Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework, Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme, Not all costs should be treated equally: Commentary on the article ‘What will it cost to prevent violence against women and girls in low- and middle-income countries? 2006, p. 11). Aidspan Report, What drives reforms in international organizations? 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. As seen with the WHO during the 1990s, this approach predicts that innovations seeking to reform agencies for greater efficiency, such as staff downsizing and accountability, are resisted by those fearing the loss of employment (Yamey 2002; Johnson 2011; Oomman 2011; Global Health Watch 2012). 2012). External pressure and bureaucratic entrepreneurs in the UN response to AIDS. 3. government transitions) or when international and domestic groups have discredited existing institutions (Clemens and Cook 1999; Mahoney and Thelen 2010). available for companionship. 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. 2012). In contrast to theories focusing on threats to individual career stability, financial resource constraints and agency leadership, path dependency focuses on the historical policy factors and experiences shaping individuals’ policy beliefs and interests and how this explains ongoing resistance to change. Eliminate loneliness because people are always Gradual transformations within the World Bank provide a good example. Global health actors claim to support health system strengthening—is this reality or rhetoric? This approach claims that actors remain committed to inefficient institutional/policy designs because of the high amount of initial investments they put into it, essentially ‘locking in’ institutional paths (David 1985; Pierson 2000a,b). Merely focusing on agency leadership is insufficient for explaining policy reform (Andresen 2002); a fuller explanation requires an analysis of agency staff, their beliefs and incentives to support reforms (Andresen 2002). In doing so, reformers work with supportive external actors to add legitimacy to their cause (Thelen 2003). Independent Evaluation Reform: Stage One, WHO’s management: struggling to transform a ‘fossilised bureaucracy’, Supporting People through Organizational Change. Instead, exogenous conditions and interests are as important for endogenous change to occur, and that this process often unfolds through an international health agency’s interaction with other international actors. Policy innovation is not divergent change in these 4. amusements. Furthermore, surveys reveal that the staff felt ‘undervalued’ and unappreciated (Ryan et al. [The Plombage in the Historical Treatment of Pulmonary Tuberculosis]. The aim of this article is neither to discourage the use of the term ‘actor’ in institutional theory (Hwang and Colyvas, in press) nor to allow this term to obscure the people that are the lifeblood of institutions (Lok et al., 2017). 2012). Disadvantages of Institutional living for the elderly. 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). It is more expensive than living in one's own home. But there are limitations to this approach. While a financial resources approach does explain the board’s inability to pursue further reforms and its staffing consequences, it provides no insight into the ongoing perceptions and beliefs of the staff and their reluctance to implement policy. family are provided. First, agencies will not be able to adequately finance their existing policies and/or create new ones (Radelet 2004; Klarner et al. 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). There has been ∼600 staff working under the Secretariat (Global Fund 2011). Alternatively, resource-based constraints are different from cognitive constraints. Advantages of institutional approach of marketing : This approach is very much popular in an organised economic system. 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. 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). Finally, with regard to the ‘Platform’, several problems have emerged questioning the Global Fund’s commitment. 8. Choice of food is limited and often repetitious. In his study of the WHO, Peabody (1995) claims that its organizational structure and culture in a more technical approach to epidemiological analyses and intervention, such as YAWS,2 present since the 1970s, ultimately hampered the WHO’s ability to effectively respond to AIDS (p. 736). nuclear fission advantages. The goal is to not only gain control over the institution, but also to use its bureaucratic procedures for new policy objectives (Thelen 2003). The institutional theory can be a rewarding concept to an organization because its stakeholder, as a whole (society), plays a vital role in determining the legitimacy of an organization, directly, and have much more power in the operations of an organization. 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. Institutional change theory helps to better explain the complex exogenous and endogenous sources of international health agency and policy reform. Yet several limitations emerge with these alternative theoretical approaches. exploring the advantages of institutional theory Eduardo J Gómez Abstract Background: This article proposes an approach to comparing and assessing the adaptive capacity of multilateral health agencies in meeting country and individual healthcare needs. 2. Responding to AIDS required technical rigour as well as social and political analyses for prevention policy (Peabody 1995). Despite DG Hiroshi Nakajima’s insistence in 1991 that a new policy strategy be adopted, Peabody (1995) maintains that the organizational culture and beliefs in the legitimacy of YAWS precluded policy reforms (p. 736). Institutional anomie theory is an extension of Merton’s anomie theory. For example, a path dependency perspective takes a historical approach to explain why decision makers within institutions fail to reform them (Rose 1990; Mahoney 2000; Pierson 2000a,b). But what about theories emphasizing the importance of agency leadership? Through this ‘Platform’, these donors provide harmonized, direct streamlined funding to support HSS in a long-term, predictable, results-focused manner while involving multiple stakeholders (Global Fund 2012). immediate policy decisions and their consequences. PPE2 protein of Mycobacterium tuberculosis affects myeloid hematopoiesis in mice. psychological and physiological disorder and economic reasons, malnutrition in Brundtland was focused on creating a more efficient WHO, while strengthening its partnership with the private sector and WHO country office capacity (Horton 2002). Like all institutional food, it is usually less First, extreme diversity exists among developing areas in terms of their economic, social, and cultural patterns. 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. (1) holding international symposia; (2) offering fellowships to staff; and (3) prescribing penicillin, and more recently, technical meetings, consultative visits and the provision of supplies (Peabody 1995). the Global Fund] and recipient governments are willing to abandon the conventional approach to sustainability [i.e. While these endeavours revealed the board’s increased commitment to diagonal funding, analysts found problems. Corroborating ‘increasing returns’ theory, some believe that the Global Fund’s lack of commitment is the result of heavily investing in a vertical approach since the beginning, leading to a sudden, recent ‘bolt on’ of HSS activities (McCoy et al. 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). A path dependency approach is therefore potentially more effective than the aforementioned literature for several reasons. shops, amusements, and community organizations. This is done to discredit elites pursuing inefficient policies. WHO) achieved this, in turn providing a more comprehensive, long-term analysis of why leaders and staff members resisted change. 2008). In this context, it may be that staff were simply afraid to upset board and senior officials, especially those not fully committed to a diagonal approach, and that as a result, staff did not fully support this approach. 5. Furthermore, this literature does not examine all the actors involved in institutional change processes, such as lower-level staff, who are often the main proponents for reform (Mahoney and Thelen 2010). An extended institutional approach could support the continuity thesis on the basis that interfirm exchange is underpinned by institutions as much as intrafirm exchange is underpinned by implicit and explicit contracts. circulatory, metabolic and mental disorders. 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. However, while an agency leadership approach informs us of the reasons why leaders may not be able to garner the support needed for reform, it ignores a focus on those individuals considered to be more important in implementing policy: agency staff (Andresen 2002). The analytical concepts guiding this process have typically been the following: ‘conversion’, ‘displacement’, ‘layering’ and ‘de-legitimization’. Second, an application of institutional change theory underscores the specific actors involved in the change process and how they interact with shifting international conditions and interests. Peabody (1995) claims that the WHO’s response led to practices that the WHO adopted for other diseases, i.e. Others explain that a diagonal approach was possible ‘but only if donors [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). Provision is made for suitable recreation and 2012). 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. 1. 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. Finally, while an agency leadership perspective does a good job of explaining the consequences of poor Global Fund leadership, there is no discussion of the perceptions and beliefs of staff responsible for implementing policy. All meals are available at reasonable costs. However, the set of institutions and cultural norms is insufficient to qualify the firm as an organizational individual. Institutional theory provides an alternative account of the spread of science and its organizational forms. This included hosting public–private partnerships for the provision of vaccines and policies for disease surveillance (Burci 2005). Messner’s and Rosenfeld’s approach is based on an image of society borrowed from structural functionalism. Seeking to pressure the board into funding these initiatives, IDA staff knew that the time had come to seek allies and collaborate with the WHO and UNESCO (Webb 1997). This is done to examine if these theories can help to understand why the WHO and the Global Fund have consistently failed to reform their bureaucracy and policies in response to global health challenges and country needs, whereas others have been more successful in doing so, such as the World Bank and UNAIDS. As Pierson (2000b) explains, institutions have advantages over others when they are the first to confront a crisis and to implement policies in response. Despite the Bank board’s resistance, arguing that funding welfare was not part of its original mandate (Webb 1997), there were others in the Bank that thought differently. Radelet (2004) claims that by 2003, yearly contributions received from member states and the private sector fell short of adequately funding projects. Institutional theory attends to the deeper and more resilient aspects of social structure. UNAIDS. than with younger people. Example of institutional theory used in information systems research – In particular, such theory used in the HISP project on health information systems strengthening in developing countries • The idea is that the second part will make it easier to digest and understand the first part. Second, the ‘Platform’s provision of joint funding between GAVI and the Global Fund will make this option difficult unless the Global Fund can switch to a rolling request evaluation process, like GAVI’s, rather than one-time yearly Round evaluations. This article compares a variety of theoretical approaches to conceptualizing institutional change. Once again, both the individual career stability and financial resource constraints approach offer a static analytical perspective. 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. The WHO and UNESCO also pressured the Bank to respond to these problems (Webb 1997; Prah Ruger 2005). Justified theoretical look of institutional theory in the study of the IT industry, is presented in the next Staff also believed that the Secretariat had become too hierarchical, imposing decisions without obtaining staff feedback (Global Fund 2011). Institutional th eorizing of emulation and diff usion take s as given the prior establishmen t of a n ewly dominant institution. than with younger people. Sociological institutional theories address policy innovation only insofar as they explain waves of conformity to newly emerging cultural institutions, or address the conditions under which extant institutions constitute the production of new policy forms. 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