Alex Shankland

Realizing Health Rights in Brazil: The Micropolitics of Sustaining Health System Reform

Brazil’s ‘Citizens’ Constitution’ of 1988 established health as ‘the right of all and the duty of the state’. It also guaranteed the right of citizens to participate in the governance of the Sistema Unico de Saude (National Health System; SUS for short) through institutions created at municipal, state and national level. Nowhere else in the world have such ambitious and far-reaching efforts been made to institutionalize citizen participation in the governance of health systems. Yet the dominant tone in the literature on participation in Brazil’s SUS is largely negative, with many observers questioning whether these institutional arrangements have had any significant impact on improving efficiency, shifting priorities towards the needs of the poorest or promoting genuinely accountable health system management.2

On the margins of aid orthodoxy: the Brazil-Mozambique collaboration to produce essential medicines in Africa

BackgroundOn the back of its recent economic development and domestic success in the fight against HIV/AIDS, Brazil is helping the Government of Mozambique to set up a pharmaceutical factory as part of its South-South cooperation programme. Until recently, a consensus existed that pharmaceutical production in Africa was not viable or sustainable. This paper looks into practicalities and evolution of this collaboration to illustrate the characteristics of Brazilian development cooperation in health, with the aim of drawing lessons for the wider debate on aid and local production of pharmaceuticals in Africa.DiscussionWe show that the project process has been very long and complex, has involved multiple public and private partners, and cost in excess of USD34 million. There have also been setbacks in the process, and although production has already started, it is unclear whether all the projects original objectives will be met.SummaryThe Brazil-Mozambiques pharmaceutical factory experience illustrates positives as well as limitations of Brazils unorthodox approach to health development cooperation, highlighting its contribution to pushing the boundaries of the debate on local production of pharmaceuticals in resource-poor settings.

Civil Society, BRICS and International Development Cooperation: Perspectives from India, South Africa and Brazil

The chapter explores Brazilian, Indian and South African civil society engagement in South–South development cooperation (SSDC) and in debates of these countries’ roles in BRICS. Despite the apparently more promising engagement environment in the ‘democratic emerging powers’, civil society efforts to achieve effective influence over the SSDC agendas of both BRICS and of their own countries face many obstacles. The chapter discusses commonalities and differences across these three countries and their fellow BRICS, Russia and China, and analyses key characteristics and tendencies of transnational civil society engagement. Final remarks include prospects for civil society engagement with BRICS international development cooperation, with a particular focus on the New Development Bank.

Engajamento com cidadãos: lições aprendidas na construção do Sistema Único de Saúde

O Sistema Unico de Saude (SUS) e um sistema universal, de financiamentopublico, baseado em direitos sociais a saude, concebido e implantado emuma era em que as reformas neoliberais em outras partes do mundotem impulsionado a mercantilizacao dos servicos de saude, oferece licoesimportantes para os futuros sistemas de saude. Neste artigo, focalizamosos mecanismos institucionais inovadores para a participacao populare prestacao de contas (accountability) que fazem parte da arquiteturade governanca do SUS. Nos argumentamos que esses mecanismos departicipacao publica tem o potencial de sustentar um pacto entre Estadoe os cidadaos e assegurar o impulso politico necessario para ampliaro acesso aos servicos basicos de saude e, ao mesmo tempo, fornecerum quadro para o surgimento de “parcerias reguladoras”, capazes deadministrar a realidade complexa da assistencia plural e de multiplicaras fontes de especialidades em saude de uma forma que assegure que asnecessidades e os direitos dos pobres e dos cidadaos marginalizados naosejam relegados para a periferia de um sistema de saude segmentado.

From Policy Transfer to Mutual Learning

The economic and geopolitical shifts of recent years have forced the oecd-dac member countries to offer greater recognition to the development cooperation activities of the BRICS and other rising powers, who claim to follow a different logic from the coercive policy transfer models associated with North-South development cooperation. At the same time, there has been rapid growth in international “mutual learning” outside the formal framework of development cooperation. This paper explores the implications of this for international policy diffusion in the age of “universal” development envisaged by the UN’s Agenda 2030.

Introduction: International Development, South-South Cooperation and the Rising Powers

This chapter examines the emergence of the BRICS as a geopolitical association with systems for intellectual, policy and financial interaction and cooperation, and their growing impact on international development and global governance arrangements. The discussion considers the history and rhetoric of South-South cooperation, exploring whether it presents an alternative to the OECD-DAC model of development aid and the future evolution of this model as the BRICS themselves develop. While the BRICS have a huge significance in global development, there has been little comparative study of what each of the BRICS has been doing in their development practices and little understanding of domestic discourses and attitudes towards development cooperation. This chapter outlines the way in which this book fills this gap. It details the economic, political and development trajectories of the BRICS grouping and introduces the various chapters examining the respective BRICS members, the BRICS grouping’s trajectory of engagement with civil society and its development of shared institutions for development cooperation.

Accountability for Health Equity: Galvanising a Movement for Universal Health Coverage

In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology. For the first time in IDS Bulletin history, themes are explored not only in text but also through a selection of online multimedia content, including a workshop video, a photo story and a documentary. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards UHC and the linked agenda of accountability for health equity. The articles and multimedia in this IDS Bulletin reflect the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.