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Institutional field-level change in Global Health: logic evolution in health initiatives

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posted on 2023-08-30, 19:28 authored by Leenkesh Ramlagun
Among the most significant changes in the global health system in the last three decades is the emergence of global health initiatives (GHIs). Thus, the field of international health looks substantially different now as opposed to thirty years ago. This thesis investigates the emergence of global health initiatives from the viewpoint of institutional theory. Using the lens of institutional logics, this research demonstrates that the institutional change occurs through a process of logic evolution. This thesis finds that institutional change does not necessarily manifest only by shifts in prevailing logic as the current literature indicates, but also by the evolution of existing logics. The process of logic evolution can be conceptualised as the reconstitution of sources of legitimacy and identity, relational networks, control mechanisms and practices. These reconstituted logic characteristics are then blended into the old overarching logic. The blending process is dependent on macro and meso level factors. The ability to crystallise change and the degree of trust in accepting alternate approaches belong to the macro level factors. Meso level factors relate to the legitimacy, and status of proliferation agents, the feasibility to create a strategic field nexus, and their ability to create a participatory hub. The participatory hub is a key factor as it enables the process of distilling and legitimising the identity of the professionals in the field. A qualitative case study design was chosen as it allows an in-depth review and explanation of the emergence of GHI networks. A qualitative approach is more likely to address questions about the emergence of the global health initiative network. This, in essence, promotes a better comprehension of the underlying dynamics and allows a contextualised and specific clarification of the consequences for the emergence of GHIs in the global health system. In-depth interviews were conducted with a purposeful selection of highly networked informants in the field. This study offers a series of contributions to institutional theory. Initially, the principle of logic evolution is presented and conceptualised. Furthermore, it demonstrates how the characteristics of an institutional logic can be reconstituted. Finally, it establishes the key macro and meso factors that permit the logic evolution process to take place.



Anglia Ruskin University

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Theses from Anglia Ruskin University/Faculty of Business and Law