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ABSTRACT
This article discusses the emergence, organisation, interaction and evolution of regional bodies responsible for cooperation in health in sub-Saharan Africa from the late 1940s to the mid-1960s. Focusing on Portugal’s under-researched role in the CCTA and the WHO’s regional office (AFRO), it addresses the issue of health diplomacy and inter-regional cooperation during a period of significant political change on the African continent. Drawing from a great variety of published and archival sources, it provides an overview of the strategies pursued by Portugal and other colonial powers with regard to trans-national and regional cooperation in health, against the background of the complex interplay of regional interests and overlapping membership of CCTA and AFRO. It shows how the tensions between constructive international and regional engagement on the one hand and colonial sovereignty and legitimacy on the other played out and shifted over time in the African region. In addition, it discusses Portugal’s health diplomacy against the background of the membership of newly independent African countries of CCTA and AFRO, and its refusal to decolonise, eventually precipitated the country’s suspension from WHO-AFRO and all technical cooperation in 1966.
Acknowledgements
The authors wish to thank the anonymous reviewers for their helpful comments.
Disclosure Statement
No potential conflict of interest was reported by the author(s ).
Notes
1 Jerónimo and Pinto, “Special Issue: International Dimensions”; Santos, A Organizacão das Nacões Unidas e a Questão Colonial Portuguesa; Jerónimo and Monteiro, “Colonial Labour Internationalized”; Ágoas and Castelo, “Ciências sociais, diplomacia e colonialismo tardio”; Jerónimo and Dores, “Enlightened Developments?”
2 Packard, A History of Global Health.
3 Cueto, Brown, and Fee, The World Health Organization, 83.
4 Henry, “A Functional Approach to Regional Cooperation,” 308, 314.
5 Pearson, The Colonial Politics of Global Health; Bonoho, “The WHO, Health Development Policies.”
6 Hodge and Hödl, “Introduction,” 15–21.
7 Havik, “Administration, Economy, and Society in the Portuguese African Empire.”
8 Havik, “Public Health and Disease Control in Former Portuguese Africa.”
9 Feldbaum and Michaud, “Health Diplomacy and the Enduring Relevance.”
10 For an account of WHO’s decentralisation process, see Siddiqi, World Health and World Politics, 53–116.
11 WHO Constitution, Basic Documents.
12 Cueto, Brown, and Fee, The World Health Organization, 77.
13 Fee, Cueto, and Brown, “At the Roots of The World Health Organization’s Challenges.”
14 Arquivo Histórico Diplomático (henceforth AHD), 2° Piso, Armário 3. Maço 689, Parecer A. Barata e Silva, 1-9-1948.
15 Archives Nationales d’Outre Mer (henceforth ANOM), Aix en Provence, Ministère d’Outre Mer, Dept. des Affaires Politiqiues, Note, WHO, RC1/AFR/Min/1; ANOM, 1AFFPOL 1400, Relations OMS-Conferences Internationales (1951–1957), Minutes of First Meeting African Bureau in Geneva, Paris, 24-9-1951.
16 On Cambournac’s career at AFRO, see Lobo and Monteiro, “A trajétoria de Francisco Cambournac na Organização Mundial de Saúde.”
17 National Archives (NA), CO 936/64/5, Brief on the Proposed Establishment of an African Health Region, Colonial Office (CO), December 1950, Previous to his appointment as WHO-AFRO director in 1951, General François Daubenton, MD (1888–1965), of Dutch nationality, joined WHO staff in 1948 and served as Consultant of the Dept. for Public Health Administration of the Regional WHO Office for the Eastern Mediterranean in Alexandria.
18 Kent, The Internationalization of Colonialism; Jerónimo, “Repressive developmentalisms”; Pearson-Patel, “Promoting Health, Protecting Empire.”
19 ANOM, 1AFFPOL 1400, J.J. Peyronnet, Confidential Memo on first meeting of African Regional Committee in Geneva, September 1951.
20 NA, London, CO 936/64/5, Policy Brief, CO; Memo, Bureau Médical Inter-Africain, French delegation, 2nd session of the CCTA, Brussels, 7-30/6/1950; Also see, Pearson-Patel, “French Colonialism and the Battle Against the WHO Regional Office for Africa.”
21 Bonoho, “The WHO, Health Development Policies,” Ch. 2.
22 Maul, Human Rights, Development and Decolonization, 59–85.
23 Henry, “A Functional Approach to Regional Cooperation,” 308.
24 Gruhn, “The Commission for Technical Co-Operation in Africa.” Eventually, the CCTA was transformed into the Scientific Technical Research Commission and absorbed into the Organization of African Unity in 1965.
25 See Havik, “Regional Cooperation and Health Diplomacy in Africa,” 126–29.
26 Ibid.
27 Pearson, “French Colonialism,” 70/71.
28 Saavedra, “Politics and Health at the WHO Regional Office.”
29 Parecer Augusto Silva Travassos, 25th August 1948, AHD, 2° Piso, Armário 3 Maço 689.
30 Pearson, “French Colonialism.”
31 WHO Constitution, Basic Documents.
32 AHD, 2° Piso, Armário 3, Maço 689, Parecer A. Barata e Silva, 1 September 1948.
33 See Art. 133, Reforma Constitucional 1951; Lei 2948, Diário do Governo, Série I, 117, 11-06-1951, which dispensed with the term empire, adopting the terminology of ‘overseas provinces’ (provínicas ultramarinas) which formed part of a ‘united and undivided nation’.
34 AHD, 2° Piso, Armário 3 Maço 689, ‘Informação de serviço’, Amândio Pinto, 14 March, 1953.
35 AHD, 2° Piso, Armário 3 Maço 689, Parecer Manuel Rocheta, 6 April 1953.
36 AHD, 2° Piso, Armário 3 Maço 689, Letter, Manuel Rocheta to Ambassador in Spain, 27 April 1953. In a treaty with then independent Morocco, Spain ceded its protectorate to the new state in 1958, while retaining Ceuta and Melilla, maintaining its presence in the Spanish Sahara until 1975.
37 AHU, MU, DGAPC 55. Jorge Janz, Instituto de Medicina Tropical, Lisbon, 22-4-1954 to sub-secretary of Ministry of Overseas Affairs (MU).
38 AHU, MU, DGAPC 55, Jorge Janz, Report Head Portuguese delegation to Ministry of Overseas Affairs, Lisbon, 26-6-1954.
39 AHD, 2° Piso, Armário 3 Maço 689, Relato de Conversa, Franco Nogueira, 12 April 1954.
40 AHD, 2° Piso, Armário 3 Maço 689, Informação de Serviço, MNE, 26 August 1953.
41 PT/AHD/MU/GM/GNP/RRI/0772/12343-001/MNE-DGNP, 2° Piso, Armário 3 Maço 689, Jorge Janz, Internal memo, Franco Nogueira, Minister of Foreign Affairs, Lisbon, 23 April 1953.
42 AHD-MU-GM-GNPR-RRI-0908-12188, Parecer DG Negócios Políticos e Administração Interna, MNE, 31 August, 1953.
43 NA, Foreign Office (henceforth FO) 371/80210, Memorandum, Relations between CCTA and WHO, Colonial Office, May 1950.
44 NA, CO 859/407 WHO Regional Office for Africa 1952–1953, Paul-Marc Henry, Secretary-General, CCTA 52/12, Report on 2nd Session WHO RCA, 10 September 1952. Member countries were well aware of AFRO’s budgetary limitations and their implications for technical assistance, suggesting that AFRO could be bypassed if governments would administrate project funding themselves; see MAE-AA, H-4542/L. 1402, CCTA (53) 43, London, 5-10-1953.
45 AHD-GNP-RRI-0908-12188, Francisco Cambournac, “Relatório Reunião de Peritos,” 31 July 1953. Several meetings on Inter-African Medical Cooperation were held, first in Accra (1946), and under the auspices of CCTA in Dakar (1951) and Leopoldville (1955).
46 Santos, A Organização das Nações Unidas e a Questão Colonial Portuguesa; Martins, “A política externa do Estado Novo, o Ultramar e a ONU”; Monteiro, Um Império Acossado, chapters 6 and 7.
47 Cueto, Brown, and Fee, The World Health Organization, 77/78.
48 AHD-MU-GM- GNP-RRI-0679-12339, Parecer DGNPAI/ MNE, 19 December 1951.
49 AHD-MU-GM- GNP-RRI-0908-12188, Francisco Cambournac, “Relatório da Reunião de Peritos destinada a preparar a actuação dos seis países membros da CCTA na sessão do Comité Regional Africano da OMS,” Paris, 24 July 1953.
50 Ibid.
51 AHD-MU-GM- GNP-RRI-0908-12188, Parecer DGNPAI/MNE, 31 August 1953.
52 ANOM, Ministére d’Outre Mer, 1AFFPOL 1400, Compte Rendu de la Réunion Preparatoire a la 3ieme session du CRA et l’OMS, J.J. Peyronnet, Paris, July 1953.
53 Lobo and Monteiro, “A trajetória de Francisco Cambournac,” 136.
54 GNP/RRI/ 0679/ 12861 Memo, MNE DGNPAI to DGAPC, MU, 19 December 1951.
55 AHU, MU. DGAPC 55, Agapito da Silva Carvalho, Governor-general Angola to MU, Luanda, 18-5-1951.
56 NA, CO 859/407, Brief, WHO Regional Office for Africa, Minutes of the 7th Session of the CCTA, January 1953.
57 NA, Commonwealth Parliament Offices (CPO), 936/147, WHO; Relations between Specialised Agencies and CCTA. 1953–1955, Minutes 8th Session CCTA, 3 June 1953; NA, CO 936/266. Evaluation of CCTA activities. 1954–1956, Internal Memo, J. Bourn, Medical aspects CCTA activities, London, 9 May 1956.
58 Ricossé and Husser, “Bilan et avenir de la lutte contre les grandes endémies en Afrique Occidentale Francofone.”
59 Memorandum, Activities of the Commission for Technical Cooperation in Africa South of the Sahara (CCTA), of interest to the United Nations Economic Commission for Africa, UN-ESC, E/CN 14/11, London 31 December 1958.
60 NA, CPO 936/147, CCTA (53) 74, London, December 1953.
61 MAE-AA, H- 4538/L. 1369, CCTA (54) 34, Memo on meeting, 22–27 March 1954 in Brazzaville, 30 March 1954. A similar meeting took place between his predecessor, Daubenton, and the CCTA secretary-general during the 5th World Health Assembly in May 1952.
62 MAE-AA, H- 4539/L. 1376, Memo, Joint Secretariat CCTA/CSA, L. (58) 232, London, 25 July 1958.
63 NA, CPO 936/147, Memo, CCTA (53) 24, March 1953.
64 CCTA/CSA, FAMA, Inter-African Cooperation; Memo, Activities of the Commission for Technical Cooperation in Africa South of the Sahara, 4.
65 Historical Archive of Mozambique (henceforth AHM), file 859.Andrade e Silva, 27 January 1959.
66 AHD-MU-GM-GNP-RRI-0908-12188, Francisco Cambournac to MU, Relatório da Reunião de Peritos, CCTA, Paris, 24 July 1953.
67 ANOM, Ministére d’Outre Mer, 1AFFPOL 1400, Compte Rendu de la Réunion Preparatoire a la 3ieme session du CRA et l’OMS, J.J. Peyronnet, Paris, July 1953.
68 World Health Organization (WHO), Third Generation Files, 1955–1983, WHO.3: Mozambique M2/372/3/MOZ, Opening address, F.C.J. Cambournac, Report Meeting on Malaria, Eradication in South Eastern Africa, Lourenço Marques (Mozambique), 25–27 August 1958, October 1958.
69 Direcção Provincial dos Serviços de Saúde e AssistÊncia – Paludismo 1966 and ‘Relatório de Campanha’, both at AHU- MU-DGSA-RSH-007-Cx 2.
70 AHD/MU/GM/GNP/RRI/0908/12192-001, Draft Report, Comité Higiene e Saúde, Ministério do Ultramar, 12 Septembro de 1957. Also see, Havik and Monteiro, “Regionalismos e colonialismo tardio em África,” 310.
71 AHM, file 859, Andrade e Silva, 27 January 1959.
72 Arquivo Histórico Ultramarino (henceforth AHU), Ministry of Overseas Affairs (henceforth UM), DGAPC 55, José Agapito da Silva Carvalho, governor-general Angola to Minister of Overseas Affairs, Luanda, 25 August 1952 and Internal note, MU/DGAPC, 127/P. B-24. 31 October 1952.
73 AHU, MU, DGAPC 55, José Agapito da Silva Carvalho, Governor-general of Angola, to MU, Luanda, 16 June 1951.
74 AHU, MU, DGAPC 55, José Agapito Da Silva Carvalho, Governor-general of Angola, to MU, Luanda, 25 August 1952; and Internal Memo, DGAPC-MU, 127/P. B-24, Lisbon, 31 October 1952.
75 PT/AHD/MU/GM/GNP/RRI/0679/12854, Ofício DGNPAI, MNE, 14 March 1959.
76 PT/AHD/MU/GM/GNP/RRI/0679/12854, Report Ministry Foreign Affairs, 14 March 1959.
77 PT/AHD/MU/GM/GNP/RRI/0679/12854, Parecer J. Ferreira da Silva, 31 January 1961.
78 AHD-MU-GM-GNP-RRI- 0679- 12861, Parecer Aires Pinto Ribeiro, 12 September 1957.
79 AHU, MU, Direcção Geral de Saúde e Assistência (henceforth DGSA), RSH-007, Dispatch, 4377/316/B/81, DGAPC, Lisboa, 23-10-1959, Director Geral Ministério do Ultramar to Comissão de Higiene e Saúde.
80 AHD, POI 8, J. M. Fragoso, Apontamento de Conversa, 1955.
81 PT/AHD/MU/GM/GNP/RRI/0679/12852-004, Parecer Joaquim Ferreira da Silva, 4 October 1962; Comentários ao Relatório da visita efectuada a Moçambique pela Consultora de Enfermagem da OMS, Louise M. Bell, Report on a Visit to Mozambique, 1 October 1962.
82 PT/AHD/MU/GM/GNP/RRI/0679/12852-004, Parecer DGSA, Ferreira da Silva, 31 May 1962.
83 Monteiro, “One of Those Too-Rare Examples.”
84 WHO, P8-451-4 JKT-1, Ian Gilchrist, MD to Marcolino Candau, Sierra Leone, 9 July 1962.
85 WHO, P8-451-4 JKT-1, Rapport de la Mission de l’OMS sur la Situation Sanitarie dans la Guinée Portugaise, l’Angola et Le Mozambique, Ernâni Braga, Ruperto Casanueva and Jean-Simon Cayla, December 1962.
86 AHU, MU, DGSA 3213, João Fraga de Azevedo, Comissão de Higiene e Saúde, Lisbon, 5-2-1960.
87 AHD-MU-GM-GNP-RNP-00115-004, Informação n° 596, 21 December 1962.
88 AHD-MU-GM-GNP-RNP-00115-004, Report Director of the GNP, 10 August 1962.
89 AHU, MU, DGSA, RSH-015, OMS, Peritos, pessoal, etc. 1963–1971, Processo 7/12 sub-processo 3, Joaquim Ferreira da Silva, Informação 412, DGSA, Lisbon, 25 March 1964.
90 AHU, UM, DGSA, RSH-015, OMS, Cx. 18. OMS Peritos, pessoal, etc. 1963–1971, Processo 7/12 sub-processo 3, Joaquim Ferreira da Silva, Informação 11, DGSA, Lisbon, 4 January 1964.
91 AHD-MU-GM-GNP-RNP-00115-004, Letter from PIDE to GNP, 16 April 1962.
92 Santos, “The Role of the Decolonization Committee of the United Nations Organization.”
93 WHO Official Records, WHO Regional Committee for Africa, Report on 11th Session, AFR/RC11/20 -Rev.1, 1-12-1961.
94 Jerónimo and Monteiro, “Internationalism and Empire.”
95 AHD/MU/GM/GNP/RRI/0908/12191, Letter from MNE to GNP, 25 October 1961.
96 AHD/MU/GM/GNP/RRI/0908/12191, Confidential letter from MNE to DGSA, 17 July 1961.
97 PT/AHD/MU/GM/GNP/RRI/0908/12191, Informação n°52, 6 June 1960.
98 AHD/MU/GM/GNP/RRI/0908/12192-001, Informação n°600, Costa Morais, 26 December 1962.
99 AHU, MU, DGSA, RHS-015 OMS, Processo 7/4, sub-processo 3, Report, L. Santos Garcia, head Portuguese delegation, 13th and 14th meeting of Regional Committee, Geneva, Lisbon, 25-9-1964.
100 Portugal’s expulsion from the Economic Commission for Africa (ECA) in 1963, emboldened African states; see NA, FO 371/172750, UNs 1797/8, Memo, marked confidential, London, 26 August 1963. See also, Akiwumi, “The Economic Commission for Africa.”
101 South Africa left UNESCO in 1965 and was expelled from UNCTAD in 1968. Its full membership of WHO was restored in May 1994 by the World Health Assembly following the holding of democratic elections and the end of the apartheid regime.
102 WHO Official Records n°. 141, September 1965, 18th WHA, Geneva, 4–21 May 1965.
103 PT/AHD/MU/GM/GNP/RRI/0908/12191, “Informação”, 11th Session Regional Committee, Costa Morais, 18 August 1961.
104 AHU, MU, DGSA, Repartição de Saúde e Higiene, Report, Portuguese delegate, Augusto de Andrade Silva, 12ª Reunião do Comité Regional Africano em Genebra (24 September to 2 October, 23 November 1962).
105 PT/AHD/MU/GM/GNP/RRI/0908/12194, Report of Portuguese Delegate, Santos Garcia, 25 September 1964.
106 AHU, MU, DGSA-RSH 015 OMS, Cx. 17, Vol. IV, Report L. Santos Garcia, Lisbon, 25 September 1964.
107 AHU, MU, OMS, DGSA – RHS-015 OMS, Vol. V: Processo 2, Guilherme A.A. Abranches Pinto, to MU, Luanda, 26 April 1966.
108 PT/AHD/MU/GM/GNP/RRI/0908/12194, Report by Head of Portuguese Delegation, L. Santos Garcia, 13th and 14th Meeting CRA, 25 September 1964.
109 AHU, MU, DGSA, RHS-015 OMS, Cx. 17, Sub-processo 2, ‘Informação’, 200/SP, 16th Meeting CRA/AFRO, Guilherme A.A. Abranches Pinto DGSA, Angola, to MU, Luanda, 26 April 1966.
110 Ibid.
111 NA, FO 371/189966, Ms. Solesby to J.E. Powell-Jones at Economic and Social Department/Foreign Office, Dispatch, marked confidential, 1795/66, UK Mission Geneva, Geneva, 4-2-1966.
112 WHO Official Records, WHO, AFR/RCI5/11 Rev.1, Resolution AFR/RC15 /R2, 15th session Regional Committee for Africa, Lusaka, 9 September 1965.
113 PT/AHD/MU/GM/GNP/RRI/0908/12193, Banha da Silva, Note 11511, Overseas Ministry, 4th November 1965.
114 PT/AHD/MU/GM/GNP/RRI/0908/12193, Minute FAM, 29th September 1965.
115 Relatório da XV sessão do Comité Regional de África, Santos Garcia, PT/AHD/MU/GM/GNP/RRI/0908/12193, Report from Overseas Ministry, 27/9/65, PT/AHD/MU/GM/GNP/RRI/0908/12193.
116 PT/AHD/MU/GM/GNP/RRI/0908/12194, 19th WHA, Geneva, 3–20 May 1966; WHO Official Records n°. 151, Geneva, September 1966; Report, Ferreira da Silva, 6 July 1971.
117 Official Records WHO, 152: Nineteenth WHA, 3–20 May 1966, Part II, November 1966: 202. https://apps.who.int/iris/handle/10665/85789.
118 AHU, MU, DGSA, RSH-015, OMS, Cx. 18, Processo 7/7, OMS Peritos, sub-processo 2.
119 AHU, MU, DGSA, RSH-015, OMS, Cx. 18. OMS, 1963–1971, Processo 7, Subprocesso 6, Letter, Alfred Quenum to Minister of Foreign Affairs Portugal, Brazzaville, 25 February 1965.
120 AHU, MU, DGSA Cx. 18, Processo 7/12, Sub-processo 8 Ofício, Joao Pinheira, DGSA to Governor-General Mozambique, Lisbon, 30 September 1969.
121 PT/AHD/MU/GM/GNP/RRI/0908/12194, Report, DGSA to MU, 3 August 1971.
122 PT/AHD/MU/GM/GNP/RRI/0728/12353, Processo KK. 10-55.
123 PT/AHD/MU/GM/GNP/RRI/0728/12353, Report DGSA to MU, 13 December 1970.
124 da Silva Cunha, “Universal and Regional Organization in Africa.”
125 NA, CO 859/1206, SSB 87/70/010, Memo, WHO Regional Committee for Africa (RCA), 8th Session, Monrovia, 22–27 September 1958, marked confidential.
126 Apontamento para sua excelência o governador geral, n.d., AHD-MU-GM-GNP-RRI-0790-12529. Jerónimo and Monteiro, “The Inventors of Human Rights in Africa.”
127 ANOM, 1AFFPOL 1400, Compte Rendu sur la 2ieme session du CRA OMS, Monrovia, Ministère d’Outre Mer, Paris, 7-8-1952.
128 PT/AHD/MU/GM/GNP/RRI/0908/12194, Report by Head of Portuguese Delegation, L. Santos Garcia, 13th and 14th Meeting CRA, 25 September 1964.
129 AHU, MU, DGSA, RHS-015 OMS, Cx. 18, Vol. V, Sub-processo 7, João Pinheira, ‘Informação’, 696, DGSA, Lisbon, 2 December 1970.
130 NA, FO 371/189966. WHO African Regional Committee 1966, US 1797/4, A. Silkin, UK Embassy Kinshasa, to J.E. Powell-Jones, Foreign Office, London, 23-9-1966.