From Paper to Pixels: A Pre‐ and Post-Implementation Analysis of Electronic Health Records in Maternal and Child Health in Zimbabwe

Background: Electronic Health Records (EHRs) are progressively recognised for their ability to improve maternal, newborn, and child health (MNCH) outcomes. Despite growing adoption, limited evidence exists on their effectiveness, scalability, and impact in resource-limited settings such as Zimbabwe. This study evaluates the health and economic implications of EHR implementation, providing data-driven insights for policymakers to optimise digital health interventions. Methods: A mixed-methods, quasi-experimental pre-post design and in-depth interviews were employed across 22 healthcare facilities in Zimbabwe. Health indicators from 2018 (pre-EHR) and 2023 (post-EHR) were compared. Quantitative data were analysed using Epi Info 7 to examine correlations between EHR adoption levels and MNCH outcomes. Focus group discussions and key informant interviews explored healthcare providers’ experiences and system usability challenges. An adoption scoring tool assessed EHR functionality based on completeness of records, ease of use, interoperability, workflow integration, and staff utilisation. Ethical approval was obtained from the Medical Research Council of Zimbabwe. Results: Urban facilities demonstrated higher EHR adoption rates (e.g., Nketa Clinic, Bulawayo: 94%), while rural settings exhibited lower adoption (e.g., Sakubva District Hospital, Manicaland: 13%) due to infrastructure limitations and inconsistent technical support. Facilities with higher EHR integration recorded improved neonatal mortality (r = -0.73), reduced maternal mortality (r = -0.59), and lower intrapartum stillbirth rates (r = -0.92). However, inconsistencies in mortality trends across sites suggest that additional factors—including staff training, patient volume, and resource availability—may influence health outcomes beyond EHR use. Healthcare providers reported benefits such as enhanced patient tracking and improved clinical decision-making. However, persistent barriers included frequent system downtimes, limited training, lack of embedded clinical guidelines, and interoperability challenges. Many cited infrastructure deficits and unreliable internet connectivity as critical obstacles to seamless EHR implementation. Conclusions: EHRs demonstrate significant potential to improve MNCH outcomes, but challenges related to infrastructure, training, and system functionality limit their full impact. Strengthening capacity-building initiatives, optimising information technology support, and addressing interoperability gaps are critical for ensuring sustainable EHR integration. Targeted efforts to scale digital health technologies in Zimbabwe could enhance healthcare efficiency, reduce preventable maternal and neonatal mortality, and support evidence-based policymaking.