Title Page Evidence-Based Management: Panacea or Placebo? Insights from Nigerian HIV/AIDS Service Delivery by Tegan Joseph Mosugu Bachelor of Arts, History, Duke University Master of Arts, Public Administration, New York University Master of Science, Global Affairs, New York University Master of Philosophy, Organizational Dynamics, University of Pennsylvania Submitted to the Graduate Faculty of the Graduate School of Public and International Affairs in partial fulfillment of the requirements for the degree of Doctor of Philosophy. University of Pittsburgh 2021 Committee Membership Page UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC AND INTERNATIONAL AFFAIRS This dissertation was presented by Tegan Joseph Mosugu It was defended on Select the Date and approved by Dr. Louis Picard, Professor, Graduate School of Public and International Affairs Dr. Paul Nelson, Associate Professor, Graduate School of Public and International Affairs Dr. Wesley Rohrer, Associate Professor Emeritus, Graduate School of Public Health Dissertation Advisor: Dr. Ilia Murtazashvili, Associate Professor, Graduate School of Public and International Affairs ii Copyright © by Tegan Joseph Mosugu 2021 iii Abstract Evidence-Based Management: Panacea or Placebo? Insights from Nigerian HIV/AIDS Service Delivery Tegan Joseph Mosugu University of Pittsburgh, 2021 New Public Management revolutionized the study of management, but increasingly, practitioners and academics focus on what is called evidence-based management (EBMgt) and new public service. Evidence-based management can be defined as the manner in which organizations utilize data and information to inform decision-making processes and shape managerial practices. This research explored how the Nigerian public health delivery is shaped to address the origins and consequences of changes in managerial practice. It is organized around the notion that organizational performance, specifically service delivery, has two aspects: organizational technology (e.g., leadership techniques) and organizational capacity. The hypothesis in this research is that an organization that adopts an evidence-based management grounded in principles of new public service is better at service delivery. This is due to the shared vision, collaboration, and citizen-centered principles that result in more sustainable impact, provided an organization has the necessary capacity. This research study used desk research, supplemented by pilot surveys and interviews of seven respondents from six different nongovernmental organizations in Abuja, Nigeria. Through qualitative interviews, themes centered around the incorporation of leadership, staffing capacity, funding streams, and evidence-based approaches to clinical care were assessed in order to understand how HIV/AIDS services are delivered. In addition, respondents were given a quantitative survey that was two-pronged. This first part of the survey assessed the interpersonal iv working relationships that respondents have with their managers as well as aspects of the work environment that either positively or negatively affect them. The second aspect looked at the extent to which staff in these organizations incorporate clinical best practices in their job functions. This study revealed that most organizations incorporate evidence-based management in their daily functions. Excluding the use of data from monitoring and evaluation teams or surveys, most organizations do not have a methodological approach for providing prevention, treatment, and support services to key populations. Nevertheless, the responses from respondents prove that effective organizational technology (i.e., the use of an organization’s systems and processes) is not predicated on one preferred leadership style. Rather, evidence-based management when coupled with a host of other factors – sustainable funding, a positive work environment, value sharing, collaboration, and policy setting – can strengthen the manner in which organizational technology can create sustainable impact. v Table of Contents Dedication ................................................................................................................................... xiii Acknowledgements .................................................................................................................... xiv 1.0 Introduction ............................................................................................................................. 1 2.0 An Evidence-Based Management Approach to HIV/AIDS in Nigeria .............................. 5 2.1 Introduction .................................................................................................................... 5 2.2 History of HIV/AIDS in Nigeria .................................................................................. 10 2.3 HIV/AIDS Service Delivery In Nigeria ....................................................................... 14 2.4 Rational Decision Making ............................................................................................ 21 2.5 Why An Evidence-Based Management Approach? .................................................. 22 2.6 Promoting Evidence-Based Health Care In Africa ................................................... 28 2.7 The Critical Role of NGOs in Combating HIV/AIDS ............................................... 33 2.8 Conclusion ..................................................................................................................... 34 3.0 Public Administration Approaches to HIV/AIDS Service Delivery in Nigeria ............... 35 3.1 Introduction .................................................................................................................. 35 3.2 An Overview Of The Public Administration Literature........................................... 36 3.3 New Public Management ............................................................................................. 38 3.4 New Public Service ....................................................................................................... 41 3.5 New Public Management In Nigeria ........................................................................... 45 3.6 Integrating New Public Service In Evidence-Based Management ........................... 48 3.7 New Public Service As An Optimal Framework For Service Delivery ................... 49 3.8 Service Delivery Issues Affecting Organizations ....................................................... 51 vi 3.9 Reforming Service Delivery In Nigeria ...................................................................... 54 3.10 How NGOs Step In Amid Government Challenges ................................................ 56 3.11 Human Resource Management ................................................................................. 58 3.12 Human Resource Management (HRM) Performance In Africa ............................ 63 3.13 HIV/AIDS Funding .................................................................................................... 66 3.14 Conclusion ................................................................................................................... 72 4.0 Organizational Technology Applications to HIV/AIDS Service Delivery ....................... 74 4.1 Introduction .................................................................................................................. 74 4.2 Ethical Management And Organizational Technology ............................................. 74 4.3 Service Delivery Evidence From Stakeholders .......................................................... 81 4.4 Engagement Of Stakeholders ...................................................................................... 84 4.5 Hypothesis ..................................................................................................................... 90 4.6 Methodology .................................................................................................................. 91 4.7 Organizational Profiles ................................................................................................ 92 4.8 Findings ....................................................................................................................... 104 4.9 Results .......................................................................................................................... 111 4.10 Discussion .................................................................................................................. 120 4.11 Limitations ................................................................................................................ 122 4.12 Threats To Validity .................................................................................................. 123 4.13 Implications ............................................................................................................... 124 4.14 Conclusion ................................................................................................................. 126 5.0 Conclusion ........................................................................................................................... 129 Appendix A Organizations ....................................................................................................... 132 vii Appendix A.1 Correspondence & Informed Consent for Research Participation ..... 132 Appendix A.2 Informed Consent for Oral Interview ...................................................