Local orders in international organisations: the World Health Organization's global programme on AIDS

Abstract

In 1990, the World Health Organization (WHO) started to downsize its renowned Global Programme on AIDS, despite continued donor and member state support. This turnaround has decisively contributed to WHO's loss of leadership in HIV/ AIDS politics. From the viewpoint of both rationalist and constructivist theories of international organisation (IO) agency, an IO engaging in 'mission shrink' is a striking irregularity. In order to account for such apparently self-defeating behaviour, this article adopts an open systems view of IOs and identifies trans-organisational coalitions as important agents of IO change. I argue that subunit dynamics rather than systemic conditions drive IO behaviour, in particular where member states' material power and their formal control of organisational veto positions do not coincide. This approach will be used to retrace the changes in subunit coalitions that drove WHO's erratic HIV/AIDS programme and thus to solve this puzzle of 'mission shrink'. On the basis of insights from the WHO case, the article concludes by offering a heuristic of trans-organisational coalitions and the types of IO change associated with them.

Gradual Change in International Organisations: Agency Theory and Historical Institutionalism

“…Yet also from a rationalist perspective, the idea that IOs are coherent agents capable of goal-oriented action is often unrealistic. Organisational fragmentation and bureaucratic politics undermine corporate agency in IOs (Graham, 2013; Hanrieder, 2013; Kassim and Menon, 2003). Where IOs are not responsive to external incentives, PA mechanisms of control are rendered ineffective (Graham, 2013).…”

“…This is not to say that IO bureaucracies only influence IO change where states are inactive (see Johnson, 2013). Bureaucrats are usually part of reform coalitions, collaborating with like-minded states across IO boundaries (see Hanrieder, 2013). However, the heuristic outlined in here contributes to specifying under what institutional conditions their role should be of particular relevance.…”

Governing effectively in a complex world? How metagovernance norms and changing repertoires of knowledge shape international organisation discourses on institutional order in global health

“…A growing body of literature on increasing institutional fragmentation and regime complexity in International Relations scholarship puts forward a portrayal of contemporary global governance in almost any field of international concern as being characterized by an ongoing multiplication of rules, actors, organizations and networks. While IOs, as institutions set up and authorized by states, thus, are still mostly treated as focal institutions for state actors (Abbott et al 2015), they are at the same time conceptualized as 'open-systems' (Hanrieder 2014;Koch 2015) and entangled in a dense web of rules and interactions. Understanding and explaining how IOs and their member states navigate these entanglements by managing their inter-organizational relationships is a central part of the research agendas on regime complexity and fragmentation.…”

The path-dependent design of international organizations: Federalism in the World Health Organization

“…Under her predecessor, Hiroshi Nakajima, the WHO had lost much legitimacy and was accused of mismanagement, fragmentation, and lack of vision (Hanrieder, 2013). In contrast to Nakajima, who was mostly supported by developing countries, Brundtland was supported by the WHO's donor states, and enjoyed direct access to heads of government due to her former career (Andresen, 2002).…”

“…When Gro Harlem Brundtland, former Norwegian prime minister and head of the World Commission on Environment and Development (the 'Brundtland Commission'), was elected WHO DG in 1998, the expectation was that she would fundamentally restructure the organization. Under her predecessor, Hiroshi Nakajima, the WHO had lost much legitimacy and was accused of mismanagement, fragmentation, and lack of vision (Hanrieder, 2013). In contrast to Nakajima, who was mostly supported by developing countries, Brundtland was supported by the WHO's donor states, and enjoyed direct access to heads of government due to her former career (Andresen, 2002).…”