Abstract
The role of multilateral donor agencies in global health is a new area of research, with limited research on how these agencies differ in terms of their governance arrangements, especially in relation to transparency, inclusiveness, accountability, and responsiveness to civil society. We argue that historical analysis of the origins of these agencies and their coalition formation processes can help to explain these differences. We propose an analytical approach that links the theoretical literature discussing institutional origins to path dependency and institutional theory relating to proto institutions in order to illustrate the differences in coalition formation processes that shape governance within four multilateral agencies involved in global health. We find that two new multilateral donor agencies that were created by a diverse coalition of state and non-state actors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI, what we call proto-institutions, were more adaptive in strengthening their governance processes. This contrasts with two well-established multilateral donor agencies, such as the World Bank and the Asian Development Bank, what we call Bretton Woods (BW) institutions, which were created by nation states alone; and hence, have different origins and consequently different path dependent processes.
Highlights
The governance and responsiveness of multilateral donor agencies working in the area of global health is an emerging area of research
We find that multilateral donor agencies, which have their origins in Bretton Woods (BW) Institutions, and United Nations agencies which have evolved with the Bretton Woods philosophy, have struggled to fully achieve strengthened governance processes
While all four agencies studied were successful in implementing new governance policies, the Global Global Fund to Fight AIDS (Fund) and Global Alliance for Vaccines Initiative (GAVI) demonstrated a persistent commitment to enforcing governance policies, such as the provision of decision-making information for increased transparency, accountability to civil society by including civil society and other non-state actors in multiple governance levels, from governing boards to board committees, as well as in-country coordination mechanisms, frequently meeting with civil society, and ensuring that civil society views and interests of other key stakeholders were consistently included in policymaking processes.c
Summary
The governance and responsiveness of multilateral donor agencies working in the area of global health is an emerging area of research. In contrast to studies which have explored the importance of endogenous organizational interests for achieving these governance outcomes within multilateral donor agencies, often kindled by well organized, pro-active civic mobilization and pressures [1,2,3,5,6,8,9], we draw on research on institutional origins, proto-institutions, and path dependency theory to explain the creation and implementation of strengthened governance processes within multilateral donor agencies. While all four agencies studied were successful in implementing new governance policies, the Global Fund and GAVI demonstrated a persistent commitment to enforcing governance policies, such as the provision of decision-making information for increased transparency, accountability to civil society by including civil society and other non-state actors in multiple governance levels, from governing boards to board committees, as well as in-country coordination mechanisms, frequently meeting with civil society, and ensuring that civil society views and interests of other key stakeholders were consistently included in policymaking processes.c
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