Khodor, Rawya;
(2024)
Health system resilience through coordination and learning: The NGO ecosystem of primary healthcare in Lebanon.
Doctoral thesis (Ph.D), UCL (University College London).
Abstract
Academics and practitioners have called for understanding relationships within the frame of international aid (Lewis et al., 2003; Mosse, 2005; Mosse, 2006; Eyben, 2008, 2010), health system governance (Brinkerhoff and Bossert, 2008; Abimbola et al., 2014), and the practice of care (Tronto, 1996, 2010; Held, 2006; Noddings, 2015; Robinson, 2015). Similar calls exist to understand the contribution of relationships between actors within a health system to health system resilience (Elloker et al., 2012; Barasa, Cloete and Gilson, 2017; Gilson et al., 2017; Palagyi et al., 2019). However, limited empirical research tackles these calls. In countries where non-governmental organisations (NGOs) deliver a substantial share of healthcare, particularly through contracting out, main actors involved in strengthening health system resilience encompass these NGOs, the government, and donors. Nevertheless, scant exploration also exists on how some relationships between these actors, within an NGO ecosystem, contribute to health system resilience. My thesis centres on how coordination and learning in an NGO ecosystem contribute to health system resilience. I examine these relationships in the context of Lebanon’s primary health system, predominantly managed by NGOs through contracts and heavily funded by donors. I employ mixed methods: document review, surveys, semi-structured interviews, and peer interviews. Using the complex adaptive systems (CAS) theory, I focus on analysing the contribution of these relationships to the resilience capacities of the health system. I also examine how power dynamics and other factors influence these relationships. I argue that in contexts, such as Lebanon, an NGO ecosystem can contribute to health system resilience provided that it involves specific configurations of NGO-government, NGO-donor, and NGO-NGO coordination and learning. The government can regulate NGOs’ behaviours through NGO-government coordination and learning while allowing them a degree of operational autonomy. Donors can enable flexible NGO-donor coordination, as well as regular and reciprocal NGO-donor learning. The government and donors can also promote NGO-NGO coordination in a competitive NGO environment. These relationships strengthen the resilience of the NGO ecosystem and of the health system. Therefore, this thesis emphasises the government’s regulatory role in health systems involving private actors, such as NGOs. It also underscores the donors’ role in tailoring and implementing flexible approaches to development, which prioritise learning to strengthen health system resilience. The thesis also calls for recognising the governments’ and donors’ roles in creating an NGO ecosystem in which NGOs simultaneously compete and coordinate, further strengthening health system resilience.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Health system resilience through coordination and learning: The NGO ecosystem of primary healthcare in Lebanon |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of the Built Environment UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of the Built Environment > Development Planning Unit |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10191426 |
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