Contesting focality in global health governance: the dynamic interplay between WHO and the World Bank

Focal international organizations are typically described as the natural fora tasked with addressing a particular cooperation problem. However, the increasing fragmentation of global governance complexes testifies to a different picture, whereby even established institutions see their previously undisputed preeminence constantly challenged. Drawing on an innovative theoretical framework and a renewed understanding of the notion of focality, I argue that focal organizations undergo continuous contestation and renegotiation of their role from the very moment they are established. Relatedly, I argue that they respond to threats undermining their focality in a manner that is modulated on the specific characteristics of the challenge faced. Expectations are tested applying the developed insights to the global health governance complex, wherein the initially unquestioned focality of World Health Organization (WHO) was progressively challenged by a plethora of new actors. Among those contesting WHO’s lead, a prominent position was rapidly gained by the World Bank (WB), whose interest in health-related matters intensified under the Presidency of Robert McNamara (1968-1981). By investigating the evolving role and relevance of the Bank since the late 1960s up to the present day, I analyze its impact on the development of global health governance throughout the last five decades. The findings show how the WB’s approach vis-à-vis WHO repeatedly changed over the years, owing to more profound shifts in the Bank’s attitude towards global health problems and possible solutions. Similarly, they indicate how WHO adjusted its response to the peculiar characteristics of the challenges faced at the Bank’s hands, alternating confrontational and cooperative approaches with mixed success.