Opportunities and challenges of trilateral South‒South cooperation for transforming development assistance for health: evidence from a DRC-UNICEF-China maternal, newborn, and child health project

Abstract

Background: Trilateral South‒South cooperation is envisioned as an equal and empowering partnership model but still faces certain challenges. This study addresses whether and how trilateral South‒South cooperation can transform traditional development assistance for health (DAH) and explores the opportunities and challenges of trilateral South‒South cooperation for transforming future DAH, in the theme of "the emerging development partner's DAH transformation facilitated by a multilateral organization".

Methods: We evaluate a maternal, newborn, and child health (MNCH) project involving the Democratic Republic of Congo (DRC), the United Nations Children's Fund (UNICEF), and China (hereinafter referred to as the "DRC-UNICEF-China project"). We analyze data from project documents and seventeen semi-structured interviews using a pragmatic analytical framework based on the DAH program logic model and the OECD's trilateral cooperation framework.

Results: Evidence from the DRC-UNICEF-China MNCH project suggests that trilateral South‒South cooperation facilitated by a multilateral organization can provide transformative opportunities for emerging development partners' DAH to generate and deliver context-based, demand-oriented solutions, harmonize rules and procedures, institutionalize mutual learning and knowledge sharing, and increase the visibility of emerging development partners as sources for South‒South development experience transfer. However, the project revealed some challenges, including the neglect of key stakeholders in the complex governance structure, the high transaction costs needed to ensure transparency, and the harm local absence of the emerging development partner poses to long-term DAH engagement.

Conclusions: This study echoes some of the findings in trilateral SSC literature that claim power structures and philanthropic, normative justification for health equity are often juxtaposed in trilateral SSC partnerships. The opportunities offered by the DRC-UNICEF-China project align with China's cognitive learning process for strengthening international engagement and global image building. However, challenges may arise as a result of complex governance structures and the entrustment of facilitating partners, which can threaten the effectiveness of trilateral cooperation. We call for strengthening the beneficiary partner's ownership at all levels, engaging the emerging development partner to better understand the beneficiary partner's local context(s) and needs, and ensuring available resources to support programmatic activities and long-term partnerships for the health and well-being of the beneficiaries.

Keywords: China; Democratic Republic of Congo; Development assistance for health; Maternal, newborn, and child health; South-South cooperation; Trilateral cooperation; United Nations Children’s Fund.

Fig. 1

Analytical framework of the study. Abbreviation: DAH Development Assistance for Health

Fig. 2

Governance structure and actors involved in the DRC–UNICEF–China MNCH project Abbreviations: CICETE China International Center for Economic and Technological Exchange; CAC Community Action Group; CIDCA China International Development Cooperation Agency; CODESA Health Area Development Committee; DAH development assistance for health; DPS Provincial Health Division; DRC Democratic Republic of Congo; IHECC International Health Exchange and Cooperation Center; MoH Ministry of Health; MNCH maternal, newborn and child health; SSCAF South‒South Cooperation Assistance Fund; UNICEF United Nations Children’s Fund; VSPH Vanke School of Public Health.

Fig. 3

Timeline of the DRC–UNICEF–China MNCH project. (Abbreviations: CICETE China International Center for Economic and Technological Exchange; CIDCA China International Development Cooperation Agency; DRC Democratic Republic of Congo; SSCAF South‒South Cooperation Assistance Fund; UNICEF United Nations Children’s Fund)

Fig. 4

Financial flow in the DRC–UNICEF–China MNCH project. (Abbreviations: DPS Provincial Health Division; DRC Democratic Republic of Congo; IHECC International Health Exchange and Cooperation Center; MNCH maternal, newborn and child health; SSCAF South‒South Cooperation Assistance Fund; UNICEF United Nations Children’s Fund; VSPH Vanke School of Public Health)