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Exploring the determinants of regional health governance modes in the Global South: A comparative analysis of Central and South America

Published online by Cambridge University Press:  17 May 2021

Giovanni Agostinis Open the ORCID record for Giovanni Agostinis [Opens in a new window]  and
Kevin Parthenay Open the ORCID record for Kevin Parthenay [Opens in a new window]
Giovanni Agostinis*
Affiliation:
Instituto de Ciencia Política, Pontificia Universidad Católica de Chile, Santiago, Chile
Kevin Parthenay
Affiliation:
Department of Law, Economy and Social Sciences, University of Tours, Tours, France
*
*Corresponding author. Email: [email protected]
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Abstract

What explains the variation in how states collectively deal with public health challenges across different regions? We tackle this puzzle by comparing the regional health governance efforts pursued within the Central American Integration System (SICA) and the Union of South American Nations (UNASUR). We show that Central America's health governance has been driven by external actors, whereas South America's was driven by states within the region, and remained insulated from external actors’ influence. We argue that the explanation for such variation lies in the interplay of state capacity and regional leadership. In Central America, weak state capacity combined with the absence of a regional leader willing to provide governance resources. This opened up space for external actors to contribute actively to regional health governance, complementing the governance of Central American governments. In South America, Brazil's regional leadership mobilised neighbouring states’ capacities by promoting a South-South cooperation agenda based on intra-regional exchanges among national health bureaucracies, which, however, proved vulnerable to intergovernmental conflicts. Through the comparison of Central and South America, the article bridges the gap between global health governance scholarship and comparative regionalism, providing new insights on the determinants and effects of regional health governance modes in the Global South.

Keywords

Regional Health GovernanceState CapacityRegional LeadershipComparative RegionalismCentral AmericaSouth America
Type
Research Article
Information
Review of International Studies , Volume 47 , Issue 4 , October 2021 , pp. 399 - 421
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the British International Studies Association

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63 Parthenay and Dabène, ‘Regionalism in Central America’.

64 As pointed out by regional bureaucrats from SICA's institutions, external funds are often grabbed by member states to meet basic administrative needs at the domestic level (for example, computers and cars). Author's interviews with Ondina Castillo and with Omar Orozco.

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67 Author's interviews with Pedro Caldentey del Pozo and Rolando Hernandez.

68 ISAGS was endowed with legal personality and headquartered in the city of Rio de Janeiro, where it operated on the basis of a Headquarters Agreement between UNASUR and the government of Brazil.

69 ISAGS was run by a small group of experts selected by the UNASUR member states upon the proposal of ISAGS’ director (who was also chosen by member states for a two-year mandate).

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71 Author's interviews with José Gomes Temporão and Henri Jouval. On the Brazilian concept of structuring health cooperation, see Buss, Paulo M., ‘Structuring cooperation for health’, Lancet, 377:9779 (2011), pp. 1722–3CrossRefGoogle ScholarPubMed.

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73 Author's interview with José Gomes Temporão.

74 UNASUR, Reglamento General de UNASUR (2012), Art. 52, available at: {http://www.itamaraty.gov.br/images/ed_integracao/docs_UNASUL/RES16.2012ANEXOI.pdf} accessed 20 April 2020.

75 Author's interview with David Álvarez.

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83 Fondo España-SICA, ‘Memoria de Labores 2006–2009’, available at: {https://www.sica.int/documentos/memoria-de-labores-2006-2009_1_58793.html} accessed 10 March 2020.

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87 During the XLVII Ordinary Meeting of COMISCA (held on 5 December 2017), member states approved a regulation on the self-sustainability of the Joint Negotiation Mechanism.

88 COMISCA, ‘Acta adjudicación Ev 02-2019’, available at: {https://www.sica.int/noticias/se-comisca-informa-resultados-del-evento-de-negociacion-conjunta-de-precios-de-medicamentos-2-2019_1_118331.html} accessed 18 April 2020.

89 {https://twitter.com/sg_sica/status/1276570767757651973} accessed 26 October 2020.

90 Campos de Murillo, ‘Negociación conjunta’.

91 Author's interviews with Tomás Pippo, Sebastian Tobar, and José Temporão.

92 Author's interview with Celso Amorim.

93 Author's interview with José Temporão.

94 Author's interview with Oscar Feo.

95 The 2003 CAN-MERCOSUR joint negotiation involved representatives of pharmaceutical laboratories producing generic and patented antiretrovirals (for example, Bayer, Glaxo Smith, Roche, etc.), resulting in a reduction of the cost of antiretroviral therapy between 30 and 93 per cent depending on the country. See ORAS-CONHU, ‘Un Ejemplo de Integración Exitosa: Proceso de negociación conjunta para el acceso a medicamentos antirretrovirales en la Subregión Andina, Argentina, México, Paraguay y Uruguay’, Organismo Andino de Salud (2003), pp. 30–1, available at: {http://www.orasconhu.org/documentos/medica_antirre.pdf} accessed 10 April 2020.

96 Author's interview with Tomás Pippo.

97 ISAGS, ‘Compra Pública de Medicamentos en los Países de UNASUR’, available at: {https://www.academia.edu/36322422/COMPRA_PÚBLICA_DE_MEDICAMENTOS_EN_LOS_PAÍSES_DE_UNASUR} accessed 10 March 2020.

98 Bianculli et al., ‘Institutional overlap’.

99 Author's interviews with Tomás Pippo and José Gomes Temporão.

100 Herrero and Tussie, ‘UNASUR Health’; Riggirozzi, ‘Regionalism, activism’.

101 For a detailed analysis of UNASUR's joint positions, see Andrea Ribeiro Hoffmann and Jana Tabak, ‘Discussing global health and access to medicines in the UN system: the case of the Union of South American Nations (UNASUR)’, in Karen Smith and Katie Laatikainen (eds), Group Politics in UN Multilateralism (Leiden: Brill, 2020), pp. 219–40.

102 Riggirozzi, ‘Regionalism, activism’.

103 Brazil pursued its own global health diplomacy, which extended beyond South America to include South-South cooperation with African and Asian countries. See Fraundorfer, Brazil's Role in Global Governance.

104 Author's interview with Tomás Pippo.

105 Malamud, Andrés, ‘Latin American regionalism and EU studies’, Journal of European Integration, 32:6 (2010), pp. 637–57CrossRefGoogle Scholar.

106 UNDRR Regional Office for the Americas and the Caribbean, ‘Central America Allied against the Coronavirus COVID-19’, available at: {https://www.undrr.org/publication/central-america-allied-against-coronavirus-covid-19} accessed 10 March 2020.

107 CEPREDENAC, ‘Plataforma de Información y Coordinación SICA COVID-19’, available at: {https://plataformaregional.cepredenac.org/portal/apps/webappviewer/index.html?id=ebfc9c26673b44f6a9ca5a8e215b90fd} accessed 10 March 2020.

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