The role of document reviews in health policy analysis among low and middle-income countries: a systematic review

Background: Health policy analysis (HPA) is a central component of health systems research (HSR) and contributes significantly to the understanding of health systems reforms including their successes and failures. In most HPA studies, document reviews feature as one of the widely used data collecting methods, especially in retrospective policy analyses. Literature indicates that a substantial number of HPA studies conducted in low and middle-income countries (LMICs) are informed by interactive data collection methods such as interviews, focus group discussions (FGDs), and observations as well as non-interactive methods such as document reviews. While efforts have been made to look into the methodologies that inform health policy analyses for LMICs in the recent years, there is a dearth in knowledge specific to document reviews and how they fit into the framework for doing health policy analysis. This paper provides findings from a qualitative systematic review of peer reviewed policy analysis studies indicating the role of document reviews; why it is employed and how this methodology is positioned and motivated for in the LMICs. Methods: Nine electronic databases were explored in search of articles with adequate information relating to the use of document reviews in HPA studies conducted in LMICs. All 28 articles included in this review were conducted in LMICs between the years 2008-2016. Articles were in English with free full text accessibility. Data extraction focused on the aims of the HPA, and the methodology and results sections in order to identify why and how document reviews were employed in HPA. Results: Twenty-eight articles from LMICs that met the inclusion criteria and examined against a quality appraisal tool were included for thematic synthesis and analysis. Reasons as to why and how health policy analysts use document reviews was directly linked to accessibility and clarity of the document and the perceived contribution of a document to the HPA process. The more accessible the documents are, the more they are likely to be used in a policy analysis. Inductively, the author also considered ‘personal contact with policy makers’ in the identification of documents as another facilitator of document use in health policy analysis studies. Besides access, it is essential that the documents are clear and do not contain conflicting information so that at all phases, intentions of the policy and outcomes are clear to the document user. Apart from validating information obtained from other data collection methods, documents have also been noted to act as advocacy instruments in the health policymaking arena. However, the results have failed to explain as to why policy analysts using document reviews fail to fully describe, quantify or properly display the data obtained from documents used. Conclusion: To the best of the author’s knowledge, this is the first systematic review that has looked into a specific data collection method adapted by many health policy analysts in the LMICs. HPA researchers will always draw on documents. This review has provided a structured way of thinking of documents and document reviews as a data collection method in HPA studies. It elaborates which documents are suitable, for what purposes and how to think of document quality and utility. It is evident from this review that document reviews are a laudable, scientifically sound methodology and that it has a significant role of contributing to the conclusions made about particular policies in evaluating their processes and gauging their current state within a given timeframe. HPA researchers should not underestimate the extent of skill required to adequately analyse documents and draw conclusions from these analyses. Documents are helpful to the policy analysis process and policy analysts should equip themselves accordingly for this kind of methodology and when they do embark on documentary reviews