Existing research interprets the rise of consulting firms in intergovernmental organizations (IGO... more Existing research interprets the rise of consulting firms in intergovernmental organizations (IGOs) primarily as evidence of the global spread of managerialism. We highlight that consultants are not merely carriers of business-like world cultural norms, but also part of contentious IGO politics and governance. We unpack the consulting black box and reconstruct how consulting firms are hired and active in IGOs. Analyzing the experiences of the World Health Organization (WHO), we show how IGOs have been informally ‘opened up’ to consulting firms (and to their funders) and we investigate what the consequences of their privileged access are in practice. Consultants curate voices and input (including their own) into reform packages, promote certain contents, and engage in self-effacement practices that undermine accountability to stakeholders. The pivotal position of the consultants can have a disempowering effect on actors excluded from the consulting agreement or marginalized through consulting practices. We illustrate our general discussion by zooming in on the consultant-mediated reform of WHO’s Roll Back Malaria partnership in 2015. Our analysis is based on primary documents, key informant interviews, informal conversations, and participant observation.
Existing research interprets the rise of consulting firms in intergovernmental organizations (IGO... more Existing research interprets the rise of consulting firms in intergovernmental organizations (IGOs) primarily as evidence of the global spread of managerialism. We highlight that consultants are not merely carriers of business-like world cultural norms, but also part of contentious IGO politics and governance. We unpack the consulting black box and reconstruct how consulting firms are hired and active in IGOs. Analyzing the experiences of the World Health Organization (WHO), we show how IGOs have been informally ‘opened up’ to consulting firms (and to their funders) and we investigate what the consequences of their privileged access are in practice. Consultants curate voices and input (including their own) into reform packages, promote certain contents, and engage in self-effacement practices that undermine accountability to stakeholders. The pivotal position of the consultants can have a disempowering effect on actors excluded from the consulting agreement or marginalized through consulting practices. We illustrate our general discussion by zooming in on the consultant-mediated reform of WHO’s Roll Back Malaria partnership in 2015. Our analysis is based on primary documents, key informant interviews, informal conversations, and participant observation.
Thoughts on "de-bureaucratization" and technologies of change in global governa... more Thoughts on "de-bureaucratization" and technologies of change in global governance.
The introduction of digital technology has sparked new debates about the value of community healt... more The introduction of digital technology has sparked new debates about the value of community health workers in low- and middle-income countries. This debate offers important insights into the conventions that are relevant in global public health. Community health workers, a workforce that was already celebrated during the 1970s Primary Health Care movement, are having a remarkable revival in recent years, and myriad actors seek to boost their impact through mobile devices. Our content analysis of the public health literature evaluating this impact reveals the centrality of attempts at reconciling equity and cost effectiveness concerns, and thus considerable normative tensions. Additionally, we find that discussions about "domestic" values such as privacy and gender roles come with a paternalistic undertone, calling for feminist and postcolonial engagement with the digitalization of community health work.
Global Governance: A Review of Multilateralism and International Organizations, 2020
The World Health Organization (WHO) is once more asked to reinvent itself and become more effecti... more The World Health Organization (WHO) is once more asked to reinvent itself and become more effective. This essay discusses recurrent reform proposals directed at the WHO which, in different ways, ask it to find a strategic focus and thereby its niche in the crowded global health arena. Looking back at decades of reform endeavors at the WHO, it exposes the contradictions and unresolved normative conflicts with regard to the WHO’s priorities. Ultimately, the WHO’s effectiveness hinges on Member State support for public authority in global health, and thus the political commitment to protect it against capture by special interests.
This article explores the professional construction of the space of Global Health. I argue that t... more This article explores the professional construction of the space of Global Health. I argue that the growth of Global Health as a field of practice does not merely indicate an intensification of North-South intervention. It is also a professional project of reimporting lessons from the South to countries in the North. I focus on the emerging didactic regime for Global Health in US medical education and the deterritorialized “global” lessons that students are taught in poor countries. By rescaling these lessons to precarious settings at home, the space of Global Health is reterritorialized as a Global Medical South stretching into the United States, reinforcing the perception that health is not a right but a privilege. The analysis is based on a content analysis of university websites and didactic handbooks and a sample of sixty-four articles evaluating the education effects of study abroad experiences. It reveals an emerging canon of Global Health virtues and the construction of dome...
The article puts forward a historical institutionalist account of how international organizations... more The article puts forward a historical institutionalist account of how international organizations are ‘designed.’ I argue that deliberate institutional design is circumscribed by path-dependent power dynamics within international organizations. Power-driven path dependence is used to explain that organizations lock in and reinforce historical privileges of international organization subunits. Early winners in the international organization lock in their privileges with the support of member-state allies, and reap increasing returns from their positions over rounds of reform. They thereby amplify features of international organization design that reformers would otherwise change later on. The argument is illustrated with a historical case study of the World Health Organization’s unique federal design, which grants the regional offices near autonomy from headquarter oversight. Vocal criticisms of the World Health Organization’s regionalization and repeated centralization attempts notw...
This chapter examines how the WHO’s orchestrating role has been reshaped by the proliferation of ... more This chapter examines how the WHO’s orchestrating role has been reshaped by the proliferation of actors in the international health field. Lacking the material capabilities to perform its technical functions on its own, WHO traditionally draws on its formal authority and convening power tomobilize other international organizations and non-governmental associations for research, surveillance and technical assistance activities. Yet as this chapter demonstrates, the growing density of the health field since the 1980s has played out differently onWHO’s ability to orchestrate. Comparing the domains of epidemiological surveillance and technical assistance, I argue that IGO focality is critical for recruiting new actors as intermediaries. As WHO’s recent empowerment in health surveillance demonstrates, new intermediaries can become powerful allies that allow a focal IGO to engage in orchestration, and even to gain greater autonomy from member-state oversight. By contrast, as WHO lacks foc...
Existing research interprets the rise of consulting firms in intergovernmental organizations (IGO... more Existing research interprets the rise of consulting firms in intergovernmental organizations (IGOs) primarily as evidence of the global spread of managerialism. We highlight that consultants are not merely carriers of business-like world cultural norms, but also part of contentious IGO politics and governance. We unpack the consulting black box and reconstruct how consulting firms are hired and active in IGOs. Analyzing the experiences of the World Health Organization (WHO), we show how IGOs have been informally ‘opened up’ to consulting firms (and to their funders) and we investigate what the consequences of their privileged access are in practice. Consultants curate voices and input (including their own) into reform packages, promote certain contents, and engage in self-effacement practices that undermine accountability to stakeholders. The pivotal position of the consultants can have a disempowering effect on actors excluded from the consulting agreement or marginalized through consulting practices. We illustrate our general discussion by zooming in on the consultant-mediated reform of WHO’s Roll Back Malaria partnership in 2015. Our analysis is based on primary documents, key informant interviews, informal conversations, and participant observation.
Existing research interprets the rise of consulting firms in intergovernmental organizations (IGO... more Existing research interprets the rise of consulting firms in intergovernmental organizations (IGOs) primarily as evidence of the global spread of managerialism. We highlight that consultants are not merely carriers of business-like world cultural norms, but also part of contentious IGO politics and governance. We unpack the consulting black box and reconstruct how consulting firms are hired and active in IGOs. Analyzing the experiences of the World Health Organization (WHO), we show how IGOs have been informally ‘opened up’ to consulting firms (and to their funders) and we investigate what the consequences of their privileged access are in practice. Consultants curate voices and input (including their own) into reform packages, promote certain contents, and engage in self-effacement practices that undermine accountability to stakeholders. The pivotal position of the consultants can have a disempowering effect on actors excluded from the consulting agreement or marginalized through consulting practices. We illustrate our general discussion by zooming in on the consultant-mediated reform of WHO’s Roll Back Malaria partnership in 2015. Our analysis is based on primary documents, key informant interviews, informal conversations, and participant observation.
Thoughts on "de-bureaucratization" and technologies of change in global governa... more Thoughts on "de-bureaucratization" and technologies of change in global governance.
The introduction of digital technology has sparked new debates about the value of community healt... more The introduction of digital technology has sparked new debates about the value of community health workers in low- and middle-income countries. This debate offers important insights into the conventions that are relevant in global public health. Community health workers, a workforce that was already celebrated during the 1970s Primary Health Care movement, are having a remarkable revival in recent years, and myriad actors seek to boost their impact through mobile devices. Our content analysis of the public health literature evaluating this impact reveals the centrality of attempts at reconciling equity and cost effectiveness concerns, and thus considerable normative tensions. Additionally, we find that discussions about "domestic" values such as privacy and gender roles come with a paternalistic undertone, calling for feminist and postcolonial engagement with the digitalization of community health work.
Global Governance: A Review of Multilateralism and International Organizations, 2020
The World Health Organization (WHO) is once more asked to reinvent itself and become more effecti... more The World Health Organization (WHO) is once more asked to reinvent itself and become more effective. This essay discusses recurrent reform proposals directed at the WHO which, in different ways, ask it to find a strategic focus and thereby its niche in the crowded global health arena. Looking back at decades of reform endeavors at the WHO, it exposes the contradictions and unresolved normative conflicts with regard to the WHO’s priorities. Ultimately, the WHO’s effectiveness hinges on Member State support for public authority in global health, and thus the political commitment to protect it against capture by special interests.
This article explores the professional construction of the space of Global Health. I argue that t... more This article explores the professional construction of the space of Global Health. I argue that the growth of Global Health as a field of practice does not merely indicate an intensification of North-South intervention. It is also a professional project of reimporting lessons from the South to countries in the North. I focus on the emerging didactic regime for Global Health in US medical education and the deterritorialized “global” lessons that students are taught in poor countries. By rescaling these lessons to precarious settings at home, the space of Global Health is reterritorialized as a Global Medical South stretching into the United States, reinforcing the perception that health is not a right but a privilege. The analysis is based on a content analysis of university websites and didactic handbooks and a sample of sixty-four articles evaluating the education effects of study abroad experiences. It reveals an emerging canon of Global Health virtues and the construction of dome...
The article puts forward a historical institutionalist account of how international organizations... more The article puts forward a historical institutionalist account of how international organizations are ‘designed.’ I argue that deliberate institutional design is circumscribed by path-dependent power dynamics within international organizations. Power-driven path dependence is used to explain that organizations lock in and reinforce historical privileges of international organization subunits. Early winners in the international organization lock in their privileges with the support of member-state allies, and reap increasing returns from their positions over rounds of reform. They thereby amplify features of international organization design that reformers would otherwise change later on. The argument is illustrated with a historical case study of the World Health Organization’s unique federal design, which grants the regional offices near autonomy from headquarter oversight. Vocal criticisms of the World Health Organization’s regionalization and repeated centralization attempts notw...
This chapter examines how the WHO’s orchestrating role has been reshaped by the proliferation of ... more This chapter examines how the WHO’s orchestrating role has been reshaped by the proliferation of actors in the international health field. Lacking the material capabilities to perform its technical functions on its own, WHO traditionally draws on its formal authority and convening power tomobilize other international organizations and non-governmental associations for research, surveillance and technical assistance activities. Yet as this chapter demonstrates, the growing density of the health field since the 1980s has played out differently onWHO’s ability to orchestrate. Comparing the domains of epidemiological surveillance and technical assistance, I argue that IGO focality is critical for recruiting new actors as intermediaries. As WHO’s recent empowerment in health surveillance demonstrates, new intermediaries can become powerful allies that allow a focal IGO to engage in orchestration, and even to gain greater autonomy from member-state oversight. By contrast, as WHO lacks foc...
The rules and services of intergovernmental organizations (IGOs) such as the World Health Organiz... more The rules and services of intergovernmental organizations (IGOs) such as the World Health Organization, the World Bank, and even the World Trade Organization affect health outcomes around the globe. Health-related IGOs have grown more numerous and more powerful but also more contested. This chapter explores the role of health-related IGOs in two main sections. The first section discusses the power of IGOs in global health, focusing on their capacity for autonomous action and their authority vis-à-vis states. The second section explores dynamics of change in and between health-related IGOs. The aim of the chapter is to outline productive cross-fertilization between the global health and IGO literatures.
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Papers by Tine Hanrieder