Regional Integration and South–South Cooperation in Health in Latin America and the Caribbean
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Informe especial / Special report Regional integration and south–south cooperation in health in Latin America 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 Andean Community of Nations, the Caribbean Community, 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- United Nations (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, Brazil. 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