Is there a social justice variant of South–South health cooperation?: a scoping and critical literature review

Figures & data

Table 1. Inclusion/exclusion criteria.

Criterion	Explanation
(1) Subject relevance	Cooperation must involve a health component.
(2) Type of literature	Excluded conference and special issue announcements and repeats of heavily overlapping literature by the same author(s).
(3) Type of cooperation relevance (South–South)	Cooperation must entail one of the following: bilateral (South–South), trilateral (South–South–South), multilateral, regional, or triangular (SSC mediated or financed by United Nations [UN] agencies or developed, capitalist countries).
(4) Clear critical component	Must involve some form of equity-oriented or leftist cooperation (redistributive, anti-imperialist, social democratic, socialist, etc.) rooted in the politics of solidarity, not charity.

Table 2. Dominant elements for data extraction.

Type of Data Extracted	Categories
Actors involved in the cooperation	i.e. countries and agencies
Type of cooperation	Bilateral Regional Triangular (South–Southcooperation also involving UN agencies or high-income countries) Multilateral (e.g. India, Brazil, and South Africa [IBSA]; Brazil, Russia, India, China, and South Africa [BRICS]) Trilateral (South–South–South)
Health-related activities:	Training and education Primary health care (PHC) and human resources Pharmaceutical production and distribution Knowledge transfer/sharing and research Health care infrastructure and equipment Disease control Domestic health policy International policy negotiations Surgery and non-PHC treatment
Social justice-oriented features of collaboration (here our review terms derive from sociological understandings of the actors, relations, and context of historical and contemporary experiences of proletarian internationalism, also drawing from our preliminary SJSSC characterization above) [34].	Shared agenda-setting and values Responsiveness to local needs Equitable partnering Policy autonomy and objectives Reciprocity Restitution, reparations, social debt
Contextual factors	i.e. cultural/linguistic, economic, geopolitical considerations
Goals of cooperation	i.e. health equity and solidarity as explicit goals
Publication type	academic or grey literature

Table 3. Themes related to values and strategies.

V A L U E S
Themes and components	Selected illustrative quotes
1. Anti-hegemonic worldview Revolutionary: anti-imperialist/anti-capitalist vision; anti-neoliberal ~ challenging free market model Challenging North–South asymmetries of power (including in cooperation) Advocating internationalism; proletarian solidarity	‘The result is that ALBA can be seen to represent a new paradigm that permits the creation of a counter-hegemonic, network-like set of relations dominated by values of fairness, social justice and solidarity’ [38, p. 99]. ‘The Cuban government has consistently promoted an internationalist foreign policy based upon a philosophy of proletarian solidarity’ [39, p. 69]. ‘The liberation ethic and unity in African [health] diplomacy are both an assertion of interests and also a defensive strategy against the power imbalances African countries face in global negotiations’ [40, p. 11].
2. Equity-oriented and redistributive political values (within national politics and translated into cooperation activities) Socialism of the South Social democracy (reflecting working class power) Social inclusion Participatory democracy	‘The correlation between the altruistic character of a domestic policy, such as health, and the corresponding dimension of solidarity expressed in foreign policy and translated into international cooperation’ [41, p. 133]. ‘Between countries with similar ideologies,’ cooperation engenders ‘the idea of social inclusion and the responsibility of governments with a great commitment to the population, to the people. This is central to the construction of new, more transparent and horizontal democracies, also enabling cooperation’ [42, p. 14].
3. Egalitarian terms of cooperation Horizontal terms of interchange; sincerity No conditionalities Responsiveness to local needs and context-relevant solutions (autochthonous to Global South) Humanitarianism (solidarity-oriented/altruistic)	‘The South-South cooperation that Uruguay carries out is based on principles of solidarity among peoples, horizontality, equity, respect for national sovereignty and non-conditionality’ [43, p. 83]. ‘Brazilian engagement in South-South cooperation [involves]: 1) Solidarity 2) Response to the demands of developing countries 3) Adaptation of the Brazilian experience to the local context 4) No conditionalities 5) No association with commercial interests 6) No interference in the domestic affairs of partner countries’ [44, p. 15].
4. Reciprocity Harmonized interests and policies Support for national autonomy and self-determination Respect for sovereignty (including via shared identities as former colonies) Unity, ubuntu, ‘liberation ethics’	China’s engagement in Africa is ‘guided by principles of non-interference with domestic affairs of a recipient country, mutual benefits in economic development and self-determination among partner countries’ [45, p. 9]. ‘Day-to-day learning, with real-world work experiences, is a process of collective, horizontal, and shared building, still a challenge for us all’ [46, p. 49]. ‘South Africa’s diplomatic activities also reflect the principles of state sovereignty, non-interventionism and resistance to western ideals, which are inevitably seen as associated with racism’ [47, p. 769–770].
S T R A T E G I E S
1. Solidarity-building Alternative governance systems: regional economic (trade) and political solidarity; regional/Third World blocs (e.g. UNASUR, G77, NAM)/Global South leadership Linguistic, cultural, and historical ties (e.g. Community of Portuguese Language Countries) Working class/ideological/political solidarity (e.g. ALBA) Building of domestic/regional capacity Countering imperialism; reducing dependency on the West	‘UNASUR was formed as contestation to the “morality” of neoliberal governance and hence regionalism has been about addressing political roots of the struggle for inclusive development and citizenship in the region’ [84, p. 670]. ‘For many Pakistanis, the Cuban experience was a revelation. In the first instance, there was a stark sense of disbelief that these individuals came to Pakistan of their own free will and that they stayed well beyond the point that most global relief efforts had wound down’ [48,para.10]. ‘The Cubans also distinguished themselves from the rest of the relief effort by … living in tents under the same conditions as those displaced by the earthquake … ’ [48, para. 11]. ‘Cuba’s assistance to African countries in the health sector’ is framed by its role ‘as a prominent member of the Non-Aligned Movement and the Group of 77, [in the context of which it has] persistently evoked the need for unity and cooperation among developing countries in their collaborative struggle against exploitation’ [56, p. 32].
2. Health justice approaches Social/health/human rights Health equity Addressing social determinants of health (SDOH); intersectoralism	‘ … Stimulating political participation; extending and defending human rights’ … ‘guaranteeing the institutional and intersectoral coordination required by program implementation’ [77, p. 177]. ‘Unlike the more traditional disease-specific approach, [Brazil focuses on] strengthening and transforming health systems as a whole … [Fiocruz cooperation] consider[s] not only the biomedical aspects of disease, but also the social and environmental determinants of health’ [49, p. 2131]. Cuba ‘now heeds a community-based approach, centered on prevention and health promotion, with personnel living in the community … making care much more attuned to local needs’ [50, p. 714–15].
3. Mutual exchange and collective justice Reciprocal exchange of resources for mutual benefit Shared agenda-setting Social debt/gratitude for supporting revolutionary movements and restitution/reparations	‘At the domestic level, internationalism, and especially its medical diplomacy, have provided the country [Cuba] with material capital including economic gains from contracts, credit, and trade, which have helped the island sort out some of its economic difficulties’ [93, p. 100–101]. ‘Both South-South cooperation and triangular cooperation represent an increasingly important dynamic of interchange in the Iberoamerican region with unique guiding principles of horizontality and consensus’ [51, p. 14]. ‘Moral obligation to provide restitution for [South Africa’s] destabilization policies pursued throughout the 1980s and which are responsible to a great extent for the deterioration of infrastructure in neighbouring countries’ [88, p. 929]. Quid pro quo: ‘China’s foreign-aid medical teams have successfully promoted South-South cooperation and played a positive role in promoting China’s entry into the UN, also safe-guarding national sovereignty in regard to the Taiwan issue’ [52, p. 92].
4. Challenging interests of dominant classes in the health arena Challenging power of professional elites Challenging domestic and global capital (e.g. pharmaceutical companies) Challenging privatization Democratizing global governance systems	Quoting a Venezuelan emergency room doctor on why Cuban cooperation was needed: ‘The doctors at the private clinics that serve the rich and middle class have no interest in serving the majority of the population’ [53, p. 74]. ‘IBSA members implemented strategies questioning prevailing international health arrangements that they considered unjust and inequitable. As a result they challenged the existing order and proposed an alternative model’ [54, p. 302]. ‘To strategically place South America in a stronger and unified position addressing health issues in global governance’ [6, p. 9].

Figure 1. Flow chart of search process and publication selection.

Figure 2. Number of SJSSC publications identified in scoping review, 1992–2017.

Table

Main Categories	Search Terms
(1) Concept: Health/Well-being	(health* OR medic* OR biomedic* OR social welfare OR human welfare OR well-being OR wellbeing OR disease* OR illness* OR pharma* OR injur* OR disabilit* OR disabl* OR primary care OR drug* OR biotech* OR mortality OR morbidity OR vaccin* OR epidemiolog* OR scientific)
(2) Relationship Descriptors: Set 1	((north-south not (north-south gradient* OR north-south cline OR north-south axis OR north-south orient* OR north-south direction OR north-south line OR north-south split OR north-south transect)) OR (south-north) OR (south-south) OR (north-south-south)
(3) Relationship Descriptors: Set 2	(cooperation OR co-operation OR collaborat* OR regional coordination OR regional integration OR agreement* OR alliance* OR diplomacy OR linkage* OR pact*)
(4) Relationship Descriptors: Set 3	((joint AND (development OR production OR research OR planning OR program* OR initiative* OR effort* OR project* OR commitment* OR action* OR activit* OR venture* OR practice* OR process*)) OR joining forces OR ((mutual* OR common* OR shar* OR similar) AND (issue* OR problem* OR experience* OR duty OR responsibilit* OR strateg* OR priorit* OR agenda* OR goal* OR position* OR interest* OR benefi* OR advantage* OR reward* OR solution* OR challenge*)) OR common ground OR mutuality OR bi-directional OR symmetr* OR complementary development OR collective action* OR collective decision-making OR consensus)
(5) Political Descriptors	(egalitarian OR equit* OR equality OR ethical OR participatory OR independence OR self-relian* OR self-sufficien* OR self-sustain* OR reciprocity OR interdependen* OR ubuntu OR liberat* OR emancipat* OR empower* OR grassroot* OR decoloniz* OR bottom-up OR (human ADJ2 rights) OR (right ADJ2 health*) OR rights-based OR progressive OR non-interference OR solidarity OR self-determin* OR sovereign* OR sustainable development OR alternative development OR nondependen* OR non-dependen* OR (reduc* and (dependenc* OR poverty OR inequit* OR inequalit*)) OR autonom* OR people-orient* OR community-orient* OR anti-imperialis* OR anti-colonial* OR anti-capitalis* OR non-imperialis* OR non-capitalis* OR justice OR democra* OR social movement* OR horizontal OR indigenous OR southern-led OR southern-based OR southern perspective OR southern-generated OR African-driven OR African-led OR political commitment OR political will OR locally-determined OR social medicine OR (popular and (resistance OR participation OR forces)) OR inclusive OR social inclusion OR accessiblit* OR accessible OR political change OR social change OR non-Western OR subaltern OR reflexive OR locally governed OR regionally driven OR region-cent* OR socialis* OR feminis* OR anti-racis* OR altruis* OR accountab* OR transformative OR legitima* OR revolutionary OR decentrali* OR non-hierarchical OR counter-hegemon* OR mobiliz* OR regional power OR leftist OR left-wing OR activis* OR radical* OR regionali* OR internationali* OR redistributi* OR anti-globalization OR alter-globalization OR anti-US OR anti-america* OR anti-oppress* OR nationali* OR local governance OR regional governance OR fairness OR ((fair OR true OR real OR genuine* OR respectful*) AND (partnership* OR collaborat* OR cooperation* OR agreement* OR trade OR exchange*))
(6) Geographical Descriptors	(latin america* OR central america* OR south* america* OR southern cone OR Caribbean OR Africa* OR intra-africa* OR inter-africa* OR cuba* OR el salvador* OR brazil* OR venezuela* OR zimbabwe* OR kenya* OR tanzania* OR mozambique OR angola* OR namibia* OR Malawi* OR Zambia* OR Botswana OR Congo* OR Uganda* OR Swaziland* OR Lesotho* OR third world OR global south OR non-aligned countries OR non-aligned movement OR NAM countries OR developing countries OR low-income countries OR middle-income countries OR LMICs OR g-77 OR g77 OR group of 77 OR underdeveloped countries OR under-developed countries OR (southern ADJ3 countries) OR emerging economies OR resource-poor countries OR resource-poor settings OR resource-limited settings OR peripheral countries OR anchor countries)
(7) Organizations/Institutions	(barrio adentro OR global policy forum OR alliance for financial inclusion OR BRICS OR UNASUR OR southern african development community OR east african community OR Bolivarian Alliance for the Peoples of Our America OR ecos familiares OR equinet OR seatini OR latin american school of medicine OR IBSA OR COMESA OR CODESRIA OR SADC OR AU ECSA health community OR ALAMES OR People’s health movement OR World Social Forum)
(8) Scope of Cooperation	(transnational OR cross border* OR cross-national OR cross-countr* OR across national boundaries OR across ADJ2 borders OR multilateral OR trilateral OR foreign polic* OR regional OR neighbo$ring countr* OR bordering countr* OR inter-government* OR beyond borders)
(9) Substantive Area	((health* workers OR human resources OR personnel OR experts OR professionals OR providers OR practitioners OR caregivers OR physicians OR clinicians OR doctors) AND (migrat* OR train* OR retain* OR mentor* OR educat* OR teach* OR export* OR deploy* OR recruit* OR exchang*)) OR ((transfer* OR flow* OR exchang* OR shar* OR trade OR trading OR pooling) AND (technolog* OR knowledge* OR data OR information OR expertise OR skills OR know-how OR resources OR fund* OR services)) OR ((build* OR improv* OR enhanc* OR strengthen* OR develop* OR foster* OR promot* OR support* OR invest*) AND (research capacit* OR technical capacit* OR institutional capacit* OR research capabilit* OR indigenous capacit* OR local capacit* OR national capacit* OR domestic capacity* OR technical capabilit* OR technical knowledge OR technical skills OR technical competence OR institutional capabilit* OR infrastructure OR competence OR primary care OR primary health* OR health* services OR health* system)) OR capacity-building OR institution-building OR capacity-strengthening OR management-strengthening OR shar* research facilities OR mutual learning OR development* assistance OR technical assistance OR technical support OR development* aid OR foreign aid OR economic assistance OR financial support OR financial assistance OR knowledge diffusion OR human resource development OR institutional development OR national strategy OR health* advocacy OR (research ADJ2 development))

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