Exploring the Challenges of Paper-Based Documentation in Clinical and Administrative Departments at Edward Francis Small Teaching Hospital, the Gambia

Abstract

Effective records management is essential for quality health care delivery, administrative efficiency, and institutional accountability. Despite global progress toward digital health systems, many health care facilities in low- and middle-income countries continue to rely on paper-based documentation. This study investigated the challenges associated with paper-based documentation within the clinical and administrative departments of the EFSTH in the Gambia. A qualitative descriptive cross-sectional study design was employed. Primary data were collected across all hospital departments using structured visual inspections and face-to-face interviews with Heads of Departments (HoDs). An inspection checklist was used to assess the availability of digital infrastructure, storage capacity, documentation practices, and the safety and security of patient data. The study revealed significant challenges associated with the continued use of paper-based records, such as high volumes of manual documentation, inadequate storage space, lack of secure filing infrastructure, and absence of designated records personnel. These challenges contributed to the frequent loss, misplacement, and damage of patient records, delayed information retrieval, and disruption of clinical and administrative workflows. The findings highlight the inadequacy of paper-based documentation systems in meeting a tertiary and teaching hospital's operational demands.