the identified challenges at Mukono Health Centre IV

4.2 Description of the Respondents

Out of 65 staff personnel at MHCIV, the respondents were a total of two people who the researcher acquired from the information needed for the study. This is because they were the ones in charge or in relation with administrative records. They included the Head of Records and the Records Assistant of Mukono Health Center IV Records Department. The researcher interviewed both the Records Manager and the Records Assistant. The two are qualified to manage all records in the health facility including the administrative records. Figure 2 below illustrates the description of the respondents at MHCIV from whom data was collected from.

Figure 2: A pie chart showing description of the respondents.

records mangers at MHCIV rest of the staff AT MHCIV total number of staff at MHCIV

4.3 Types of administrative records at Mukono health center IV

Objective one was to examine the types of administrative records managed at MHCIV. Administrative records are records that are used to run organizational activities or duties. They are referred to for decision making and budgeting for the organization. According to the Head of Records department at MHCIV, different types of administrative records are handled and they include;

a) Organizational records. These include; functional charts from the different departments of the hospital, fiscal records like; electricity and water bills, medicine and issuing vouchers. b) Government records. These include; HMIS manuals, Clinical guidelines, notices and orders (notices) c) Reporting records. These included; HMIS reports, minutes, statistical reports, internship letters, legal documents. Figure 3 (a and c) show examples of monthly HMIS reports for outpatient and inpatient respectively.

Figure 3 below shows the HMIS tools used by records managers to manage administrative data or records at MHCIV.

Figure 3: HMIS Tools. a) Outpatient monthly report b) General tally sheet

c) Inpatient monthly report

4.4 Process of a Records Life cycle

Objective two was to assess the process of a records lifecycle at MHCIV. The records life cycle has different stages that records undergo from the time of creation to the time of disposal. Below are the findings from the study;

Stage1: Creation. Here records are created through writing up of minutes, statistical, notices and other documents.

Stage2: Distribution and use. In this stage records are distributed by the health records managers and used by the hospital staff whenever needed.

Stage3: Storage and preservation. The third stage, records are stored and preserved in cabinets, shelves and boxes in the records storage area.

Stage4: Destruction. This is the last storage of the records lifecycle. Destruction of records relies on the disposal and retention schedules after appraisal. This is done by the records department in order to dispose off unwanted records.

MHCIV records are managed under the HMIS system, which is operated manually using HMIS forms (105 and 108) and electronically under the ICT4MP and DHS2 system.

The Health facility departments which include; SMC, OPD, IPD, MCH, ART, theatre and the mortuary are responsible for the creation of records which include; budgets, minutes and reports.

These records are then submitted to the records department of MHCIV through gathering and collecting by the records personnel. The records are then tallied and compiled by the records managers.

The records then are handled either manually or electronically by the records department. Manually, records are recorded in the HMIS registers then also recorded in the HMIS reporting tools which include; HMIS reporting form 105 for Outpatient services and 108 for Inpatient services.

Electronically, after collecting, gathering, tallying and complying, records are recorded in the ICT4MPower and forwarded to the in-charge head.

The HMIS forms are then submitted to the in-charge head for signing and verification, and then submitted to the Principal Medical Officer. From there, one copy is left in the office of the Principle Medical Officer, another copy at the district biostatistics and another copy is kept in the records department of MHCIV.

The records department of MHCIV then submits the reporting tools to DHIS system then finally to the MOH of the government of Uganda.

This process of the records cycle at MHCIV is illustrated in figure 4 as shown below.

Figure 4: Structure of a records life cycle at MHCIV.

HEALTH FACILITIES DEPARTMENTS (SMC,

OPD, IPD, MCH, ART, THEATRE, and MORTUARY)  Health Facility departmental heads in-charges

Creation (budgets, minutes, reports)

MHCIV RECORDS DEPARTMENT (Head of health records and health information assistant)

Collect, gather, tally and comply Collect, gather, tally and comply records (Recording in the HMIS records (Recording in the registers (manually)) ICT4MPower (electronically))

HMIS reporting tool/ form 105 (Outpatient services) and 108 (Inpatient services)

In charge head (sign and verify)

PRINCIPLE MEDICAL OFFICER

Office District (Biostatistics) MHCIV RECORDS DEPARTMENT (Head of health records and health information assistant)

DHIS2 System (District Health Information System) Software for

to the MOH MINISTRY OF HEALTH (MOH, GOVERNMENT OF UGANDA)

4.5 Filing systems used in administrative records management at MHCIV

Objective three was to identify the filing systems used to manage administrative records at MHCIV. Filing is defined as a systematic arrangement and keeping of records so that they may be found and delivered when needed for future reference. MHCIV manages records using three (3) filing systems namely;

a) Chronological order: The use of dates to file records for example; 12th/February/2017 especially in OPD and MCH. b) Numerical order: use of numbers to file records especially in the ART Department for example; 1267, 6342… c) Subject order: use of subjects to file records for example; reports, minutes, court orders….

4.6 Challenges and solutions for managing administrative records

Objective four was to assess the challenges faced in managing administrative records at MHCIV and the possible solutions to the challenges faced. The following challenges are faced in management of administrative records at MHCIV;

a) Limited storage space

The researcher observed and was told by the head of the health records department that one of the biggest challenges faced in management of administrative records is the limited storage space at the records center. This leads to wastage of a lot of time when retrieving records that are needed for use.

b) Less stationery

The records department at MHCIV faces a challenge of less stationary for management of administrative records. In otherwise the equipments needed that is; files, papers, glue and many others for management of administrative records are not enough.

27 c) On and off of the HMIS /DHIS Systems

Findings indicate that; the government systems that are used for handling data at MHCIV are not reliable that is; they are always on and off which affects not only the records department but also the activities that are done at the hospital. d) Limited number of records managers

The researcher observed that there were only two (2) records managers that handle all the records in this big health facility. This was more evident by the interview that was carried out between the head of the health records department and thus he said more Records Managers are needed at MHCIV due to the work load. e) Lack of standard HMIS tools

That is the government supplies (National Medical Store, NMS) only two HMIS books in a month which are filled in just one day due to the high rate of activities carried out. In this, the records managers end up duplicating the original copies for example tally sheets in order to perform the rest of the activities which is a challenge. f) Weak policy

Respondents revealed that; the government policy that manages records as a department at MHCIV is weak, the government passes on orders but they end up not being implemented due to the weak records policy. For example, the electronic system was introduced to handle records but still the manual system is still in place which is slow and less accurate. g) High records growth

Also this problem is faced due to paper records and also the lack of an appraisal schedule to work on records to be destroyed has led to the high growth of records at MHCIV.

4.4 Chapter Summary This chapter discusses the findings based on the objectives of the research that were; to examine the types of administrative records managed, to assess the process of the life cycle of records, to identify the filing systems used to manage administrative records, to assess the challenges faced when managing administrative records and to suggest the possible solutions to the identified solutions to the identified challenges at MHCIV.

CHAPTER FIVE SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction In this chapter, the researcher summaries the findings of the study, makes conclusions basing on the study’s objectives and finally comes up with recommendations basing on the findings of the study. The researcher used the following methods to collect data: interviewing the records staff and observation methods.

5.2 Summary of the Study The study attempted to assess the management of administrative records at Mukono Health Centre IV.

5.2.1 Types of administrative records managed at Mukono Health Centre IV. MHCIV mainly handles three types of administrative records which include: organizational records, government records and reporting records.

5.2.2 The process of the life cycle of records at Mukono Health Centre IV. Records at MHCIV undergo the following stages below in the process of their life cycle: In creation, records are created through writing up of minutes, statistical, notices and other documents; distribution and use involves distribution of records by the records managers and used by the hospital staff whenever needed. Storage and preservation is where records are stored and preserved in cabinets, shelves and boxes in the records storage area and it relies on the disposal and retention schedules after appraisal. This is done by the records department in order dispose off unwanted records.

5.2.3 The filing systems used to manage the administrative records at Mukono Health Centre IV. MHCIV uses three types of filing systems which are: chronological, numerical and subject filing systems.

5.2.4 Challenges and solutions for managing administrative records at Mukono Health Centre IV. The challenges faced in management of administrative records at MHCIV include; limited storage space, less stationery, on and off HMIS or DHIS Systems, limited number of records managers, lack of standard HMIS tools, weak policy, high records growth and limited number of records managers.

The solutions to the identified challenges faced in management of administrative records at MHCIV included; reallocation of the records department to a bigger room to accommodate records, recruiting of more skilled records managers in the records department of MHCIV, improvement of the electronic system, recruitment of more records managers, installation of an appraisal, and disposal policy and revision of annual budget.

5.3 Conclusion The researcher drew the following conclusion from the study, the management of administrative records at Mukono Health Centre IV should be improved by improving the electronic system that is HMIS and DHIS systems since the manual systems are slow and a lot of it will also work on problems of storage space required for storage of these records, accuracy and speed, misplacement of records and also allow quick and timely decisions to be taken by the in charges at MHCIV.

It was also concluded by the researcher that lack of enough equipment like shelving cabinets, stationery, file folders and many more has greatly affected the records department so, the government should facilitate MHCIV with enough equipments in order to manage administrative records well.

5.4 Recommendations The following recommendations could be employed by MHCIV through the government in order to improve management of administrative records at MHCIV:

5.4.1 Reallocation of the records department to a bigger room

The researcher recommends a bigger work space for the records department in order to solve the problem of limited storage space.

5.4.2 Recruiting of more skilled records managers in the records department The government should recruit more records managers in the records department in order to work on issues of time wastage, quick access and retrieval of administrative records when performing work manually. 5.4.3 Improvement of the electronic system The electronic system used at MHCIV to manage administrative records should be improved by the government of Uganda that is; the HMIS and DHIS systems should be improved. All in all, the MOH resource centre should be stabilized. 5.4.4 Installation of an appraisal and disposal policy MHCIV should put in place appraisal and disposal schedules and policy in order to work on the problem of records growth. This will save space and also help in disposition of unnecessary records that are kept in MHCIV records centre. 5.4.5 Revision of annual budget Also, the budget that is made by the government should be revised by the records department of MHCIV in order to get access to enough equipment that is supplied by the NMS.

5.5 Area of Further Study

The researcher recommends the following areas below for further study;

• Management of health records at MHCIV • Electronic records management at MHCIV

REFERENCES

ARMA International (2007), Records and Information Management core competencies. Lenexa;

Education Development Committee, ARMA international.

Barry, Rick (2006). Managing E-records. Records Management Journal, 16 (1) Retrieved

March 06 2017, from Emerald Database.

Doll M. (20 June 2015). Welcome to Mukono Health Centre IV. Megadoll.com. Retrieved

4 April 2016.

Enon, J.C. (2003), Essential component of an efficient records storage facility: Division of court

Operations – Office of Records Management.

Ginn, R.A. (2010) Records Management. Alabama: United States of America.

Google (4 April 2016). Location of Mukono Health Center IV (Map). Google Maps. Google.

Retrieved 4 April 2016.

Holliday, J. (2007). Records Management and Development: New York: As professional share

point.

IRMT.Principles of Records and archives management. London; International Records

Management Trust, ISO 15489-2001 Information and Documentation Management.

Ministry of Health (2003). Data Analysis and Utilization Guide for District, Epidemiological

Surveillance Division Health Sub-District and Health Facility level.

Ministry of Health, revised edition (November, 2001) HMIS Manual.

Mayamba.J. (6 April 2015). Mukono leadership demand for upgrade of Health Centre IV,

Kampala: Uganda Radio Network.

Ministry of Health (1997). Review of the Health Management Information System for Uganda:

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Stewart, Jeffrey R. (2002). Professional and Information -2nd edition MC Graw Hill. New York.

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Appendix I: Interview Guide The researcher is carrying out a study titled; ASSESMENT OF ADMINISTRATIVE RECORDS MANAGEMENT AT MUKONO HEALTH CENTRE IV. The researcher will use this set of formal questions that are asked the respondent in the process of interview.

SECTION A: Back ground information

1. When did Mukono Health Centre IV come into existence?

2. Where is Mukono Health Centre IV located?

SECTION B: Types of administrative records at Mukono Health Center IV

1. What are administrative records?

2. What types of administrative records are handled at Mukono Health Centre IV? (Organizational, government, reporting and operational records)

SECTION C: Process of a records life cycle.

1. What is a records lifecycle?

2. What steps or stages do records under go when being managed?

SECTION D: Filing systems used in administrative records management.

1. What are filing systems?

2. What is the filing system used in management of administrative records at Mukono Health Centre IV?

3. What are other types of filing system used in management of administrative records at Mukono Health Centre IV?

SECTION E: Challenges and solutions for managing administrative records

1. What are the problems faced when managing administrative records at MHCIV? 2. What are the possible solutions t4o the above mentioned challenges faced when managing records?

Appendix II: Observation Guide The researcher is carrying out a study titled; ASSESSMENT OF ADMINISTRATIVE RECORDS MANAGEMENT AT MUKONO HEALTH CENTRE IV.

This is a set of activities that the researcher did to see how administrative records are managed at Mukono Health Centre IV.

1. See how administrative records are generated.

2. Look at how administrative records are filled.

3. See how administrative records are stored in the records area.

4. See the equipments used to handle and manage administrative records.

5. Look at the way the records area is maintained.

6. Observe the general state of the records.

7. See how records are retrieved.

8. Look at the way records are used.

Appendix III: Document Review Guide

The researcher is carrying out a study titled; ASSESSMENT OF ADMINISTRATIVE RECORDS MANAGEMENT AT MUKONO HEALTH CENTRE IV.

The researcher will use this document review guide to go through documents in order to gather or collect information required to carry out research.

a) Types of filing systems used to arrange documents or records at MHCIV b) Types of administrative records at MHCIV c) HMIS tools used to manage administrative records at MHCIV

Documents to be reviewed include: HMIS tally sheets, HMIS monthly reports, HMIS manuals, clinical guidelines, notices, orders, electricity and water bills.