Date of Award


Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Edward Frongillo


Maternal and child undernutrition contributes to more than one-third of child deaths. Global Health Partnerships (GHP) have emerged as a response to undernutrition and other pressing health problems. GHPs promote joint decision-making among donors, multilateral agencies, and country partners. Despite their positive impact on health problems, GHPs have generated unintended negative effects on country partners. This study aimed to understand the factors, strategies, and processes conducive to the establishment of an effective GHP in the context of a cooperative regional effort to reduce undernutrition and improve maternal and child health in eight countries in Latin America, Regional Health Initiative (RHI). The study used participant observation, document review, and semi-structured interviews to examine the planning and implementation of RHI overall and particularly in two of the eight countries. Deductive analysis was conducted using predetermined themes from the policy science framework. We also conducted inductive analysis that allowed for the identification of emergent themes.

RHI partners had different, and in some instances, diverging perspectives. The lack of alignment of perspectives caused unintended consequences to the implementation of RHI in two countries such as the establishment of unrealistic aims for the country action plans, tension during the formulation of the action plans, and disagreements among partners that led to unexpected changes to the country action plans. We identified three factors that influenced this lack of alignment: 1) challenges in knowledge management, 2) non-inclusive governance structure, and 3) limited time for planning.

Formulation of country action plans is often a contentious process. The successful formulation of an action plan occurs when the process pursues goals of feasibility, alignment, and ownership. Although RHI promoted feasibility, ownership, and alignment, the country context was a key determinant of the attainment of these goals. Lack of national health plans and aims, weak leadership of the Ministry of Health, and an upcoming political transition were factors that prevented reaching these three goals.

These findings bring attention to the process of development of GHPs. The establishment of mechanisms to build trust and promote frequent communication among partners can lead to the early identification and alignment of perspectives. Furthermore, sociopolitical factors of country partners influence GHPs and should be taken into consideration during their planning and implementation. By recognizing that a complex context can delay or impede the attainment of goals during the formulation of country action plans, GHPs can be responsive to the country-specific challenges, devise appropriate procedures to address them, and adapt expectations to the context.