Dissertation
From Deficit Analysis to Adaptive Capacity: An Organizational-Theory Approach to Health System Resilience in Nigeria
Abstract: Nigeria contained Ebola within 93 days and later organized a national COVID-19 response, despite having fewer than half the health workers the World Health Organization considers necessary for essential services. This dissertation asks how that capacity was built, tracing Nigeria's health system across Ebola in 2014, Lassa fever in 2018, and COVID-19 from 2020 to 2021.
The study develops the Crisis-Induced Adaptive Capacity framework, which explains adaptation through capability reconfiguration, reliability-seeking behavior, and institutionalized learning. It uses process tracing across documentary evidence and a composite index of twenty indicators measured at four points in time, from a 2013 baseline through the COVID-19 period.
Capacity developed iteratively rather than through advance preparation or added resources. Personnel, coordination routines, and data systems built for polio eradication were redirected to new crisis functions. After-action reviews became more structured and assigned clearer timelines and responsibility. Effective practices were then written into standard operating procedures, training, surveillance systems, and law. The composite index rose from 0.02 at baseline to 1.00 during COVID-19, and the trajectory held under alternative weightings. Distributed and dual-use assets, such as laboratory networks and trained reserve personnel, proved more sustainable than emergency assets that sat idle between crises. Growth remained uneven across federal and state institutions.
Repeated crises do not by themselves produce stronger systems. Crisis experience becomes adaptive capacity only when institutions review their performance, reorganize available assets, and preserve effective changes.
Published
Giwa, A. (2025), The Social Paradox of Women's Autonomy and Child Mortality in Tanzania: A Multi-Level Analysis with Policy Implications. Sociological Inquiry. https://doi.org/10.1111/soin.70019
Mirzaei, S., Giwa, A., & Bar, E. (2025). Missing from the Curriculum: A Content Analysis of Labor Politics in International Relations Textbooks. Journal of Political Science Education, 1–23. https://doi.org/10.1080/15512169.2025.2553335
Giwa, A., Ngakam, J., Mirzaei, S. and Ikuomola, A.D. (2025), Emerging Dependencies: GCC States and Sub-Saharan African Healthcare Labor Migration Through World Systems Theory. World Medical & Health Policy. https://doi.org/10.1002/wmh3.70037 (theoretical)
Giwa, A. (2025), Trust as Foundation: Can Nigeria's New Health Workforce Policy Stem the Migration Tide?. International Journal of Health Planning and Management, 40: 494-498. https://doi.org/10.1002/hpm.3879 (perspective)
Under review/revise and resubmit
Giwa A., The Capability Conversion Problem: Why Resource Mobilization Fails to Strengthen Health Systems in Low-Resource Settings
Public Facing
Giwa, A. (2025). Attacks on Women’s Bodies Reveal the Logic of Genocide in Sudan: Sexual violence and the destruction of medical infrastructure are not separate catastrophes. The New School’s Public Seminar. Link
Mirzaei, S., Bar, E., & Giwa, A. (2025). Textbook Analysis Guide and Exercise for Undergraduate Methods Courses. APSA Educate. Link.