Brazil's engagement in health co-operation: what can it contribute to the global health debate?

Abstract

Brazil and other emerging powers, such as China and India, are becoming increasingly influential world players. As they expand their global recognition and the associated diplomatic influence and access to markets, these countries are multiplying their development co-operation efforts with low-income countries often located in the southern hemisphere (Kragelund 2008). Within this ‘South–South co-operation’ these so-called ‘emerging donors’ are progressively turning to health interventions as effective foreign policy soft-power tools (Feldbaum and Michaud 2010). In the debate on the relationship between health and foreign policy objectives, it has been argued that the two interact in more than just one way and end up exerting mutual influence (Kickbush 2011). Although the former are often regarded as tools for the latter, public health objectives are also seen as benefiting from foreign policy action, as demonstrated by Brazil’s diplomatic efforts for worldwide tobacco control and access to antiretroviral (ARV) drugs (Lee et al. 2010). However, many take the view that there will always be a tension between global health and foreign policy, and that co-operation projects need to be read through the lenses of foreign policies to understand the potential and limitations of this new form of ‘health diplomacy’ (Feldbaum and Michaud 2010). The tension between foreign policy and development goals is in part reflected in emerging donors’ questioning of the traditional principles of aid effectiveness affirmed in the 2005 Paris Declaration and subsequent Accra Agenda. Such principles of aid effectiveness aimed, among other things, at separating aid from non-aid goals by seeking traditional donors’ commitment to measurable results and sustainability of co-operation projects. In more than one way, the recent Busan High Level Forum on Aid Effectiveness has come to bridge the existing rift between old and new donors, not only by hailing ‘horizontal partnership’ and ‘development cooperation’ instead of vertical aid (Martini et al. 2012) but also by relaxing contentious aid principles like that of alignment to national governments’ policies, and donor harmonization (HLF4 2011). As a result, the new consensus emerging from Busan puts forward a more inclusive model of development cooperation focused on ownership, focus on results, global partnership, transparency and accountability, but based on donors’ differential commitments (Hill et al. 2011, Russo et al 2013). This commentary draws on a study on Brazilian projects in Africa (Russo et al. 2011) and the authors’ direct involvement with Brazilian health co-operation to argue that, although shaped by its foreign policy goals, Brazil’s engagement is contributing to a shift in the discourse on health development co-operation, by offering home-grown examples of health development, by adopting new concepts of health co-operation and by leading unusually bold action on key global health issues. The consideration also emerges that Brazilian health co-operation, being relatively young and still learning its trade, would also benefit from a deeper engagement in the discussion on effectiveness and sustainability of development interventions.