This has contributed to a sense of fear and low morale (Ryan et al. Some claim that 1998 marked a turning point in the WHO’s strategies with the arrival of DG Gro Harlem Brundtland (Horton 2002; McCarthy 2002). 2012). First, and as I explain shortly, an application of institutional change theory reveals that bureaucratic and policy change is not an entirely endogenous process. 1998), instead of selecting cases to test a theory’s effectiveness, the goal is to select cases based on their known value on the dependent variable. Holiday celebrations for those who have no Close and constant contact with some people who Elderly people tire Early policy decisions, therefore, ‘lock in’ a policy onto a particular path, as the benefits these policies provide for their supporters are too lucrative to forgo (Pierson 2000a,b). While DGs Brundtland, Lee, Nordström and Chan were effective in setting their policy agenda (Lerer and Matzopoulos 2001; Saez 2011), they have consistently failed to work with staff to implement it (Global Health Watch 2012; WHO 2012b). Even when seemingly more effective policy alternatives emerge, these coalitional beneficiaries resist them in favour of earlier policies that continuously provide them with benefits (Pierson 2000b). This is done to discredit elites pursuing inefficient policies. Masters Thesis, Department of International Relations. I then arrive at a definition of institutional advantage and develop theory about its predictors, emphasizing a firm's interaction with institutions over its life cycle. This approach seems to provide a more robust, long-term explanation than these three alternative approaches, which are often static in their explanation, i.e. In contrast to other theoretical approaches emphasizing the importance of individual career stability, financial resource constraints and agency leadership, path dependency appears to be helpful in providing a more thorough explanation for the reasons why agencies do not pursue reforms. The most important of these problems is the generally static nature of institutional explanations. 4. Council on Foreign Relations, Background Report, Actions to preserve WHO’s core functions cannot wait for organizational reform, Organizational change capacity in public services: the case of the World Health Organization, The worst of both worlds: the management reform of the World Health Organization, Revisiting general theory in historical sociology. Theory. Moreover, the WHO has recently lacked the funding needed to engage in its traditional line of work, such as research and evaluation (Global Health Watch 2012; Kamal-Yanni 2012). Nevertheless, this article has not addressed how path dependency and institutional change theory can be ‘combined’ to explain institutional transformation. University of Brussels, Comparative Historical Analysis in the Social Sciences, The Global Fund Strategic Approach to Health Systems Strengthening, WHO Reforms for a Health Future. Others explain that a diagonal approach was possible ‘but only if donors [i.e. 2012). The present study is an effort to resolve the conflict between researchers belonging to different schools of thought on the theory. Disadvantages . Include disease and physical handicaps like Beliefs are the primary variables leading to institution/policy choices; the inability to transform them is the product of individuals’ cognitive constraints, whereby beliefs in the legitimacy of an institution or policy, as well as the inheritance of knowledge and policy learning, create incentives to maintain inefficient institutions/policies (Rose 1990; Clemens and Cook 1999; Mahoney 2000). institutional framework for understanding the factors of influence of the state and the large multinationals, in which companies can better understand the industry and implement strategic actions promoting lasting competitive advantages. While these approaches help to highlight the obstacles to reforming international health agencies, scholars have overlooked the potential benefits of applying institutional theories. Understanding the ability of international health agencies to transform for greater efficiency has been of ongoing interest. Short-term staff must, therefore, compete with each other to obtain a long-term position (Ryan et al. Leaders must, therefore, work closely with staff to ensure that they are incorporated into decision-making processes, representing their interests and securing their support (Andresen 2002; Global Health Watch 2012). Choice of food is limited and often repetitious. than with younger people. A study of the World Bank and UNAIDS is introduced to illustrate the potential effectiveness of this approach. Eliminate loneliness because people are always In this literature, the focus is often on explaining the conditions most conducive for organizational change to introduce health policies. This has created to a lack of trust within the Secretariat, which seems to have contributed to low staff morale and enthusiasm for implementing policy (Sherry et al. the Global Fund] and recipient governments are willing to abandon the conventional approach to sustainability [i.e. Surveys conducted by the Secretariat’s office reveal that staff believe that they have been repeatedly ignored when it comes to making important policy decisions (Global Fund 2011). Second, agencies are often forced to adopt unpopular neo-liberal measures, such as reducing staff to balance budgets (Chorev 2012), while experiencing an exodus of staff due to financial uncertainties (Bloom 2011; Johnson 2011). When seeking to explain why and how international health agencies transform for greater effectiveness, the cases of the World Bank and UNAIDS suggest that institutional change theory can help to underscore the exogenous and endogenous sources of reform. Thus, an individual career stability perspective seems to provide no insight into the staff’s ‘ongoing’ policy beliefs and reactions, and how prior policies continuously shape staff reluctance to embrace a diagonal approach. (BS) Developed by Therithal info, Chennai. But the sequencing of policy decisions also matters (Pierson 2000b; Thelen 2003). 2. Similarly, the next DG, Lee Jong-Wook, assembled a change team to implement his policies, such as job rotation, transparency and the decentralization of resources to WHO country offices. First, the board was not able to secure HSS funding for Round 11 (Glassman and Savedoff 2011), which was supposed to be used for HSS ‘Platform’ requests. Nay’s (2012) discussion of the UNAIDS’ transformation since 2005 provides a good example of ‘displacement’ processes, where a change in the international environment gradually empowered UNAIDS officials to supplant bureaucratic procedures and policies with new ones. 3. Findings suggest that this may have been the case. appealing than home-cooked food. government transitions) or when international and domestic groups have discredited existing institutions (Clemens and Cook 1999; Mahoney and Thelen 2010). Old people tend to have Findings suggest that several advantages emerge from the application of these institutional theories. Organizations attempt to conform to easily recognizable and acceptable standards within the organizational field, which helps foster the organization’s legitimacy. It is more expensive than living in one's own Alternatively, others argue that a leader’s vision and managerial commitment to change is necessary (Garside 1998). Although the ostensible subject is stability and order in social life, students of institutions must perforce attend not jus… Changes in Physiological functions include, Adjustment in physical changes of Middle age, Common Changes in Appearance during Old Age, Physical and Psychological needs in living arrangements for the elderly, Some important conditions contributing to happiness in old age, Causes of Blindness and Characteristic of Partially blind child. institution. Regarding data, this article relied on qualitative data in the form of journal articles, newspaper articles, policy reports and books. All meals are available at reasonable costs. 7. Institutional theory provides an alternative account of the spread of science and its organizational forms. Nevertheless, scholars have not considered how the literature discussing institutional change processes may help to better understand these reforms. This loss has not helped to retain and hire staff, while gradually depleting the pool of talented personnel (Global Fund 2011). the Bank’s emphasis on social welfare, or to pursue entirely new bureaucratic and policy procedures, e.g. Institutional Theory as a Framework for Analyzing Conflicts on Global Projects Ashwin Mahalingam1 and Raymond E. Levitt, M.ASCE2 Abstract: Global construction projects that involve collaboration between participants from multiple countries often result in unique challenges, and costs due to cross-national interactions. circulatory, metabolic and mental disorders. Path dependency can help to explain why international health agencies, such as the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria, continue to experience difficulty in reforming their agencies and health policies for greater effectiveness. 2007). Over time individuals resist alternative institutional/policy designs and pursue the same ones because they believe they are still popular, notwithstanding their inefficiencies. However, it is important to note that the Bank’s transformation occurred prior to the emergence of Bank Presidents harbouring the need to fund poverty and social welfare policies (Mason and Asher 1973; Webb 1997). This perspective claims that policy choices made at an earlier point in time establish institutions/policies that are incessantly reinforced through different types of processes, ranging from individuals’ cognitive beliefs and legitimacy, to the ongoing investment of resources and policy coalitions (Mahoney 2000; Pierson 2000a,b). Second, path dependency provides a fuller explanation for the reasons why individuals continue to resist reform. Does this explain why the Global Fund could not fully commit to a diagonal approach? This article suggests that these institutional theories can help to better understand these differences in international agency adaptive capacity, while highlighting new areas of policy research and analysis. External pressure and bureaucratic entrepreneurs in the UN response to AIDS. Global health actors claim to support health system strengthening—is this reality or rhetoric? 2009; Steinlage 2010; McCoy et al. Institutional th eorizing of emulation and diff usion take s as given the prior establishmen t of a n ewly dominant institution. Advantages and Original language: Indeed while many staff members survived Brundtland’s downsizing, they continue to resist policy change and behave inefficiently when tasked to regulate policy under DG Margaret Chan (WHO 2011), thus requiring additional reforms, such as staff evaluation and increased accountability. This has reduced the number of individuals available to conduct research, devise policies and provide technical assistance (Andresen 2002; Kamal-Yanni 2012), while complicating recruitment (WHO 2012a,b). UNAIDS. However, the set of institutions and cultural norms is insufficient to qualify the firm as an organizational individual. Institutional theory(ctd) • It is precisely this ability of government to command the loyalty of its citizens, to enact policies governing the whole society, and to monopolize the legitimate use of force that encourages individuals and groups to work for enactment of their preferences into policy. For Round 8 (2008), the board allowed for HSS activities; however, this was to be built into disease-specific proposals or as a ‘discrete’ HSS section within a disease application (McCoy et al. Advantages . Holiday celebrations for those who have no And because of the worsening financial situation, staff have left in search of other positions (Global Fund 2011). Yet, little is known about the potential benefits of using social science institutional theory, such as path dependency and institutional change theory, to explain why some international agencies, such as the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria, fail to adapt, whereas others, such as the World Bank and UNAIDS, have. than in former homes. However, Klarner et al. In contrast, the aforementioned approaches seem to assume that policy beliefs and strategies are shaped by crisis situations and future benefits, failing to account for the psychological impact of policy history and supportive coalitions. Choice of food is limited and often repetitious. Of recent interest is the capacity of international health agencies to adapt to changes in the global health environment and country needs. An assessment of the WHO provides a good example of how ‘legitimacy’ and ‘learning’ hampers reforms. due to lack of income or low economic status they become dependent and have to 5. Such fears also incentivize staff to leave for more secure positions elsewhere, thus reducing the agency’s pool of expertise (Oomman 2011). 2008; Marchal et al. Maintenance and repairs are provided by the New bureaucratic rules/policies reflect new policy visions (Clemens and Cook 1999; Mahoney and Thelen 2010). Society can thus be divided into four institutional structural areas: family (reproduction, care/support of persons in need of help) Effective leadership, such as through the WHO’s Director Generals (DG), has been viewed as vital for ensuring an agency’s ability to achieve its goals (Andresen 2002; Prah Ruger 2007). the Bank’s IDA working with the WHO and UNESCO, while using these allies and international pressures to discredit and pressure agencies into using existing financial procedures for new policy ends, e.g. ‘De-legitimization’ occurs when reformers highlight the ongoing inefficiencies associated with an institution/policy and strategically use these criticisms to de-legitimize them while proposing and implementing effective alternatives (Mahoney and Thelen 2010). Like all institutional food, it is usually less appealing than home-cooked food. These constraints often deal with issues of ‘legitimacy’ and ‘learning’. Some believe that until DG Chan addresses this problem, she will not be able to achieve her policy objectives (Bollyky 2012; Global Health Watch 2012). These disputes highlight the ongoing problem of conflicting policy interests over a diagonal approach, which has weakened the board’s ‘Platform’ commitment (Hill et al. Furthermore, increased global trade allows businesses to sell their products anywhere. Notwithstanding a change in WHO leadership in the late-1990s, policy ‘legitimacy’ and ‘learning’ appears to have continued to hamper the WHO’s ability to reform policy. Scholars will need to examine the conditions under which reformers within agencies use changes in the international environment to ‘de-legitimize’ inefficient agency policies and implement reforms. 2008). While staff disdain with a hierarchical leadership style may dissipate, their beliefs about the WHO’s appropriate policies will endure (Andresen 2002; WHO 2011). Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia’, An innovative model for management of cardiovascular disease risk factors in the low resource setting of Cambodia, About the London School of Hygiene and Tropical Medicine, Receive exclusive offers and updates from Oxford Academic, Critical interactions between Global Fund-supported programmes and health systems: a case study in Lao People’s Democratic Republic, Adoption of evidence-based global policies at the national level: intermittent preventive treatment for malaria in pregnancy and first trimester treatment in Kenya, Malawi, Mali and The Gambia, The role of the Technical Review Panel of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: an analysis of grant recommendations, The effectiveness of social marketing in global health: a systematic review. 4. 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