A multi-theoretical perspective in understanding the governance of Mutual Health Organisations in the South-Kivu in Eastern DR Congo

In this article, we develop a comprehensive theoretical framework for understanding the issue of governance of MHOs in the context of South Kivu province in the DR Congo. Although there are theoretical and empirical studies on the governance of third sector organizations, few of them address the issue of MHOs governance; and even fewer focus on Africa in general and particularly the DRCongo. Many scholars approach this topic from a global perspective by considering a variety of Non-Profit Organizations (NPOs). An overview of the literature has been carried out, examining the importance of each theory of governance to understand the governance of MHOs. Our findings reveal that taken alone, none of the theoretical approaches used in the literature on governance can better explain the governance of MHOs. We suggest that the issue of governance should be rather viewed from a global perspective integrating the different theories of governance. Firstly, the stakeholder theory combined with the agency allows to identify different stakeholders or “principals” involved in the development of MHOs, who have different expectations and interests, including external partners (donors, NGOs, etc.), local partners or support structures, local communities(members), health care providers and the government. Second, the neo-institutional framework combined with the agency theory and the resource dependency theory explain the adoption of decoupling strategies by MHOs’ managers and local partners in order to maintain external donors’ fundings. This situation would be explained by social norms and values and a weak regulation of the sector. MHO’s managers would follow practices of their peers in other third-sector organisations like NGOs and Villages Savings and Loans Associations. This study contributes to the debate on NPOs governance by clearly defining the nature of the principal-agent relationship (common agency theory) within MHOs and by highlighting the adoption of decoupling strategies by MHOs managers.