Abstract
This paper proposes a theoretical account of institutional transformation and the emergence of order in global inter-organisational relations, which is centred on the concept of “metagovernance”. It does so by theorising on the advent of governance architectures in global health governance—relationships between international organisations (IOs) in this field that are stable over time. Global health governance is routinely portrayed as an exceptionally fragmented field of international cooperation with a perceived lack of synergy and choreography between international and transnational organisations. However, our paper starts from the observation that there are also movements of convergence between international organisations. We seek to explain these by looking at the effects of international norms that define good global governance as <em>orderly and harmonised </em>global governance. We conceptualize such norms as “metagovernance norms” that are enacted in reflexive practices which govern and order the relationships between international organisations. Empirically, this paper traces changing interactions and institutional arrangements between IOs (World Health Organization; World Bank; Gavi, the Vaccine Alliance; and the Global Fund to Fight AIDS, Tuberculosis and Malaria) in global health governance since the late 1940s and shows how patterns therein reflect and (re)produce broader discursive perceptions of what “health” is about and how the governance thereof ought to be organised.
Highlights
In global governance scholarship, it is an almost ritualistic acknowledgement that contemporary international relations are characterised by an escalating institutional fragmentation, competing/intersecting spheres of authority and the resulting pluralism of norm, rules and implementation structures
Pointing to the manifold instances of inter-organisational convergence in global health, we propose an explanatory framework which highlights the role of metagovernance norms and reflexive governance practices to account for transformations in inter-organisational relations and the emergence of governance architectures
We argue for an analysis of historically grown discursive perceptions about how governance ought to be pursued, as well as of how such metagovernance norms are enacted in governance practices to explain convergence between actors, the emergence andorganisation of order in organisational fields and the ensuing stabilisation of institutional constellations
Summary
It is an almost ritualistic acknowledgement that contemporary international relations are characterised by an escalating institutional fragmentation, competing/intersecting spheres of authority and the resulting pluralism of norm, rules and implementation structures. Global governance structures that were created for the provision of public goods in the health area— the eradication of infectious diseases, such as HIV—are emblematic of a core characteristic of global governance in the 21st century: the simultaneous drive of state and non-state actors towards more international order and more coherent institutional architectures on the one hand and on-going contestation and erosion of these institutional constellations on the other. While some call it a dilemma (Karns & Mingst, 2004), others see a dialectic between these two processes We take a closer look at how - in this historically grown web of meanings and institutions - the numerous contemporary initiatives towards coordination and harmonisation among global health actors came to emerge and how they are underpinned by the formulation of norms that equate good global health governance with orderly and harmonised interactions
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