Talking Reform, But Not Doing Reform? Investigating the International Dynamics of Reform in the Health Sector of Humanitarian Assistance.

Abstract

The primary purpose of humanitarian aid is to save lives, reduce suffering and ensure respect for human dignity. Conducting humanitarian response has become a multi-billion-dollar operation and facilitated the creation of an elaborate health Cluster System, focused on responding to increasingly complex global emergencies. This study examines the impact of such an expensive system, with a focus on health emergencies given the size, and function of the health Cluster System. The study analyses whether respective path dependencies and institutional dynamics of the humanitarian sector inhibits the system and unintentionally prevents reform. It identifies problems of fit and misfit of purpose that require resolution through institutional or financial reform. Importantly, the thesis offers a conceptual framework that seeks to illustrate and understand the importance and resonance of imbalances within humanitarian organisations that limit reform, and impact on the functioning of the health Cluster System more widely. This thesis contributes to scholarly research, using a new institutional conceptual lens; which is a sociological approach that emphasises the role of institutions in shaping social life and how organisations interact with them. The methodology for this thesis represents a qualitative inductive approach and draws upon 66 completed qualitative semi-structured interviews. Such a qualitative inductive approach is preferred since it more easily reveals the nuances in the operation of the health Cluster System in relation to international humanitarian health response. It can capture complex understanding of when and where health organisations may have issues towards reform due to often unintentional path dependencies that are created and shaped by prevailing institutional dynamics.