International cooperation in health: the case of Fiocruz

International cooperation in health International cooperation in health: the case of Fiocruz FERREIRA, José Roberto et al. International cooperation in health: the case of Fiocruz. História, Ciências, Saúde – Manguinhos, Rio de Janeiro, v.23, n.2, abr.-jun. 2016. Available at: http://www. scielo.br/hcsm. Abstract José Roberto Ferreira Program coordinator, Centro de Relações Internacionais em Saúde (Cris)/Fiocruz. Claudia Hoirisch Researcher, Cris/Fiocruz. Luiz Eduardo Fonseca Coordinator of cooperation with Africa, Cris/Fiocruz. This article reviews the trajectory of international cooperation in the light of the adjustments made at the leading international conferences on the topic (Buenos Aires, 1978; Rome, 2003; Paris, 2005; Accra, 2008; and Busan, 2011). This article aligns these new approaches with the practices Fiocruz has adopted, such as “structural cooperation in health,” namely a diplomatic approach that includes various aspects raised at the aforementioned international conferences oriented towards supporting health systems as a whole. The new approach does not focus exclusively on specific diseases or health issues and addresses health from the perspective of its biological, social and environmental determinants. Keywords: international cooperation; South-South cooperation; structural cooperation in health; global health. Paulo Marchiori Buss Director, Cris/Fiocruz. Cris/Fiocruz. Avenida Brasil, 4365 21045-900 – Rio de Janeiro – RJ – Brasil Received for publication in July 2013. Approved for publication in May 2015. Translated by Derrick Guy Phillips. http://dx.doi.org/10.1590/S0104-59702016000200002 v.20, n.2, abr.-jun. 2016 v.23, 2013, p.653-673 1 José Roberto Ferreira et al H ealth has been politically important at the international level and as a key element in the sphere of cooperation between countries, corresponding to actions that could be considered “diplomatic” in essence. This article reviews the trajectory of international cooperation for development, taking into considerations the conferences that sought to regulate it (Buenos Aires, 1978; Rome, 2003; Paris, 2005; Accra, 2008; and Busan, 2011), and how the recommendations made have influenced international cooperation in health at Fiocruz. Since 2009, Fiocruz has been working on the implementation of the “structural cooperation” process, beginning with joint strategic planning with its partners seeking not merely its adoption, but enhanced ownership of its results. Fiocruz has also sought to promote mutual accountability and harmonization as strategic elements of cooperation, as well as promote cooperation networks with partner countries. The network concept has the potential to broaden the exchange of information among all the partners and enable them to establish closer ties. These “structural networks in health” include the institutions that possess a structuring capacity to assist in the development of national health systems: national health institutes, public health schools, technical health schools and the health ministries and departments per se. Technical cooperation between developing countries International cooperation involving the non-commercial transfer of techniques and knowhow became more accentuated from the Second World War onwards, and was historically dependent on the initiatives and financial availability of the major powers for the purpose of contributing to the promotion of the development of the poorer countries. However, while they did provide benefits, such initiatives still bore traces of nineteenth century colonialism, fostering a form of relative dependence marked by maintaining the hegemony of supply over demand (Buss, Ferreira, 2010a, p.99). The perception of the limitations of these initiatives became more accentuated in the post-war period, with the creation of the United Nations Organization (UN), which is made up of both developed and developing nations. The movement that led to the creation of the UN sought to transcend the different areas of tension and disagreement between nations, as well as the glaring inequalities that exist between them, and gradually came to call into question the unilateral provision of solutions for development problems within the scope of international cooperation (UN, 4 dez. 1948, p.38). In the 1970s, several international meetings continued the debate on international cooperation stressing the importance of the autonomy of developing countries and placing emphasis on economic cooperation and the enhancement of human resources. This process culminated in a conference held in September 1978 where the Buenos Aires Plan of Action (BAPA) was drawn up, which introduced the term “South-South cooperation” to foster the practice of Technical Cooperation among Developing Countries (TCDC). This document highlighted the responsibility of the industrialized countries to maintain technical assistance in the light of the ongoing decolonization process, and admitted that a considerable number of developing nations could also take part in “international negotiations” in an increasingly 2 História, Ciências, Saúde – Manguinhos, Rio de Janeiro International cooperation in health interdependent world (UNDP, 1978, p.3, 5-10). While promoting this horizontal exchange, the document stressed that besides the aspect of economic interdependence there must be the recognition of the sovereignty of all countries, equal participation in international relations and the equitable distribution of benefits, thereby incorporating principles of a diplomatic nature. Indirectly, the strategy of cooperation between developing countries emphasized the limitations prevalent in the assistance traditionally provided by developed countries. Generally speaking, assistance was based on predefined objectives by the “donor” countries and was not always suited to the needs and potential for implementation of the “recipient” countries. However, if on the one hand the BAPA advocated coordination of assistance provided by developed countries for more productive results, on the other hand the TCDC highlighted the need for developing countries to take upon themselves the objectives and procedures to ensure greater cooperation. The document introduced an ethical element, acknowledging that this attitude, heeding the aspect of sovereignty and economic independence of nations, broadened the national autonomy and collectively strengthened the relationship between the countries, irrespective of their size, level of development and social and economic system. The Buenos Aires meeting formalized the beginning of this process, and even though it represented a significant milestone in the attempt to establish a new international order to overcome inequality and poverty, its recommendations – that were abundantly clear and detailed in 38 resolutions – had little impact on the scenario of international cooperation at that time. Possibly, as it was centered on the relatio (...truncated)