Local orders in international organisations: The world health organization's global programme on aids

Abstract

In 1990, the World Health Organization (WHO) started to downsize its renowned Global Programme on AIDS, despite continued donor and member state support. This turnaround has decisively contributed to WHO's loss of leadership in HIV/AIDS politics. From the viewpoint of both rationalist and constructivist theories of international organisation (IO) agency, an IO engaging in 'mission shrink' is a striking irregularity. In order to account for such apparently self-defeating behaviour, this article adopts an open systems view of IOs and identifies trans-organisational coalitions as important agents of IO change. I argue that subunit dynamics rather than systemic conditions drive IO behaviour, in particular where member states' material power and their formal control of organisational veto positions do not coincide. This approach will be used to retrace the changes in subunit coalitions that drove WHO's erratic HIV/AIDS programme and thus to solve this puzzle of 'mission shrink'. On the basis of insights from the WHO case, the article concludes by offering a heuristic of trans-organisational coalitions and the types of IO change associated with them. © 2014 Macmillan Publishers Ltd. 1408-6980/14.