A Typology of Strategic Collective Decision-Making in Health NGOs

Abstract

Strategic collective decision-making in non-governmental organisations (NGOs) has been largely neglected by researchers, with limited attention given to how contextual conditions shape the unfolding of strategic decisions in practice. This paper examines decision-making in health NGOs operating under resource constraints, donor pressures, and governance complexity. The findings are drawn from a more extensive Straussian grounded theory study of five diverse South African health NGOs, in which data were collected through semi-structured interviews. The research identified three types of strategic collective decision-making: Simple, Conventional, and Onerous. This typology emerges from specific configurations of contextual factors, including funding uncertainty, stakeholder salience, governance structures, and information ambiguity, and reflects distinct patterns of strategic collective decision-making. Simple strategic collective decision-making is characterised by pragmatic coordination and moderate consultation in response to manageable strategic challenges. On the other hand, conventional strategic collective decision-making reflects routinised and historically embedded practices that provide organisational stability but may limit critical reflection. Finally, onerous strategic collective decision-making arises under conditions of high uncertainty and organisational risk, involving intensive collective deliberation, emotional engagement, and complex negotiation among strategic decision-makers. The findings demonstrate that strategic collective decision-making is a contextually contingent and negotiated organisational practice. NGOs move dynamically between the types as contextual pressures shift, with each type reflecting different levels of perceived risk, urgency, and organisational alignment. In this way, strategic collective decision-making is understood as an interactive process through which organisations continuously balance inclusivity, responsiveness, and sustainability. The paper therefore offers a contextually sensitive understanding of how strategic decisions are enacted in mission-driven organisations, and provides practical insights for NGO leaders, funders, and policymakers directly or indirectly involved in collective strategic decision-making under conditions of uncertainty, particularly in resource-constrained and donor-driven environments.