Collaborative Governance in a Developing Non-Democracy: Uganda's Organizational Success Fighting HIV/AIDS

• Author: Michael P. Ryan
• DOI: 10.1177/02750740211059113
• Published date: 01 April 2022
• Date: 01 April 2022
• Subject Matter: Articles

Collaborative Governance in a

Developing Non-Democracy: Uganda’s

Organizational Success Fighting

HIV/AIDS

Michael P. Ryan

Abstract

Organization and management scholars seek theory-grounded and theory-building research regarding establishing and structur-

ing organization forms to tackle large, intractable problems, especially grand challenges of poverty, disease, and hunger.

Developing countries tend to have intractable social problemsof rampant poverty and poor health and struggle with epidemics.

The case of HIV/AIDS in Uganda contributes new understanding regarding public organization and state capacity in developing

countries, especially regarding grand challenges of intractable social problems. Field research study of HIV/AIDS action in

Uganda contributes unexpected insights regarding collaborative governance in an institution context under-explored in public

administration and organization studies, the developing non-democracy. Ugandan public executives innovated a participatory

organization model of cross-sector collaborative governance to fight their intractable social problem of HIV/AIDS during

their start-up era. The participatory organization model innovated by the Ugandan public chief executive, called a best practice

by WHO/UNAIDS and influential with PEPFAR designers, yields a construct of network coordination and network control for

study of the organization of cross-sector collaborative governance. Integration of public administration and organization studies

with development and international relations studies informs study of tensions between efficiency and inclusiveness and

between social power and social legitimacy with respect to collaborative governance outcomes of network effectiveness

and participatory accountability in the institution context of a developingnon-democracy. Is non-democracy meaningful or mean-

ingless to collaborative governance?

Keywords

collaborative governance, network control, non-democracy, developing countries

Introduction

Governance through public-nonprofit-private network may be a

tool for “resolving highly complex and intractable social prob-

lems such as poverty”by “bring[ing] together the full array of

stakeholders and offer[ing] more integrated and holistic

responses”(Keast et al., 2004, pp. 363–364). Cross-sector

network governance holds promise for “unstructured, cross-

cutting, and relentless”social problems because they are more

flexible and efficient (Weber & Khademian, 2008, p. 337).

Organization and management scholars seek theory-grounded

and theory-building research regarding establishing and struc-

turing organization forms in pursuit of “bold ideas and the adop-

tion of less conventional approaches to tackling large,

unresolved problems,”especially grand challenges of poverty,

disease, and hunger (Colquitt & Gerard, 2011, p. 432).

Organization theorists hypothesize that grand challenges of

intractable social problems need participatory architectures

that encourage diverse experimentation (Ferraro et al., 2015).

Collaborative governance of a public-nonprofit-private,

or cross-sector, network in public administration and

organization studies means “a governing arrangement

where one or more public agencies directly engage non-state

stakeholders in a collective decision-making process that is

formal, consensus-oriented, and deliberate and that aims to

make or implement public policy or manage public programs

or assets”(Ansell & Gash, 2008, p. 544). Public-nonprofit-

private collaborative governance in public administration

and organization studies involves “the processes and struc-

tures of public policy decision-making and management

that engage people constructively across the boundaries of

public agencies, levels of government, and/or the public,

private, and civic spheres in order to carry out a public

Georgetown University McDonough School of Business, Washington, DC,

USA

Corresponding Author:

Michael P. Ryan, Georgetown University McDonough School of Business,

Rafik B. Hariri Building, 37

th

and O Streets, Northwest, Washington, DC

200057, USA.

Email: ryanmp@georgetown.edu

Article

American Review of Public Administration

2022, Vol. 52(3) 175–190

© The Author(s) 2021

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/02750740211059113

journals.sagepub.com/home/arp

purpose that could not otherwise be accomplished”(Emerson

et al., 2012, p. 2). Collaborative governance is “the use of

institutions and resources to coordinate and control joint

action across the network as a whole”(Provan & Kenis,

2008, p. 231).

Organization structure attracts less interest than process in

network collaboration scholarship and merits more study,

especially regarding governance, organization complexity,

institution and resource context, and tensions such as

power (Bryson et al., 2015, p. 653). Research questions

regarding collaborative governance approaches to solve, or

mitigate, intractable, relentless social problems engage theo-

retical and practical of collaborative capacity and public

accountability (Weber & Khademian, 2008). “The social

and political complexity associated with such problems can

be overwhelming. Participants or stakeholders in the

problem are numerous, with a variety of worldviews, politi-

cal agendas, educational and professional backgrounds, pro-

grammatic responsibilities, and cultural traditions”(Weber &

Khademian, 2008, p. 336). How do network collaboration

innovators organize governance to coordinate resources and

capabilities to achieve outcome effectiveness? How do

network collaboration innovators organize governance to

achieve participation and accountability? How do network

collaboration innovators organize governance to subject

social power to social legitimacy? How does resource and

institution context of developing non-democracy influence

the organization designs of innovators of network collabora-

tion governance when they confront grand challenges of

intractable social problems?

Developing countries tend to have intractable social prob-

lems of rampant poverty and poor health outcomes and strug-

gle with epidemics. Study of vaccine immunization in Africa

and other developing countries finds that international finan-

cial, human, and technical resources of humanitarian and

development assistance must be engaged to provide effective

national health services (Gauri & Khaleghian, 2002).

International nongovernmental participation in developing

countries contributes to increases in state health spending,

though with unknown impacts on state capacities (Murdie

& Hicks, 2013). Yet, international nongovernmental organi-

zations implement humanitarian and development assistance

in post-conflict countries with uncooperative behavior, dys-

functional local government relationships, and disappointing

project outcomes (Cooley & Ron, 2002). The case of HIV/

AIDS in Uganda contributes new understanding regarding

public organization and state capacity in developing coun-

tries, especially regarding grand challenges of intractable

social problems.

Uganda is developing; Uganda is resource-poor, even by

African standards. Uganda is notable for ineffective state

governance and public organization; Uganda ranks among

the lowest-performing African countries in governance mea-

sures. Uganda is not a democracy; Yoweri Museveni seized

power in Uganda in 1986. Despite being poor, despite

lacking effective state governance and public organization

in general, and despite not being a democracy, Ugandans dra-

matically reduced HIV prevalence in their country. “Uganda

reversed a double-digit rate in the 1990s—success often

attributed to strong leadership by the president…”

(Kauffman, 2004, p. 25, 27). “Bilateral and multilateral

donors herald Uganda for its success in tackling AIDS. In

1991, its incidence rate was around 20 percent; by 2003, it

was 4.1%”(Patterson, 2006, p. 29). Other countries in

Sub-Saharan Africa struggled in the 2000s with 18% preva-

lence rates and more. Uganda “was one of the first African

countries to react against AIDS and to react with considerable

success. …Things could have been very different. Many of

Uganda’s East African neighbors mounted what could only

be described as a lackluster response to AIDS during the

1990s, and there were strong forces working within the

country to inhibit any sort of policy response. There was

no precedent for action…” (Kinsman, 2010, p. 41).

Why and how did Ugandans achieve success against HIV/

AIDS in their country? Public executives in Uganda drew in

international donors, such as the World Health Organization,

the US Agency for International Development, and the UK

Department for International Development. Ugandan public

executives brought in international nongovernmental organi-

zations, such as Catholic Relief Charities and the Elizabeth

Glaser Pediatric AIDS Foundation. They helped found hun-

dreds of local community groups and specialized nongovern-

mental organizations around the country, such as The AIDS

Support Organization (TASO) and the national resource

center Pediatric AIDS Clinic of the Mulago National

Teaching Hospital.Resource-poor Ugandan public executives

leveraged international networks to draw in resources and

capabilities; they mobilized local networks; they organized

network collaborations against their HIV/AIDS epidemic.

Field research study of HIV/AIDS action in Uganda con-

tributes unexpected insights regarding collaborative gover-

nance in an institution context under-explored in public

administration and organization studies, the developing non-

democracy. Ugandan public executives innovated a partici-

patory organization model of cross-sector collaborative gov-

ernance to fight their intractable social problem of HIV/AIDS

during their start-up era. The participatory organization

model innovated by the Ugandan public chief executive,

called a best practice by WHO/UNAIDS and influential

with PEPFAR designers, yields a construct of network coor-

dination and network control for study of the organization of

cross-sector collaborative governance. Integration of public

administration and organization studies with development

and international relations studies informs study of tensions

between efficiency and inclusiveness and between social

power and social legitimacy with respect to collaborative

governance outcomes of network effectiveness and participa-

tory accountability in the institution context of a developing

non-democracy. Is non-democracy meaningful or meaning-

less to collaborative governance?

176 American Review of Public Administration 52(3)