Outsourcing sovereignty: global health partnerships and the state in Zambia

Abstract

ABSTRACT Global health organisations are increasingly involved in large-scale health interventions in countries in the Global South, partnering with states to implement programmes to strengthen national health systems and promote Universal Health Coverage (UHC). Drawing on an ethnography of a large-scale global health partnership between the Zambian state and the Clinton Foundation, this paper examines the novel configurations of sovereignty that are created by these large-scale global health partnerships. It shows how officials from the Clinton Foundation came to believe that senior Zambian government actors had granted them the authority to implement the programme outside of the formal channels of the government health system. I conceptualise this as an informal mode of ‘outsourcing sovereignty’ and show how it led Clinton Foundation employees to behave as de facto state actors in rural Zambia. This paper contributes to the broader critical task of describing and analysing new forms of governmental pluralism in contemporary global health and highlights some of the politically troubling consequences when sovereignty is informally outsourced in this way.