The influence of democratization and reforms in the health and economic sectors on NGO-state relations

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)

First Committee Member

William C. Smith, Committee Chair


As a consequence of both the shift from state-centered development to a market-based development model, and the shift toward more democratic electoral regimes and away from authoritarian and oligarchical politics, the historically adversarial relationship between governments and nongovernmental organizations (NGOs) within the health care sector is being redefined. Prior to the 1990's NGOs delivering health care services in Central America were totally marginalized from national health care systems. As a consequence of both the economic and political reforms of the 1990s, the existing economic and political arrangements that governed NGO-state relations is being redefined. These economic and political changes have compelled NGOs and the state to change their traditional stance toward each other. By surveying 44 NGOs in El Salvador and Guatemala (the two case studies), the dissertation shows how these changes are blurring the boundary between the two sectors and creating new forms of NGO-Government association. The dissertation demonstrates that the intensity of these new forms of association is determined by two factors---the institutional strategies assumed by NGOs with regard to rapprochement with the state, and the caliber of pro-collaboration policies implemented by the state. The dissertation concludes by constructing scenarios that describe the possible future forms of association. These scenarios show how NGOs are changing from being advocates of the rights of citizens to government contractors, and how this transformation is altering the rights of citizenship.


Health Sciences, Public Health; Political Science, Public Administration; Sociology, Public and Social Welfare; Health Sciences, Health Care Management

Link to Full Text