Association for Public Policy Analysis & Management

This paper examines the consequences of persistent institutional competition within the context of regime complexity, using the case of the World Health Organization (WHO) as a challenged international organization. I argue that the continued proliferation of issues and encroaching institutions have engendered institutional overlaps that challenge to compete away the WHO’s dominance in global health governance. As such, the institution has had to learn to operate across global, regional and functional platforms layered with reinforcing and contradictory configurations. First, I expound how the complexity of the global health regime and the institutional design of the WHO have complicated its survival as a single governing monopolist. Indeed, the numerosity of health-related issue-area configurations possible within the regime complex has encouraged the creation of multiple regime clusters purpose-built for specific challenges. Yet, even in the absence of extraneous institutional competition, the WHO’s convoluted mandates have limited its ability to affirm a cohesive and authoritative position in global health. This suggests that the WHO’s ability to project regime complexity inwards - by forging a more adaptable structure - is intrinsically connected to its potential to regain oversight of the global health domain. Second, I examine how the institution has strategically responded to encroaching competition by assessing two cases where institutional overlaps yielded radically distinct outcomes. The case of the Ebola response serves to illustrate a crucial instance where a competing institution shifted the politics of the humanitarian health regime cluster away from the WHO, thereby affecting its legitimacy descent in complex ways. The case of health economism, on the other hand, balances the argument by illustrating how institutional overlaps have engendered nuanced opportunities for the WHO to strengthen its mandate. In effect, as challengers have continued to encroach in the WHO’s health territory, the institution has sought to ascribe new meaning to its modus operandi by becoming an active progenitor of policies outside of its habitual health silo. Co-habiting the global health regime with leaner and meaner players is no easy task for the WHO, yet the institution continues to hold the source code of the regime complex. Mobilized strategically, opportunities abound for the WHO to reaffirm its position as a legitimate leader able to filter through the regime’s cacophony. Considering that the most relevant politics for health continue to shift into traditionally non-health fora, it is crucial that the WHO embraces institutional overlaps as opportunities to revive its dominance. I conclude that regime complexity should not be equated with a maelstrom of monopoly losses. Instead, growing institutional competition should be reconceived as an opportunity to expand the boundaries of regime complexes.