Thesis (Ph. D.)--Duke University, 2007.

There has during a rapid growth of third sector organizations (TSOs) in the third world during the 1990s. Such growth has occurred during a period of severe cutbacks in state investment as well as rapid globalization of trade. Social activists have often organized TSOs in these countries as an alternative to private and public organizations. However the question of how leaders and managers of these TSOs sustain their activities remains important. Their dilemma of help is the focus of this study. / Through a study of strategy formation in three third sector organizations in the third world, this study focuses on how TSOs can be sustainable yet effective change agents. It develops a typology of TSOs with particular attention to type of third sector activity (operating, support, community), type of organizational form (Grassroots initiatives, Grassroots Organizations, Grassroots Federations, Development Support Organizations and International Development Support Organizations) and dominant strategy approach (domain, distinctiveness, and design). This study argues that attention to these three aspects needs to be complemented by exploring the processes through which strategies form in these organizations. / Accordingly the strategy process in three TSOs in South India was examined, in particular the origin of the strategy, tactics of consensus, and interests of participants. Examining the strategy process in TSOs revealed that strategies originated in intent or event, promoters' consensus-tactics were conceived or improvised and participant's interests were fixed or shifting. / These findings on strategy process show varied origins, interests and consensus tactics in TSOs. They also seem to be associated with particular capacities in these organizations to perform their chosen activities, as well as with changes in mission. The study concludes with a discussion of the significance of these findings and a call for bridging the literatures on good management and effective social change, for further researching capacity building in TSOs, and encouraging initiatives for cross sector learning.

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All governments aim to ensure better health and nutrition to children. The Rajasthan state (India) has implemented a unique frontline coordination model where Accredited Health Social Activist (ASHA) Sahyoginis are expected to support two other frontline workers (FLWs) i.e. the Anganwadi Workers from the Integrated Child Development Services and the Auxiliary Nurse Midwives from the Health department to improve child health. This thesis focuses on examining the existing coordination between the three groups of FLWs in Rajasthan by exploring FLWs' participation in child immunisation and Vitamin A supplementation (two common activities), service coverage and beneficiary's' knowledge (expected outcomes), and the challenges faced and areas that need improvement for better frontline coordination. A mixed methods design was used. Sixteen villages from two blocks (tribal and non-tribal) of Udaipur district (Rajasthan) were selected using multistage purposive sampling. The formative stage included 12 FLWs' in-depth interviews (IDIs) as well as a review of FLWs' job descriptions to understand the process and government expectations on their participation in routine childhood immunisation, polio camps, routine Vitamin A supplementation and Vitamin A campaigns. The next stage included data collection from the 16 selected villages i.e. structured questionnaire survey of FLWs (46), observations of Maternal and Child Health and Nutrition Day (16), review of FLWs' immunisation and Vitamin A registers (32) and a structured questionnaire survey of registered infants' mothers (321)-all to ascertain the actual participation of FLWs in these four activities and the outcomes. IDIs with FLWs (46) and FLWs' line managers (17) were conducted to understand their experience, issues and solutions for better frontline coordination. The participation of FLWs in three of the four activities (except Polio Camps) was found to be limited. The FLWs and their line managers were also dissatisfied with coordination between FLWs. Poor outcomes also indicated unsatisfactory coordination. Overall, frontline participation and outcomes were better in tribal than non-tribal villages. A variety of factors (i.e. personal, professional, organisational, and geo-socio-cultural) appeared to affect coordination between FLWs. Appropriate recruitment, training, monitoring and supervision and rewards to the FLWs along with greater political commitment for coordinated approached and addressing intra-departmental challenges are proposed to improve frontline coordination and child health in Rajasthan.