The changing structure of relationships between foreign aid and local systems

Abstract

This dissertation project examines the extent to which the interaction between the international aid and the public health systems in Thailand generates change in both systems by examining the Global Fund process over the last ten years. This research uses complexity science, network theory, and organizational collaboration literatures, taking Elinor Ostrom’s institutional analysis and development framework as its theoretical foundation. The Global Fund is an action arena that bridges both the local public health action arena and the Thai foreign aid action arena. It creates structures that result in organizational interactions, program design and implementation, and program evaluations that feed back into both the local public health and foreign aid action arenas, resulting in change in both. This project uses document analysis, network analysis and interviews conducted during fieldwork in Thailand to examine how interactions between organizations change the structure of relationships, organizational roles and influence and program outcomes. It finds that the Global Fund process results in network structural and substantive changes, including changes in density, development of sub-network structures and changes in participants and program focus. Through these changes, the process engenders positive adaptation within the public health sector in Thailand, by improving human, organizational and community capacity and by reaching previously underserved populations, and positive adaptation in the foreign aid system in Thailand through the changing the roles of these organizations, adapting from agenda setters to providers of technical assistance. This study makes important contributions to the fields of complexity and systems, organizational collaboration and network theory. It finds that the bridging action arena creates and enhances relationships between organizational members, resulting in adaptation within the arenas it overlaps. The results are changes in the attributes of the community and the rules in which they operate within both systems. It also changes the material conditions of both the systems it overlaps. This study is an exploratory endeavor that seeks to expand the understanding of overlapping systems and contribute to theories surrounding this phenomenon. In the process of this research, theoretical questions emerged about the nature of these overlapping systems, about the participants within them, and about how they develop over time that will inform future research agendas.

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