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The need for agile and adaptable health systems to cope with disasters such as the COVID-19 pandemic is well established. Developing countries’ health systems are a mix of market, hierarchy, and collaborative arrangements. Collaborative arrangements are considered superior in responding to a crisis, but a comparative assessment of the three modes in the face of a crisis needs to be improved. Further, very little is known about the adaptation of collaborative arrangements that existed before the crisis, as extant research has primarily examined arrangements that emerged in the wake of the crisis. We assess the response of three governance modes to the COVID-19 pandemic in India. A mixed-method approach has been adopted: structured interviews with the domain experts, secondary data, and Twitter analytics framework. Both hierarchy and markets demonstrated adaptability, but market arrangements were mal-adapted to exploit the situation. Contrary to expectations, hierarchy arrangements responded with agility and delivered services substantially. Preexisting collaborative arrangements had limited adaptability due to non-convergence of expectations and reduced dependence, leading partners to choose alternative venues rather than engaging in bargaining and negotiation. The findings contribute to the limited literature on the comparative assessment of modes of governance and adaptability of preexisting collaborative arrangements.

Adaptability of Governance Arrangements in Response to COVID-19: Effectiveness of Hierarchy Market or Collaborative?