Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Global Governance and Human Security

First Advisor

Courtenay Sprague

Second Advisor

Stacy VanDeveer

Third Advisor

Meghan Kallman


The institutional puzzle addressed in this research is how institutional norms within global health networks influence NGO adoption of structures and processes, and how this adoption shapes effectiveness of programming, as there is little research that connects these concepts. The dissertation considers if and how effectiveness of Early Childhood Development (ECD) programs is shaped by these decisions. Using New Institutionalism as the theoretical framework, the research compares two NGOs operating in Rwanda and across geographical scales, Save the Children and Global Communities. New Institutionalism helps us better comprehend global health governance, networked power, and how both shape organizational behavior. To understand relationships between networks and NGOs as they relate to organizational legitimacy and effectiveness, research must analyze NGO behavior across scales, from global to local. NGOs are the primary actors through which ECD interventions are implemented in Rwanda and globally, therefore research about why and how they choose to implement particular programs -- and the impact these decision-making processes have on effectiveness -- is imperative to ensure health security throughout Rwanda and elsewhere. From August 2018-September 2019, qualitative methods including 45 semi-structured in-depth interviews and six focus group discussions, were deployed to gain greater insight into the dynamics between institutional norms, global health networks, and international NGOs (INGOs) implementing ECD programming. Findings illustrated the presence of normative expectations (best practices) in Rwanda that influence behaviors enacted by INGOs: the most salient of which is partnerships between INGOs and national NGOs. Proponents of such partnerships argued that they achieved “win-wins” for both the INGOs and national NGOs due to their ability to ground projects in the local context while building capacity of national NGOs, thereby increasing organizational survivability. Partnerships also presented challenges which, notably, resulted from engaging in assumed best practices. Those challenges included time in the field versus time spent on reporting mechanisms; translating global and national priorities at the local scale; and navigating funding uncertainties. Therefore, that which makes NGOs more legitimate organizations also stretches internal resources, setting up trade-offs and tensions between organizational legitimacy and program effectiveness. Findings yield a greater understanding of the contribution NGOs make to global health and global governance; the challenges they face when operating across scales; and the role they play in both shaping and perpetuating institutional norms.


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