(Re-)Fit for Purpose? The Ritual of Reform in Global Health Partnerships

• Main Author: Pillinger, Mara
• Language: ENG
• Published: The George Washington University 2020
• Subjects: International Relations|Public health
• Online Access: http://pqdtopen.proquest.com/#viewpdf?dispub=27540615

My dissertation focuses on the politics of organizational reform in major multisectoral global health partnerships (e.g. the Global Polio Eradication Initiative and Roll Back Malaria). Such organizations appear to be locked in a never-end cycle of reform and restructuring. Partners consistently present reform efforts as attempts make the partnership "fit for purpose". But with rare exceptions, the changes that result are either superficial or accomplish the opposite of what reformers promised—for example, by creating more talk and bureaucracy rather than less. So why do most reforms fail? And why do organizations keep repeating the pattern? I find that there is often a fundamental contradiction between what partners say they want from the organization vs. what they actually want. For example, partners demand greater efficiency and efficacy, while also insisting on extensive voice opportunity and consensus decision-making. Or they expect the partnership to "orchestrate" partners’ activities and improve on-the-ground results, but then are unwilling to sacrifice their own autonomy to achieve coordination. Restructuring fails to address these contradictory priorities and so cannot truly make the partnership fit for purpose. Instead, reform efforts constitute an exercise in “organized hypocrisy”—i.e. partners talk about making the partnership more efficient and effective while implementing changes that move in a different direction. So too, restructuring serves as a kind of ritual. By "performing" reform efforts, partners reaffirm their normative commitment to principles like efficiency, efficacy, and coordination, without disrupting the pragmatic realities of life in global governance organizations. As rituals, reform efforts serve a clear purpose, even if they fail to make the organization more efficient and effective. But they are also costly in time, money, and energy. Over time, repeated reform efforts risk destabilizing a partnership by reinforcing a narrative of poor performance. This danger can be minimized under two conditions. First, partners must be on the same page when it comes to their priorities, contradictions and all. Second, those contradictions cannot be so severe that they undermine the partnership’s purpose and legitimacy. Based on these findings, I develop a set of recommendations for strengthening multisectoral partnerships and crafting more effective organizational reforms.