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The policy making approaches, social policy agendas and instruments deployed by large, Western philanthropic donors - referred to as big philanthropies in this study - have tangible consequences for the institutions, mechanisms and processes of social policy formation and social policy delivery across the Global South. Over the past decade, big philanthropies have also become increasingly integrated and influential actors in the processes and structures of global social governance. Given their significance in shaping global social policy trends as well as aid architecture and welfare outcomes in the Global South, this research seeks to contribute to a better understanding of the social policy approaches deployed and promoted by contemporary philanthropic donors, as well as the theoretical frameworks that explain them. This doctoral thesis examines these issues through a qualitative case study of the Bill and Melinda Gates Foundation's work in the health sector in Tanzania. Two primary research interests guide the analysis: (i) understanding whether the ideologies, policy goals and instruments promoted by big philanthropies represent a coherent and distinctive global social policy paradigm; and, (ii) identifying the sources of authority and strategies deployed by the Gates Foundation to instigate transnational social policy transfer. The research also explores the perspectives of a wide range of stakeholders on the comparative advantages and potential risks of social policy delivery by big philanthropies in a development context. Crucially, in addition to interviews with representatives of the Gates Foundation itself, the study examines the views and experiences of the government and civil society actors on the ground in Tanzania. The analysis is primarily guided by: Peter Hall's theory of policy paradigms; policy transfer analytical frameworks; and Global Social Policy theory. The findings of the thesis suggest that big philanthropies are significant policy actors and operate within a coherent social policy model. Underpinned by the view that poor populations lack the necessary assets to fully realise their economic capacity, the model constitutes an instrumental 'social investment' approach. It is primarily focused on strengthening individual capacity in order to spur employment, productivity and economic growth, in contrast to approaches that pursue social justice or social equality through universal welfare systems. It is also differentiated from other paradigms by its emphasis on private sector methods and targeted vertical interventions (focusing on specific diseases or targets as opposed to broader system-wide objectives) that prioritise innovation, use of data and technology. The overall method is analogous to Third Way models - driven by short-term pragmatism rather than dogma, and promoting social policy approaches that integrate private, public and third sector actors. The analysis also shows that big philanthropies have unique forms of normative and epistemic authority, derived from the legitimacy of altruism, celebrity status, up-to-date scientific knowledge and private sector expertise. Combined with extensive access to different cross-sectoral networks, these characteristics enhance their policy influence as global policy entrepreneurs. The evidence also demonstrates that the Gates Foundation's policy transfer strategies combine high visibility policy promotion, covert influence notably through local policy intermediaries, and subtle financial pressure through 'soft conditionalities'. Local stakeholder perspectives pointed to several risks and caveats associated with the involvement of big philanthropies, and the Gates Foundation specifically. These included the omission of national policy plans and priorities, exacerbation of fragmentation of development efforts, and friction with the domestic policy environment - potentially leading to inappropriate policy transfer. This thesis underscores the fact that external actors - including Western big philanthropies - continue to influence social policy directions in the Global South and that this renders their involvement problematic. The study also demonstrates the robustness of policy transfer frameworks in explaining this phenomenon and shows that social policy ideas and approaches travel transnationally both through epistemic-hegemonic influences and hard mechanisms drawing on financial pressure.

Background: In recent years cash transfer programs have increasingly become the strategy of choice for poverty alleviation in middle and low income countries. Several child cash transfer programs have been implemented in middle and low-income regions such as Latin America, Asia, and Africa, and many of them have been found to be effective in improving child outcomes. South Africa's child support grant (CSG) constitutes the largest cash transfer programme in the country and the continent. Even though evidence exists which shows that the CSG is associated with improved child outcomes,less research has gone into examining how the different aspects of the grant all work together to facilitate or limit it as a policy instrument for child poverty reduction. Such evidence is important in facilitating an understanding of the capacity of the CSG as a poverty alleviation strategy in a developing country context. Methods: This dissertation utilises a mixed-methods approach to explore: 1) barriers to CSG take up; 2) the adequacy of the CSG in supporting its recipients; 3) participants' views on current topical issues surrounding the CSG. Results: Despite evidence that the CSG is important in tackling child poverty, this dissertation found that the grant is not without its shortcomings as a poverty alleviation instrument. The limitations of the grant are influenced by the policy environment, operations, institutions working alongside the CSG, and the social context in which the grant is implemented. Conclusion: The findings raise important questions about the capacity of cash transfers to make a significant difference in the lives of poor children and their families if they are neither substantial nor linked to other poverty measures in developing country contexts. The policy recommendations that have been made can strengthen theChild Support Grant's potential to lift children out of poverty in South Africa.

Health is deemed central to a nation’s development. Accordingly, health care reform and expansion are key policy priorities in developing countries. Many such nations are now testing various methods of funding and delivering health care to local disadvantaged populations. Similarly, India launched the Rashtriya Swasthya Bima Yojana (RSBY) national health insurance programme for low-income groups in 2008. The RSBY intends preventing catastrophic health-related expenditure by improving recipients’ access to hospital-based care. This thesis is an in-depth qualitative evaluation of the RSBY in Delhi state. It examines the RSBY’s effectiveness in fulfilling its goals and meeting local health care needs. Walt and Gilson’s (1994) actors-content-process-context model informs the research design and an actor-centred “responsive” (Stake 1975) or “constructivist” approach guides data analysis. Three research questions are examined: (i). Why was a health insurance programme launched and why now? Why was this model favoured over alternate methods of service expansion? (ii). Is the RSBY delivered as intended? If not, why? (iii) How does the RSBY affect patients’ access to services? The findings are based on documentary sources, observation of implementation sites and activities and 164 semi-structured interviews with RSBY policymakers, insurers, NGOs, doctors, and patients. The results show improved access to curative and surgical care for RSBY patients. However, RSBY’s focus on hospitalisation and omission of primary and outpatient services had undesired negative effects. The lack of ambulatory facilities led RSBY patients to self-medicate or use dubious quality informal providers. By only allowing inpatient care, the RSBY also seemingly encouraged the substitution of outpatient care with costlier hospitalisations. In effect, the RSBY’s design contributed to cost increases and poor patient outcomes. While more funds and human resources were needed to improve RSBY implementation, the performance of frontline agencies could potentially improve through more stable, longer-term contracts. Similarly, modifying RSBY’s monetary incentives for doctors may lead to better service delivery by them. By evaluating the RSBY’s strong points and shortcomings, this thesis provides key lessons on strengthening policy design and health service delivery in developing countries. Thereby, it makes a broader contribution to understanding the determinants of successful policymaking.