Strategic Management of Public Health Organizations in Nigeria: Governance, Performance, and Accountability Frameworks

This dissertation develops a comprehensive theoretical and empirical account of strategic management practices in Nigerian public health organizations, with particular focus on governance quality, organizational performance, and accountability framework design. Public health organizations in Nigeria operate at the intersection of government resource constraints, population health emergencies, and international development pressures, creating complex strategic management environments. Strategic management in public organizations theory, governance theory, and performance management literature provide the theoretical scaffolding. The research employs a multi-strategy design combining institutional ethnography at five Nigerian tertiary health institutions with a quantitative survey of 280 health organization managers from all six geopolitical zones. Structural equation modelling tested the hypothesized governance-performance relationships, while ethnographic findings provided explanatory depth. Findings reveal that governance quality, specifically board strategic competency, management autonomy from political interference, and accountability system credibility, mediates the relationship between resource availability and organizational performance in Nigerian public health organizations. The study identifies dual accountability failure, where organizations are simultaneously over-accountable to political principals and under-accountable to patient populations, as a systemic strategic management pathology unique to the Nigerian public health context. The dissertation advances strategic management in public organizations theory through the development of the Contextual Accountability-Performance Framework and provides policy-relevant recommendations for Nigerian health system reform. Keywords: public health organizations, strategic management, governance, accountability, Nigeria.