Between Coordination and Competition: How External Fragmentation Shapes the WHO’s Effectiveness in Global Health Governance

This thesis examines how external institutional fragmentation has shaped the World Health Organization’s (WHO) output effectiveness in the governance of the HIV/AIDS pandemic. Drawing on regime complexity theory, it conceptualizes fragmentation as the proliferation of overlapping institutions that diffuse authority and complicate coordination. Using qualitative process tracing, the study reconstructs key institutional shifts across four periods: the WHO’s early leadership (1986–1995), the creation of UNAIDS (1996–2001), the rise of the Global Fund (2002–2010), and the partial re-integration of governance efforts (2011–2020). Evidence from primary documents, policy analyses, and scholarly accounts reveals that high fragmentation, marked by mandate ambiguity, donor realignment, and competing governance centers, reduced WHO’s ability to generate coherent policies and assert strategic leadership. Conversely, moderate fragmentation, supported by mechanisms such as the UNAIDS co-...Show moreThis thesis examines how external institutional fragmentation has shaped the World Health Organization’s (WHO) output effectiveness in the governance of the HIV/AIDS pandemic. Drawing on regime complexity theory, it conceptualizes fragmentation as the proliferation of overlapping institutions that diffuse authority and complicate coordination. Using qualitative process tracing, the study reconstructs key institutional shifts across four periods: the WHO’s early leadership (1986–1995), the creation of UNAIDS (1996–2001), the rise of the Global Fund (2002–2010), and the partial re-integration of governance efforts (2011–2020). Evidence from primary documents, policy analyses, and scholarly accounts reveals that high fragmentation, marked by mandate ambiguity, donor realignment, and competing governance centers, reduced WHO’s ability to generate coherent policies and assert strategic leadership. Conversely, moderate fragmentation, supported by mechanisms such as the UNAIDS co- sponsorship model and strengthened WHO–Global Fund collaboration, facilitated complementary specialization and improved policy uptake. The findings show that fragmentation is not inherently detrimental; rather, its effects depend on the structure of inter- institutional coordination. The thesis contributes to scholarship on global health governance by demonstrating how variations in institutional architecture condition the authority and effectiveness of the WHO.Show less

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Between Coordination and Competition: How External Fragmentation Shapes the WHO’s Effectiveness in Global Health Governance