ASSESSING THE USE OF MANAGEMENT AUDIT FOR EFFECTIVE MANAGEMENT IN THE CAMEROON HEALTH SECTOR

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The health sector in Cameroon encounters a multitude of obstacles that impede its efficacy and efficiency. The sector has been plagued by long-standing issues such as insufficient funding, resource mismanagement, inadequate infrastructure, and a lack of openness. These problems have a significant effect on the quality of healthcare services offered to the community, resulting in less than optimal health outcomes. The emergence of the notion of management audit is seen as a potential instrument to improve the efficacy of management practices in the sector. A management audit is a thorough and meticulous evaluation of an organization's management practices, policies, and processes (Keller, 2019). Management audits evaluate the efficiency and effectiveness of management in attaining an organization's objectives, in contrast to financial audits which solely examine financial data. Management audits are essential in the health sector to ensure that healthcare facilities perform at their best, resources are utilised efficiently, and services satisfy the necessary requirements (Maxine et al., 2020).

Implementing regular management audits and conducting subsequent assessments of detected deficiencies can enhance internal stability within organisations. This stability is mostly derived from good management, which is crucial for ensuring long-term sustainability (Keller, 2019). Currently, only a small number of organisations are knowledgeable about this type of audit, let alone carry it out. Furthermore, firms, or their managers, sometimes misunderstand the significance and objective of management audit as being the same as personnel audit (Dayo, 2019). A management audit is a comprehensive evaluation and examination of the skills and capacities of a company's leadership team in executing business goals and objectives. The objective of a management audit is not to assess the performance of individual executives, but rather to assess the efficacy of the management team in serving the interests of shareholders, maintaining positive employee relations, and upholding reputational standards. The management audit evaluates the comprehensive management of the organisation, rather than the performance of individual managers (Dayo, 2019).

Ling (2022) defines Management Audit as a thorough assessment procedure aimed at evaluating and improving the overall efficiency of an organization's management operations. It extends beyond just financial examination and explores the strategic, operational, and leadership dimensions of the firm. An audit often conducts a thorough analysis of management policies, decision-making processes, communication channels, and leadership initiatives (Kotler, 2017: Ling, 2022). A management audit seeks to identify the strengths, weaknesses, and areas for improvement in an organization's management structure by analysing these components. The main objective is to offer important perspectives that can inform strategic choices, enhance effectiveness, and contribute to the long-term prosperity of the firm. A management audit is a comprehensive assessment that organisations can use to optimise their managerial procedures and match them with broader company objectives.

Ajibola (2021) argues that management audit evaluates the techniques and policies employed by an organization's management in the management and utilisation of resources, as well as in tactical and strategic planning, and the enhancement of employees and the organisation as a whole. It evaluates the efficacy, productivity, and cost-effectiveness of your company's operations. Supporting this assertion, Mike et al., (2022) contend that management audit does not include identifying blame, but rather, it focusses on identifying areas where a company may enhance, enhance, and streamline operations. According to Keller, Jones & Sheriff (2018), a management audit refers to an autonomous and methodical examination and assessment of a company's total operations and performances. It is a helpful instrument utilised to assess the effectiveness, operations, successes, and attainments of the firm. Ikott (2023) defines a management audit as an impartial evaluation of firm management carried out by expert management consultants who specialise exclusively in this specific sort of assessment. It encompasses all aspects related to organisational management, such as production control, marketing, sales, finance, and human activities. Magnus, Mangvwat & Asher (2021) define management audit as a detached, unbiased, and consultative process that aims to enhance enterprise management and assist the enterprise in achieving its objectives. This is accomplished by implementing a systematic and methodical approach to evaluate and enhance the effectiveness of management and its associated processes. 

Following from the above definitions as well as those made by several other authors concerned with management and auditing, it may be argued that management audit includes certain characteristics, which includes independence – management audit must be carried out, processed and evaluated by an unbiased auditor; objectivity – implementation, processing and evaluation of management audit must be factual and impartial; comprehensiveness – management audit is to cover main management activities of an enterprise and its processes; expertise – it is to be applied to both the activity standpoint (when all management audit activities must be appropriately prepared in advance, managed, checked and documented) and the auditor's perspective as management audit must be conducted by a competent and qualified person; systematicity – most importantly, management audit is an organized assessment of management activities of an enterprise, and identifies the most urgent needs to improve efficiency of enterprise management (Ikott, 2023). In addition, management audit provides several unique services, such as consulting, which involves discussing the suitability of the current management system within an enterprise with its managers and management team. It also includes advisory services, which recommend and suggest measures to ensure effective management to the managers and management team of the enterprise. Validation involves assessing if the firm successfully meets its established objectives, effectively utilises its resources, adequately adjusts to its environment (and promptly responds to changes), has a well-defined strategy, and employs an acceptable organisational structure. Evaluation involves classifying the management system currently being implemented inside the organisation and assessing its appropriateness. Assurance is the act of providing confidence and certainty to managers and the management team of a company regarding their accurate decision-making in managing the enterprise. Alternatively, if necessary, assurance can be used to identify and highlight any erroneous judgements made by the managers. Detection refers to identifying instances of poorly executed management activities and potentially ineffective management functions within the organisation. The purpose of this is to gather information and share the findings and evaluations with the managers and management team of the firm (Magnus et al., 2021).

The health sector plays a vital role in a nation's infrastructure, directly influencing the well-being and general progress of the population. Cameroon's health system encounters various obstacles, such as constrained resources, insufficient facilities, and a dearth of proficient healthcare practitioners (Tenni, 2019). These problems are worsened by ineffective management practices, which might impede the efficient provision of healthcare services. Conducting a management audit in the health industry can assist in identifying and resolving these inefficiencies. A management audit methodically assesses management processes to identify areas requiring improvement, suggest optimal procedures, and ensure efficient allocation and utilisation of resources. Implementing this procedure can result in more effective decision-making, greater quality of patient care, and improved overall organisational performance (Tenni, 2019). Utilising management audits has substantial potential to enhance the efficiency of management in the health sector of Cameroon. Through a methodical evaluation and improvement of management strategies, healthcare institutions can more effectively provide to the people, optimise the utilisation of resources, and accomplish their organisational goals. This study aims to enhance comprehension of the role of management audits in this particular context and offer practical suggestions for improving management efficiency in the health sector.

1.2 Statement of the problem

The healthcare system in Cameroon, similar to that of several developing nations, encounters substantial obstacles pertaining to administration and allocation of resources. Notwithstanding attempts to enhance healthcare service and infrastructure, problems such as inefficiency, mismanagement, and a dearth of accountability continue to exist (Benda, 2021). A management audit is a methodical evaluation of an organization's management processes and controls, which has the capacity to improve the efficiency of management practices in this industry.

Nevertheless, the degree to which management audits are utilised and their influence on enhancing management practices in Cameroon's healthcare system are not well understood. The intricate nature of the sector, together with resource constraints and differing levels of proficiency in management auditing, gives rise to crucial enquiries regarding the present condition and efficacy of management audits (Benda, 2021). It is necessary to comprehend the current use of management audits, the difficulties encountered in implementing them, and their overall influence on management effectiveness and healthcare outcomes.

One significant obstacle in carrying out a management audit is the process of choosing audit personnel (Boniface, 2019). The auditors must possess a high level of competence in their background, experience, and professional skills. Furthermore, they must exhibit proficiency in effectively managing interpersonal conflicts. Put simply, individuals need to be capable of impartially evaluating the behaviour of others without arousing unnecessary doubts and exacerbating an already tense situation. Ajayi (2018) argues that individuals typically experience defensiveness when being audited, perceiving the auditors as agents acting on behalf of a boss with malicious intent. It is imperative to refrain from adopting this mindset. In order to accomplish this, the more competent auditors will set a pre-audit condition indicating their readiness to engage in a discussion with the manager who will be affected by their evaluation, prior to reporting it to upper management (Boniface, 2019). Often, this will develop into a negotiation-discussion process where the individuals involved start to see the audit as an opportunity to identify faults and enhance their performances (and rewards).

The health industry in Cameroon has multiple obstacles that hinder its capacity to provide healthcare services of superior quality. The issues encompass constraints in finances, insufficient infrastructure, and a dearth of proficient healthcare personnel (Reno, 2023). These difficulties are exacerbated by inefficiencies in management methods, leading to suboptimal resource utilisation, delayed decision-making, and inadequate service delivery (Benda, 2021). Despite concerted efforts to enhance healthcare services, these persistent management inefficiencies continue to impede the sector's overall performance and efficacy. Management audits, which methodically assess management procedures, have the capacity to tackle these inefficiencies by pinpointing areas that require enhancement and suggesting optimal approaches. Nevertheless, the examination and influence of management audits in the healthcare sector of Cameroon have not been thoroughly investigated. This knowledge gap requires a thorough investigation of how management audits might be used to enhance the efficacy of management and improve healthcare outcomes in Cameroon. Hence, the necessity for doing this investigation.

Objectives of the study

The primary objective of this study is to critically assess the use of management audit for effective management in the Cameroon health sector. Specific objectives of this study are to:

To determine the extent of management audits in Cameroonian healthcare sector

To identify the challenges that impede implementation of management audit in the Cameroon health sector

To determine the impact of management audits on the performance of healthcare institutions in Cameroon.

To determine the impact of management audits on improving efficiency and service delivery in healthcare institutions in Cameroon

To determine the impact of management audits on resource utilization in healthcare institutions in Cameroon

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

To what extent is management audit carried out within healthcare institutions in Cameroon?

What are the challenges that impede implementation of management audit in the Cameroon health sector?

What is the impact of management audits on the performance of healthcare institutions in Cameroon?

What is the impact of management audits on improving efficiency and service delivery in healthcare institutions in Cameroon?

What is the impact of management audits on resource utilization in healthcare institutions in Cameroon?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The extent in which management audit is carried out within healthcare institutions in Cameroon is low.

Ha: The extent in which management audit is carried out within healthcare institutions in Cameroon is high.

1.6 Significance of the study

This study is important because it tackles crucial matters about the efficiency and effectiveness of management in Cameroon's health system. The acquired knowledge can result in tangible enhancements in healthcare administration, more responsibility, and improved healthcare results for the populace. The study will function as a fundamental reference point for healthcare practitioners, policymakers, researchers, and scholars.

Management audits are essential instruments for guaranteeing accountability and transparency inside organisations. It is crucial to comprehend how management audits can tackle issues of mismanagement and corruption in Cameroon's health sector, where such problems are often widespread. This study aims to emphasise the significance of management audits in promoting a culture of accountability and transparency, therefore enhancing governance in the healthcare industry.

Moreover, through the assessment and efficacy analysis of management audits, this study can offer useful insights on how to enhance the optimisation of these audits for the purpose of improving healthcare facility management. Implementing enhanced management methods can result in increased resource utilisation efficiency, improved organisational performance, and enhanced delivery of healthcare services. In the health sector, better healthcare outcomes are directly connected to good management. This study aims to evaluate the impact of management audits on improving management practices in order to enhance the quality of healthcare services and results for the population.

Moreover, the results of this study can provide valuable insights to policymakers, healthcare administrators, and other individuals involved in the decision-making process regarding the efficacy of existing audit methods and the possible requirement for improvements or modifications. Evidence-based suggestions can provide guidance for the creation of policies and practices that promote improved management and operational efficiency in the health sector.

In addition, conducting effective management audits can assist in identifying inefficiencies and wastage in the distribution of resources. This study aims to elucidate the role of management audits in optimising resource utilisation, resulting in cost savings and improved financial management in healthcare organisations.

This research will ultimately enhance the academic literature on management audits and their implementation in the health sector, specifically in poor nations. It can serve as a point of reference for future studies and establish a basis for additional research on management practices in comparable environments.

1.7 Scope of the study

Broadly, this study focus is to critically assess the use of management audit for effective management in the Cameroon organizations. Specifically, this study seeks to determine the extent of management audits in Cameroonian organizations, identify the challenges that impede implementation of management audit in the Cameroon organizations and determine the impact of management audits on the performance of institutions in Cameroon. 

Further, this study will focus on determine the impact of management audits on improving efficiency and service delivery in institutions in Cameroon and it also seeks to determine the impact of management audits on resource utilization in institutions in Cameroon.

 The study is carried out in Cameroon. 

1.8 Limitations of the study

As with any human endeavour, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the topic, due to the limited availability of data regarding the evaluation of management audit for efficient management in the health sector of Cameroon. Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data. 

Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on Cameroon. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Moreover, the limits faced by the researcher were primarily due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation charges at the research location posed a challenge in meeting the expenses for transportation fees.

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Audit: Audit is the examination or inspection of various books of accounts by an auditor followed by physical checking of inventory to make sure that all departments are following documented system of recording transactions. It is done to ascertain the accuracy of financial statements provided by the organization.

Corporate governance: Corporate governance is the structure of rules, practices, and processes used to direct and manage a company. A company's board of directors is the primary force influencing corporate governance.

Accountability: Accountability is the practice of being held to a certain standard of excellence. It is the idea that an individual is responsible for their actions and, if that individual chooses unfavorable actions, they will face consequences.

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