Panel 2.

Case study Documents tell part of the story in Niger

In a multi-country policy analysis of integrated Community Case Management of childhood illness (iCCM), Niger was among the few countries that scaled up the policy at national level (Bennett et al., 2015). Alongside key stakeholder interviews and non-participant observation, document analysis was used to reconstruct the policy process leading to this outcome.  In total, 103 documents were obtained from policy actors in Niger, researchers working on similar topics, or collected on the Internet (Dalglish et al., 2015). Documents included official policies and strategies, field reports, legal regulations, program evaluations, funding proposals, newsletters and newspaper articles, among other sources. Document acquisition was greatly facilitated by asking for documents during stakeholder interviews, although some documents were not available due to a fire that destroyed World Health Organization (WHO) servers in the years preceding the study. Data from the documents was extracted into a Microsoft Excel file, recording information about specific aspects of child health policy and programs, framing of issues, use of research evidence, and mention of international recommendations, among other topics. Documents were also used to compile a timeline of events in the policy process.  Policy processes were elucidated by creating a timeline of events, which documented how specific decrees, workshops, meetings, and other events occurred over time. The timeline was overlaid with measures of implementation (number of health posts built, number of health workers trained) to understand how decision-making processes propelled real-world outcomes, and served as proxies for financial data that were rarely included in policy documents (Dalglish et al., 2015).  Additionally, document analysis revealed a partial account of what was driving these events. Many documents showed a concern for reaching the Millennium Development Goal on child mortality (Figure, Representations of progress toward Millennium Development Goal 4 in Nigerien policy documents). Graphs mapping country progress toward Millennium Development Goal (MDG)-4 appeared in nearly all documentation on iCCM, and progress was regularly reported on by the Nigerien National Institute of Statistics, suggesting that these were a significant motivating factor in policy and resource allocation decisions. Yet older historical documents showed a long-standing recognition of the problem of children's access to life-saving healthcare (well before the MDGs), with policy remedies going back to least 1965 in the form of rural first-aid workers (Fournier and Djermakoye, 1975). Triangulation with interviews and observation also showed that national policymakers’ practical knowledge and ethical imperative to save children's lives was at least as important as the MDGs in motivating policy action (Dalglish et al., 2017). Taken together, the document and non-document data showed that, as in other contexts, the MDGs were useful mainly to direct international fundraising and satisfy donor norms in expectation of funding increases (Marten, 2019).