Documents or written records allow access to subjects – in this case, global or supra-national organisations – that may be difficult to research through direct or personal contact and can provide an understanding of the producers of the documents. Additionally, documents differ from speech or action in that they persist beyond the local context of their production (Miller and Alvarado, 2005). The documents examined in this study are meant to provide an understanding of the assumptions that feed into policy implementation and change management approaches of the global organisations that publish guidance on policies and their implementation.
There are two main approaches to qualitative document analysis, namely content analysis, which focuses on content and examines trends and patterns in documents; and context analysis, in which the document is regarded as a reflection of the wider contextual environment (Atkinson et al., 2001; Miller and Alvarado, 2005). In the latter, documents are considered within their social settings, which may extend to how documents are manufactured and how they function rather than their content alone, and treats documents as more than resources for evidence and data (Prior, 2003 p4). Thus, this research is better aligned to context analysis.
Any understanding of policy implementation and change management in Nigeria must also take into account how these subjects are handled on a global level. This study proposes that the transfer of policies, and the degree to which they are successfully adopted, from global organisations such as the World Bank and the WHO to emerging economies can be traced or followed through an examination of
‘language’ or narratives and assumptions contained within the documents from these global organisations. These can then be compared with implementation on the national and local levels in Nigeria’s emerging economy. An initial assessment was undertaken to identify key messages on what reforms are required to enhance policy implementation to achieve desired results, and a subsequent narrative analysis was completed specifically on documents from the WHO.
This study also explored the reasons behind policy failures in order to shed light on how to revise approaches. However, the arguments from the WHO and the World Bank are approached from positivist rational and economic perspectives. As highlighted in chapter 2, considerations largely suited with the positivist or
functionalist perspectives are often inadequate to explain policy implementation. As such, a narrative approach to the documents was taken to provide insight into how policy is successfully or unsuccessfully adopted / implemented by emerging economies and how change management is perceived by managers, and to open up certain assumptions within the documents for scrutiny. This revealed how management in the investigated global organisations impose order on experiences of policy implementation and change management. The approach used is demonstrated in some depth in an analysis of one of the documents from the WHO in chapter 5, after which the findings and interpretations are set out in relation to both the World Bank and the WHO.
The documents selected for analysis in this study, and listed in appendix 1, are those in which the agencies set out what changes or reform are needed regarding policies and their implementation across several nations, including some with emerging economies. These agencies also determine in varying degrees what changes or reforms are to be followed in the public sector of these economies.
Public sector reform can be defined as improving the operation of the government and building organisational capacity to achieve desired objectives. The following points arose in the documents.
The World Bank document ‘Public Sector Reform: What Works and Why?: An IEG Evaluation of World Bank Support’ (World Bank, 2008) argues that sound financial management, an efficient civil service and administrative policy, efficient and fair collection of taxes, and transparent operations that are relatively free of corruption all contribute to good delivery of public services. This document was analysed in
conjunction with the strategy document ‘Reforming Public Institutions and Strengthening Governance: A World Bank Strategy’ (World Bank, 2000).
Within the WHO’s 6-point agenda are priorities to strengthen health systems including the provision of adequate numbers of appropriately trained staff, sufficient financing, and the improvement of its own performance through ongoing reform aimed at efficiency and effectiveness at both the international and national levels (WHO, undated). Additionally, the agenda incorporates promoting development;
fostering health security as outbreaks of emerging and epidemic-prone diseases demand collective action; strengthening health systems since, for health improvement to operate as a poverty-reduction strategy, health services must reach poor and under-served populations; harnessing research, information and evidence, as evidence provides the foundation for setting priorities, defining strategies, and measuring results; enhancing partnerships, including collaboration with the private sector (WHO, undated).
The WHO also publishes an annual report with assessments of different aspects of global health. The 2008 report focuses on primary care, highlighting the need for fair and efficient health care. This report in conjunction with the Alma-Ata Declaration and the Millennium Development Goals provide the primary documents for deciphering what changes, from the WHO’s perspective, are needed in the public sector in emerging economies and the WHO’s underlying assumptions about policy implementation and change management (WHO, 1978; WHO, 2008b;
United Nations, 2000). The 2010 report on healthcare financing was also accessed (WHO, 2010).
This study takes the stance that there is no objective recounting of the facts against which to evaluate how and to what extent the narratives are embellished (Boudens, 2005). The documents from the World Bank and the WHO may therefore be seen as the official or formal views of these global organisations.