By Lara Gautier, global health researcher at the Institute of Public Health of Heidelberg University, PhD candidate at Université de Montréal
Several scholars, development experts and commentators had great expectations that BRICS become important players of the post-2015 discussions. Given their demographic, economic, and political weight, their involvement would somehow counter-balance traditional donors’ hegemony in the debate. But do they really undertake this role as a coordinated political body?
During the 5th BRICS Summit in South Africa in March 2013, the BRICS welcomed the establishment of the Open Working Group (OWG) on the Sustainable Development Goals (SDGs), agreeing to commit to a coordinated intergovernmental process for the elaboration of the new UN development agenda. The following common features can be identified across the five giants’ aspirations in the broader post-2015 agenda: finishing the MDGs business, committing traditional donors to universal targets, enhancing access to technologies, and respecting national sovereignty on political issues. While their concerns overlap in these official debates, they do not speak as a single voice, not unlike in the WHO arena. And it is probably too early to say whether their concerns will be fully acknowledged by the OWG and within the SDG process.
What about the specific health agenda? In their 2012 Geneva meeting on the sidelines of the 65th World Health Assembly, BRICS health ministers did commit to “work collaboratively to shape debate on MDGs and beyond 2015.” Later on in Cape Town, the same ministers “called upon Member States to consider health as an important issue in post-2015”.
Therefore what is their take on the post-2015 global health debate so far? Many of you have come across a plethora of recent literature on BRICS’ influence on major global health major issues ranging from governance to universal health coverage (UHC) ( see recent Contemporary Politics and WHO Bulletin special issues, etc.). But despite the BRICS’ predominant place in today’s global health discussions, only three of these recent publications (Creswell et al., Harmer & Buse; Kickbusch) directly tackle how they weigh on the burning post-2015 health debate.
We know that in their various declarations, the BRICS have repeatedly affirmed their support to UHC (McKee et al). They even said that UHC is “an essential instrument for the achievement of the right to health”. But unlike WHO and other UHC partisans, they do not go as far as pushing it to be the ultimate health goal. Indeed, China (together with Kazakhstan and Indonesia) clearly states that UHC cannot be the “overarching goal of the health sector”. Building from this argument, Chinese delegates added that before we decide on UHC as a key target “we have to ensure that we have adequate means that can support national effort to fulfill this target”. Others somehow corroborate this opinion, with Russia speaking about UHC simply as an “interesting idea”, and India recognizing its “importance”. And while South Africa is “fully supportive of the proposal for the implementation of UHC”, it warns that “it should be noted that countries have different ‘starting points’ in their readiness to implement it”.Interestingly, without apparent coordination both China and South Africa speak about a more limited version of UHC: universal access to healthcare services. Brazil seems to be the most supportive of UHC in the post-2015 discussions, proposing to adopt the very comprehensive Resolution 67/81’s definition from the Rio+20 outcome document.
Overall BRICS countries, and particularly China, South Africa and Russia are in favor of pursuing the “unfinished business” of the health MDGs, i.e. lowering maternal and child mortality and fighting AIDS, TB and malaria. China particularly advocates for “finishing the unfinished business of […] MDG5b on universal access to reproductive health, including access to modern use of contraception for all […]”. Brazilian and South African delegates fully support this proposal.
South African delegates also ask for greater focus on prevention of communicable and non-communicable diseases. Similarly, and not surprisingly – as one the strongest advocates, Russia is pushing for NCDs to be a key target of the future global health agenda. In fact, all the BRICS countries agree to have NCDs fully covered by future health-related targets – which is in full coherence with their own epidemiologic profiles and efforts to reform their health systems.
Kickbusch believes that BRICS will get strongly involved in “global governance for health that reaches beyond the health sector”, covering trade, intellectual property, food security, climate change, and biodiversity. However, none of them explicitly make the link between these topics and health in post-2015 discussions, except for trade and intellectual property. In this field, Brazil appears to be particularly vocal: within health-related means of implementation, Brazil asks for an “indispensable sub-item” which would reaffirm countries’ right to fully use existing flexibilities in the TRIPS agreement. Such call for preserving trade flexibilities is also supported by India.
In a nutshell, for BRICS countries the post-2015 health development agenda should build on the MDG framework. As such, maternal and child health, controlling HIV, malaria, and TB, and NCDs (which is the only significant change) should be the top priorities. In terms of global governance, they emphasize the need for discussions to be framed in a universal, more inclusive and transparent intergovernmental process. To date, these contributions are not so different from what traditional donors have been promoting. Therefore it appears that BRICS are not (yet?) the anticipated ‘power brokers’ or ‘Southern voice advocates’ in the discussions on the health development agenda, at least not within traditional intergovernmental fora.
While I agree with Harmer and Kickbuschthat BRICS ought to play an increasing role in global health governance in the next future, I do not think that it will happen inside of the UN framework. Referring to the broader development agenda, my take is that they are thinking about building their own framework for international cooperation (perhaps along the lines of the ‘win-win’ South-South cooperation model, rather than the ‘donor-recipient’ model of the 2000s), substantially different from the already existing one – which is already challenged by the Busan process. They advocate for a different way of doing cooperation, based on mutual understanding, sharing experiences, and exchanging simpler and less costly technologies. Let’s see how the soon-to-be-launched BRICS development bank concretizes this new concept of development assistance.