Informe especial / Special report

Regional integration and south–south cooperation in health in and the Caribbean

Alejandra Carrillo Roa1 and José Paranaguá de Santana 2

Suggested citation Carrillo Roa A, Santana JP. Regional integration and south–south cooperation in health in Latin America and the Caribbean. Rev Panam Salud Publica. 2012;32(5):368–75.

abstract This paper analyzes whether south–south cooperation is legitimately a recent practice or merely an improved version of previous regional integration processes in Latin America and the Caribbean. The authors reviewed and systematized the historic development of subregional integration processes in Latin America and the Caribbean and focused on health cooperation in the following contexts: the Central American Integration System, the of Nations, the , the Amazon Cooperation Treaty Organization, the Southern Common Market, and the Union of South American Nations. The study concludes that the conceptual and methodologic foundations of south–south cooperation in health were born from and nurtured by the processes of regional integration in Latin America and the Caribbean. This paper posits that regional political and economic integration initiatives bring potential benefits to the health sector and act as an important mechanism to develop south–south cooperation in this domain. The study recommends furthering this type of research to provide information that will allow national and multilateral agencies, or other stakeholders, to formulate and implement better policies for international health cooperation that target reducing inequities and promoting health and well- being for all people.

Key words International cooperation; technical cooperation; horizontal cooperation; Latin America.

South–south cooperation (SSC) has ac- (UN) to the millennium of international aid and technical coop- quired a progressively relevant position development goals, of which three are eration (1). on the agendas of Latin America and the directly linked to health and the other SSC appears as an innovation or trans- Caribbean (LAC) subregional blocs as a five are correlated. formation of international cooperation strategy for development. A strong argu- At the same time, failure to reduce eco- (2) in the midst of a process of changes ment to establish health as a priority in nomic and social inequalities between occurring in international relations cooperation emerges from the commit- developed countries, mostly located in where global southern countries plan ment made by member countries of the the north, and developing nations, in the to build cooperation projects, including south, discredits the effectiveness of tra- with support of the wealthiest countries 1 Center for Bioethics and Health Diplomacy ditional cooperation models, identified and mediation of the UN, but truly fit- Studies, Campus Universitário Darcy Ribeiro, as north–south cooperation (NSC). The ting in the designs of their own devel- Brasilia, . Send correspondence to: Alejandra Carrillo Roa, [email protected] fact that developing countries continue opment (3). Such innovations in health 2 Organização Pan-Americana da Saúde, Representa- to be called such shows a lack of mean- care are being heralded as a paradigm ção no Brasil, Brasília, Brazil. ingful development in spite of decades of cooperation. For instance, the Bra-

368 Rev Panam Salud Publica 32(5), 2012 Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean Special report zilian structuring approach to health during the UN Conference of Septem- donor countries in technical cooperation cooperation states that, compared with ber 1978, introduced the term “technical is that they are able to draw on their own previous paradigms, this new paradigm cooperation between developing coun- experiences that more closely resemble innovates in two respects: it includes the tries” and recognized that, in addition program country contexts than those of training of human resources, organiza- to being recipients, developing countries northern donors” (18). They strive for tional strengthening, and institutional were becoming cooperation donors (5). recognition in the international arena development and it breaks with the tra- Although expectations were high, hopes with a renewed discourse of opposition ditional passive transfer of knowledge were dashed after the meeting in Buenos to the prevailing world order (19, 20). and technologies (4). Aires. The oil crises of the 1970s sub- Despite difficulties in defining the SSC, Undoubtedly, SSC brings fresh impe- stantially increased international interest there is a consensus on its governing tus to international cooperation. How- rates and adversely affected developing principles: solidarity and equal relation- ever, it is worth asking whether it is le- countries already floundering in foreign ships, reciprocal benefits, respect for na- gitimately a recent practice and whether debt and high inflation. The effects of the tional sovereignty, shared responsibility, the new paradigms are truly innovative debt crisis of the 1980s and estrangement noninterference, nonintervention, self- or merely enhanced editions of previous of the nonaligned integration movement determination, and independence. SSC regional integration processes in LAC. induced developing countries to seek admits that it complements rather than This paper aims to answer that ques- individual negotiations with wealthy substitutes for NSC (20), although its tion by reviewing and systematizing the countries. In the 1980s and early 1990s, origins are based on opposition to tradi- historic development of subregional in- structural adjustment programs based tional practices of cooperation (3, 4). tegration processes in LAC and focusing on neoliberal principles occupied the Some authors list the following ad- on health cooperation in the following center of economic and political for- vantages of SSC: greater flexibility for contexts: the Central American Integra- mulations as well as international co- transferring good practices; better ad- tion System, the Andean Community operation (4). The excessive conditions aptation of cooperation initiatives to of Nations (CAN), the Caribbean Com- required by donors made it difficult for recipient needs; horizontal cooperation; munity (CARICOM), the Amazon Coop- recipient countries to appropriate aid. less or no conditionality linked to as- eration Treaty Organization (ACTO), the Numerous studies have shown that sistance; reduced economic cost of ini- Southern Common Market (MERCO- aid priorities were correlated not to the tiatives; swift and direct impact on the SUR), and the Union of South American needs of recipient countries but to the beneficiary population; preservation of Nations (UNASUR). Although NSC is needs of donors (6–12). Many traditional local cultural diversity and identity; and recognizably an important reference in practices of cooperation sought to export increased use of local resources, which this debate, comparing NSC with SSC is local products, services, and capital; to generates an increased sense of owner- beyond the scope of this study. secure access to strategic materials; and ship (2, 6, 15). These issues are contro- A brief historic review of SSC is in- to obtain political privilege (13, 14). Fur- versial, as the same authors and others troduced, given its importance in con- thermore, a lot of foreign aid has been also list SSC limitations that partially co- structing the proposed narrative. Then characterized by volatility, unequal and incide with the ills of NSC: fragmented the historic development of health coop- inequitable patterns of distribution, con- assistance and coordination problems eration within LAC regional integration tingency on all donor interests, and lack among donors, lack of accessible and processes is presented. Finally, certain of responsibility or accountability (15). understandable information, financing elements of such processes that eventu- Consequently, the perceived failure of difficulties, not necessarily aligned with ally became core characteristics of SSC structural adjustment programs embed- development strategies of the recipient, are highlighted. ded in a number of traditional Official and little impact assessment culture (2, Development Assistance programs be- 6, 15, 18). SOUTH–SOUTH COOPERATION came widespread during the late 1980s Even if one considers horizontal re- and the 1990s, which led the UN to lations as a distinctive aspect of SSC, The meaning of SSC dates back to the develop an alternative for promoting it would be naïve to ignore specific emergence of southern consciousness development that took social, environ- foreign policy interests, even among na- (2).3 The Bandung Conference in 1955, mental, and human rights concerns into tions of the south (3, 21). In short, SSC is the Nonaligned Movement in 1961, and account. Thus, the processes of regional a concept with ideologic, political, and the Group of 77 in 1964 were the first po- integration regained momentum and technical hues that is innovating inter- litical dialogues between southern coun- provided a basis for SSC, which has national cooperation for development tries to promote shared interests and to been propelled both by the impulse of but whose operation has not fully pulled strengthen their negotiating capacity in emerging countries and by the fatigue of away from the paradigm of traditional the unequal international system estab- traditional donors (15). NSC. lished after World War II. As the leading actors in SSC, emerging The Buenos Aires Plan of Action, ap- countries rely on traditional diplomatic REGIONAL INTEGRATION AND proved by delegates from 138 countries schemes but conduct them in ways that SOUTH–SOUTH COOPERATION contrast with NSC, as they focus on IN HEALTH 3 Southern consciousness can be defined as having the exchange of experiences, knowledge, occurred when developing countries, identified and techniques adjusted to the realities In the past four decades, LAC countries as the south, recognized their common identities and challenges and realized the need to join forces of other southern countries (16, 17). “In have identified challenging health prob- against international system asymmetries. fact, one major advantage of southern lems they have in common and have ad-

Rev Panam Salud Publica 32(5), 2012 369 Special report Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean

Figure 1. Timeline of regional integration and south–south cooperation in health in Latin America and the Caribbean Initial Experience Phase Crisis and Innovation Phase Institutional Reorganization Phase Regional Strengthening Phase

2002 Regional plan for prevention and control of chronic noncommunicable disease

opted cooperation as a means to address health field were CAN, CARICOM, and oping countries and approval of the 1978 them more effectively. Taking into con- ACTO.4 Buenos Aires Plan of Action. sideration the peculiarities of each sub- The Andean Pact, now CAN, emerged The Caribbean Community was es- region while avoiding the reductionism as subregional protectionism in response tablished in 1973 by the Treaty of Cha- of interpretation, this exploratory study to the unsuccessful attempt of the Latin guaramas. This region has a long his- briefly presents the history of health co- American Free Trade Association to tory of health cooperation. Even before operation as it developed at the core of form a free trade area in Latin America CARICOM, the region had established subregional integration processes. (22). Although the bloc’s primary em- several cooperative health activities; Four historic phases, named according phasis was on economic and trade inte- among them, the Medical School of the to the general characteristics of health gration, the agreement included social University of the West Indies started in integration processes experienced in dif- integration and cooperation (23). This 1948 under the auspices of the Univer- ferent LAC subregions, are proposed: ini- agreement resulted in the Hipólito Un- sity of London, the Caribbean Food and tial experiences (1970–1980), crisis and anue Agreement on Health Cooperation Nutrition Institute in 1967, the Medi- innovation (1980–1990), institutional re- between Andean Countries, signed in cal Research Council of the Caribbean organization (1990–2000), and regional 1971 (24). It is the first formal initiative of Community in 1972, and the Caribbean strengthening (2000–2010). Figure 1 and subregional health cooperation in Latin Epidemiology Center in 1974. Creation Table 1 summarize these phases, as de- America, ahead of the 1972 special unit of the Medical School of the University tailed below. for technical cooperation between devel- of the West Indies signaled that Antil- lean governments recognized how lo- Initial experiences 4 The Organization of Central American States, now cally trained physicians were best fit to Central American Integration System, although address regional health issues (25). founded in 1951 through the Charter of San Salva- The first subregional blocs in Latin dor, did not sign a specific agreement in the field of The Amazon Cooperation Treaty America to implement initiatives in the health until the 1980s. (ACT), signed in July 1978, included pro-

370 Rev Panam Salud Publica 32(5), 2012 Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean Special report

TABLE 1. Summary of south–south cooperation initiatives in health in subregional blocs in Latin America and the Caribbean

Subregional bloc: Integrative initiatives in Health political body: country, year of health: country, year of Goals of initiatives in country, year of Relevant health documents: establishment Member countries establishment health establishment country, year of adoption Central American Belize, , El Central American Health Use health as a bridge Central American Health Declaration of Montelimar: Integration System: , , Initiative: Costa Rica, to peace by identifying Ministers’ Council: , 1990 Salvador, 1951 , Nicaragua, 1984 common problems and Honduras, 1991 Declaration of Belize: and Plan of Immediate jointly solving them. Belize, 1990 Actions in Health Declaration of Tegucigalpa: in : Honduras, 1991 Honduras, 1995 Health Agenda of Central America and the Dominican Republic 2009–2018: Honduras, 2009 Andean Community of , , Hipólito Unanue Strengthen national and Health Ministers’ Cartagena de Indias Nations: Colombia, 1969 , and Agreement on subregional capacity in Council: country not Manifest: Colombia, 1989 Cooperation on Health health through better use available, 1972 Protocol of Trujillo: Peru, in the Andean Area of technical resources 1996 Countries: Peru, 1971 and autochthonous Integrated Social Andean Cooperation in institutions. Development Plan: United Health: of States of America, 2004 America, 1987 Caribbean Community: Antigua and Barbuda, Caribbean Cooperation Share knowledge and Council for Human and Declaration on Health for Trinidad and Tobago, Bahamas, Barbados, in Health: country not experiences with other Social Development: the Caribbean Community: 1973 Belize, Dominica, available, 1984 Caribbean countries, , 2001 Saint Lucia, 1982 Grenada, Guyana, Haiti, Pan Caribbean mainly in treatment of Revised Chaguaramas Jamaica, Montserrat, Partnership similar problems. Treaty: Trinidad and Saint Lucia, Saint Kitts Against Human Tobago, 2001 and Nevis, Saint Vincent Immunodeficiency Nassau Declaration: and the Grenadines, Virus–Acquired Immune Bahamas, 2001 Surinam, and Trinidad Deficiency Syndrome: Port of Spain Declaration: and Tobago Barbados, 2001 Trinidad and Tobago, 2007 Regional Initiative for Human Immunodeficiency Virus- and Syphilis-Free Generations: United States of America, 2009 Amazon Cooperation Bolivia, Brazil, Colombia, Pan Amazonian Network Support strengthening Special Commission of Santiago de Cali Treaty Organization Ecuador, Guyana, Peru, of Science, Technology of national and regional the Amazon Region on Declaration: Colombia, (ACTO): Brazil, 1978 Surinam, and and Innovation in Health: capacity for studies, Health: Brazil, 1988 1983 Brazil, 2007 technology, and Manaus Declaration: Brazil, innovation in health 2004 to improve health ACTO Strategic Plan: conditions of the country not available, 2004 Amazonian population. Southern Common , Brazil, Health Sub-Working Harmonize legislation Meeting of health Protocol of Ouro Preto: Market (): , and Group 11: Brazil, 1996 in member states with ministers of Brazil, 1994 Paraguay, 1991 regard to health goods, MERCOSUR: country Minimum matrix of services, and raw not available, 1995 professional exercise: materials and products; Brazil, 2004 aim to promote and Harmonization of goals protect health and life of for tobacco control in population and eliminate MERCOSUR: Brazil, 2006 obstacles to regional trade. Union of South American Argentina, Bolivia, UNASUR Health: Brazil, Improve quality of Health Ministers’ Five-Year Plan 2010– Nations (UNASUR): Brazil, , Colombia, 2008 South America’s Council: Brazil, 2009 2015—South American Brazil, 2008 Ecuador, Guyana, South American Institute health governance by Health: Ecuador, 2010 Paraguay, Peru, of Health Governance: training leaders, using Surinam, Uruguay, and Brazil, 2011 knowledge management, Venezuela and providing technical support to health care systems.

posals for promoting and coordinating Crisis and innovation tion processes among Latin American international actions not only in health countries, which were required to fol- care but also with regard to scientific and The regional and world economic low the guidelines and priorities set by technological research in this field (26). crisis of 1980 weakened the coopera- international financial institutions. This

Rev Panam Salud Publica 32(5), 2012 371 Special report Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean situation caused breaks in cooperation appropriately focused on areas critical A related process begun 11 years earlier processes begun earlier, undermining to improving regional health and that culminated in December 2002 when the the incipient institutional structures of the initiative was beneficial to Carib- permanent secretariat of ACTO was cre- country blocs. bean countries. Thus, in 1996, the second ated. This brief historic review shows the Worsening poverty, inequality, and phase of the Caribbean Cooperation in prominence of health in the context of social exclusion that resulted from the Health for the period 1997–2001 was ap- international institutions in the Amazon crisis spurred new forms of interaction proved (31). region. that corresponded to the resource short- CAN had a similar experience in 1987 The Andean region has also under- ages in the region, expanding interna- with the Andean Cooperation in Health, gone institutional reform, sealed in 1996 tional cooperation into a crisis reaction which aimed to reduce marginalization with the Protocol of Trujillo, which sub- strategy. Competition for these scarce of the Andean population by identi- stituted the Andean Pact with the An- resources intensified the search for inter- fying key common problems and rec- dean Community and created the An- national assistance and fed the trend to ommending use of regional resources dean Integration System. The Hipólito modernize cooperation practices. and expertise. The cooperation seeks Unanue Agreement was attached to the The experience of the Central Ameri- to strengthen national and subregional Andean Integration System, and the can Integration System clearly demon- capacity in health through better use of name Andean Health Organization was strates this trend. The precarious eco- technical resources and autochthonous added to the original agreement (24). nomic, political, and social conditions institutions. Institutionalization of the Furthermore, the Andean Foreign Min- that surrounded the Central American process implies that, as countries seize isters Council joined the new Andean In- region in the 1980s were worsened by the plan, greater participation of institu- tegration System, facilitating discussions armed conflicts in Honduras, El Sal- tions is achieved (32). of health problems within the foreign vador, and Nicaragua. In this context, policy framework of the bloc (34). This under the guidance of the Pan Ameri- Institutional reorganization new institutional architecture had im- can Health Organization (PAHO), the portant implications for the convergence Health Priority Needs Plan for Central The distinctive feature of this phase, of foreign policies and health policies America and Panama, then called the conventionally begun in 1990, is the of member countries and the bloc as a Central American Health Initiative, was legal and institutional reorganization of whole. A concrete result of this institu- approved and endorsed in 1984. The subregional blocs. In some cases, this tional reconfiguration was the Integrated driving force was that health would reorganization resulted from new roles Social Development Plan, approved in serve as a bridge for peace as common assumed by heads of state in integration 2004 (35). problems were identified and countries policies. In other cases, new political The last Latin American subregional solved them together (27). The plan and institutional bodies gave greater re- bloc established in the 20th century was presented to the countries of the sponsibilities to ministers of health and was MERCOSUR, created by the Treaty Contadora Group (Colombia, , foreign affairs. Together, they expressed of Asunción in 1991. Several authors Panama, and Venezuela) and other in- the institutional strengthening of health argue that MERCOSUR is essentially ternational forums, including the World issues in the political agendas of LAC an economic and trade bloc and that Health Assembly in 1984, urging in- communities. the lack of social characteristics dif- ternational assistance to develop the The first act in this historic sequence ferentiates it from other regional blocs initiative. In fact, most national and was creation of the Council of Cen- (36, 37). Its initial structure did not two-thirds of subregional projects were tral American Health Ministers in 1991. include any social areas, much less wholly or partly executed in the follow- The new Central American Integration health. Nevertheless, the dynamics of ing years (28). In 1990, inspired by these System was then established with the integration made it necessary to include promising results, the second phase of Declaration of Tegucigalpa. According these fields, which was done in De- the Central American Health Initiative to the Central American Court of Justice, cember 1994 with the Protocol of Ouro was presented with the motto Health the declaration became the constituent Preto, which created the Joint Parlia- and Peace for Development and Democ- treaty of greater hierarchy in Central mentary Commission and the Economic racy in Central America (29, 30). American integration, reconfiguring it as and Social Advisory Forum within the The experience acquired in Central a legally organized region (33).5 institutional structure of MERCOSUR. America led PAHO to propose the Ca- Institutional reorganization in the Another relevant measure was adopted ribbean Cooperation in Health in 1984, Amazon region has evolved more in 1995 with creation of the Meeting which sought to foster intercountry co- slowly. The initial relevant act in the of Health Ministers of MERCOSUR. In operation and to strengthen health sys- health field occurred in 1987 with cre- 1996, the Common Market Group en- tems. This initiative gained international ation of the sectoral coordinating body recognition as an innovative mechanism of the Amazon Cooperation Council: 5 According to the International Court of Justice in for health development, which suc- the Special Commission of the Amazon the Advisory Opinion on the Legality of the Use by a State of Nuclear Weapons in Armed Conflict, con- ceeded in obtaining US$31 million in Region on Health, responsible for en- stituent treaties are multilateral treaties that allow external funding in June 1990 (25). An couraging, coordinating, and supervis- for secondary supranational delegations and create subjects of law endowed with certain autonomy to assessment of the initiative in 1992–1994 ing implementation of regional health which the parties entrust the task of realizing com- verified that its priorities and activities programs undertaken by the treaty (26). mon goals.

372 Rev Panam Salud Publica 32(5), 2012 Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean Special report dorsed the Health Sub-Working Group strategic objectives within the framework toric and multidimensional construction 11 (SGT-11) as a deliberative technical of the millennium development goals. of a concept. This exploratory study body with the goal of harmonizing In addition to this range of experi- strengthens the notion that the concep- the laws of member states in terms ences in health cooperation in the con- tual and methodologic foundations of of health goods, services, raw materi- text of regional integration, another bloc SSC in health were born from the pro- als, and products as well as adopting of Latin American countries was set cesses of regional integration in LAC criteria for epidemiologic and sanitary up in the new millennium: UNASUR. and have since been nurtured by them. surveillance. Therefore, health has be- The concept was to create a space for Many elements of the so-called new come part of the diplomatic context of cultural, social, economic, and political paradigm of SSC—such as the exchange MERCOSUR, albeit under the aegis of integration among the people, giving of good practices, the building of na- an economic and trade framework. priority to social policies (40). The South tional and regional capacity by strength- American Health Council was created ening autochthonous institutions, and Regional strengthening at the first meeting of heads of state and the training of local human resources— government, held in Brazil in December developed as regional integration pro- The final phase began when the Mil- 2008, and the first Constituent Meeting cesses evolved. lennium Declaration of the UN trig- of the South American Health Council It is postulated that regional politi- gered a set of global commitments trans- took place in April 2009. At these meet- cal and economic integration initiatives lated into targets related to millennium ings, important decisions were made, not only reduce economic and non- development goals. These commitments such as approval of the health agenda economic transaction barriers but also turned into policies within the sub- and other recommendations. Over the bring potential benefits to the health regional blocs and increased the de- next 2 years, five working groups,7 an sector, hence becoming an important mand for health cooperation, given its equal number of structuring institution development mechanism for SSC. For preponderance in all the goals. As a networks, and the South American Insti- example, regional integration agree- result, this phase is characterized by the tute of Health Governance were estab- ments can benefit member states by proliferation of international coopera- lished. In the words of Buss and Ferreira providing economies of scale in the pro- tion processes in health with objectives (41), “this large intergovernmental array curement of drugs and vaccines; allow- and goals based on global commitments called UNASUR Salud is a great example ing for seamless health care reforms in but with strategies and operations that of ‘South–South cooperation’ and ‘health individual countries, despite frequent increasingly depended on regional diplomacy’ which the South American changes in leadership, because of re- initiatives. countries and their Ministries of External gional commitments that bind them Within CARICOM, the Regional Plan Relations and Ministers of Health offer together; facilitating the exchange of for the Prevention and Control of Non- the world.” good practices because of better un- Communicable Chronic Diseases, ap- derstanding and adaptation to local proved by heads of state in 2002, has CONCLUSION contexts; and providing mechanisms become the core priority of the Third for joint action on cross-border issues, Phase of the Caribbean Cooperation in The development of subregional in- such as floods, droughts, and disease Health Initiative (38). MERCOSUR inter- tegration processes shows that all LAC outbreaks. In short, regional integra- governmental health commissions have blocs, to a greater or lesser extent, in- tion agreements allow member states to promoted and approved plans, strate- cluded health in their general objectives tackle health issues in ways they could gies, policies, and regulations in several and established political and institutional not do on their own because of technical areas, such as dengue control in 2004, bodies dedicated to this field. ­Despite and financial limitations. access to antiretroviral drugs in 2004, drawbacks inherent in integration pro- Many questions remain unanswered. reduced mother-to-child transmission of cesses, LAC countries have for four de- How do these historic actions relate to HIV and congenital syphilis in 2004, cades practiced a type of health coopera- the present context of World Health Or- tobacco control in 2003–2005, and sexual tion that fits perfectly with the term that ganization policies or the Global Fund? and reproductive health in 2005.6 has been considered a novelty: SSC. Has cooperation in the health domain Progress at the political level was noted One cannot deny the innovative char- been stronger than in other fields? How at ACTO in 2004, with the approval of its acter of this “new” meaning as the his- can the benefits and limitations of south– strategic plan for 2004–2012 (39). How- south cooperation be objectively evalu- ever, slowness and inertia have persisted, ated? Furthering this line of research as observed in the Amazon Health Plan 6 Regional coordination has been established at would not only be appropriate but could 2007–2012 announced in 2006, which has broader international forums, such as adoption provide critical input for national and of common positions on issues like international produced no results. The Health Agenda health regulations and the declaration of South multilateral agencies, or other stakehold- of Central America and the Dominican American health ministers on health, innovation, ers, enabling them to formulate and im- Republic 2009–2018, approved in 2009, and intellectual property. plement better policies for international 7 The topics of the five working groups are: South contains policy guidelines and priorities American network of health surveillance and re- health cooperation that are targeted at for investment in the region and seeks sponse, development of universal health systems, reducing inequities and promoting the universal access to medicine, health promotion and effective harmonization and alignment of action on the determinants of health, and develop- health and the well-being of all people external cooperation in terms of regional ment and management of human resources for health. through all means.

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374 Rev Panam Salud Publica 32(5), 2012 Carrillo Roa and Santana • South–south cooperation in health in Latin America and the Caribbean Special report

Suramericanas. Quito: Comunidad Andina, 41. Buss P, Ferreira R. Health diplomacy and Secretaría General; 2008. Available from: south–south cooperation: the experiences of http://www.comunidadandina.org/un UNASUR Salud and CPLP’s Strategic Plan for asur/tratado_constitutivo.htm Accessed 30 Cooperation in Health. Rev Electron Comun Manuscript received on 29 November 2011. Revised ver- June 2010. Inf Inov Saude. 2010;4(1):99–110. sion accepted for publication on 30 July 2012.

resumen Este artículo analiza si la cooperación sur-sur constituye legítimamente una práctica reciente o es solo una versión mejorada de los procesos anteriores de integración regional en América Latina y el Caribe. Los autores analizaron y sistematizaron el Integración regional y desarrollo histórico de los procesos de integración subregional en América Latina cooperación sur-sur en y el Caribe y se centraron en la cooperación en materia de salud en los siguientes materia de salud en América contextos: el Sistema de Integración Centroamericana, la Comunidad Andina de Naciones, la Comunidad del Caribe, la Organización del Tratado de Cooperación Latina y el Caribe Amazónica, el Mercado Común del Sur y la Unión de Naciones Suramericanas. El es- tudio concluye que las bases conceptuales y metodológicas de la cooperación sur-sur en materia de salud nacieron y se nutrieron de los procesos de integración regional en América Latina y el Caribe. Este artículo postula que las iniciativas regionales de integración política y económica aportan beneficios potenciales al sector de la salud y actúan como un mecanismo importante para desarrollar la cooperación sur-sur en este dominio. El estudio recomienda fomentar este tipo de investigaciones con objeto de proporcionar información que permitirá a los organismos nacionales y multilate- rales, o a otros interesados directos, formular e implantar mejoras en las políticas de cooperación internacional en materia de salud que tengan como meta la reducción de las desigualdades y la promoción de la salud y del bienestar de todas las personas.

Palabras clave Cooperación internacional; cooperación técnica; cooperación horizontal; América Latina.

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