Organizational barriers to addressing climate-sensitive diseases in the Global South: A case study of Peru’s dengue response

To address infectious diseases such as dengue, the World Health organization advocates a 'whole-of-government' approach that promotes coordination across all levels of government within the health sector and across related sectors. Yet not all health systems have the organizational arrangements needed to facilitate such coordination. This paper examines Peru's dengue control program to investigate how the organization of the health system shapes the government's capacity to respond to public health threats. Drawing on the sociology of organizations and qualitative analysis, the study examines how decentralization and performance-based management-legacies of adopting New Public Management (NPM) principles and neoliberal reforms in the 1990s and early 2000s-shape the organizational culture and design of Peru's health system. The findings identify several barriers to coordination across government levels and policy sectors. These include cultural factors such as context-blind universalism and organizational environments that discourage public-sector entrepreneurship, as well as organizational design features such as fragmented data systems, a lack of incentives to pursue a public health career, and rigid performance-based budgeting. Together, these factors limit coordination within the health sector and hinder intersectoral collaboration. The study proposes that improving the government's capacity to respond to health threats requires integrating whole-of-government principles into existing NPM arrangements to strengthen both hierarchical and horizontal coordination.