Contesting focality in global health governance : the World Health Organization-World Bank relationship in historical perspective

Focal organisations are typically seen as the undisputed leaders in addressing specific cooperation problems. However, as global governance becomes increasingly fragmented and contested, even well-established organisations are now facing challenges to their traditionally unquestioned focality. Drawing on new theoretical insights, the article contends that the contestation of focal organisations is not a new phenomenon. On the contrary, most focal organisations experience challenges to their focality from their very establishment. At the same time, focal organisations are likely to respond to these challenges with tailored, ad hoc strategies. The article tests these expectations in the case of the global health governance complex, where the initial focality of the World Health Organization was contested by various actors since the outset. Among those contesting the World Health Organization’s focality, a prominent position was gained by the World Bank. By examining the interinstitutional relationship between the World Health Organization and the World Bank from the 1970s onwards, the article shows how this dynamic impacted the World Health Organization’s focality and influenced the broader evolution of the global health complex over the past decades.