The enormous and increasing influence of the BRICS countries (Brazil, Russia, India, China and South Africa) can be seen in many areas including economics, politics and culture. The economies of the BRICS countries have expanded significantly, and in 2011 China overtook Japan to become the second largest global economy. Brazil and India are now sixth and ninth, respectively.  In their recent meeting in India, the leaders of these countries discussed on a number of issues of common interest and offered at the conclusion of their meeting, a list of proposals to the developing countries in order to tackle their current economic problems.
The expanding influence of the BRICS countries is impacting global economics, politics and culture. The health sector is no exception. While growth in the BRICS countries has recently begun to slow, they have shown much greater resilience than the US and Europe in the face of the global financial crisis. Their foreign assistance spending also has been increasing at very high rates. One of the distinguishing features of these countries is beyond direct assistance, they are investing considerable time, money and energy building their capacity for science and technology. Through platforms like the BRICS forum, they are also exploring opportunities for more formal collaboration among themselves and with other developing countries.
Without much of the propaganda pomp, the BRICS countries are all established providers of foreign assistance; however their contributions have increased significantly over the last five years. They are often referred to as “emerging” or “non-traditional” donors, but each has been providing different levels of assistance to other countries for decades. As the US and Europe have slowed donor spending due to their economic crisis, the BRICS countries’ assistance programs have become much more prominent.
The funding involved is still relatively small when compared to overall spending by the US and Western European countries. China is by far the largest contributor, and South Africa is likely the smallest by a significant margin. However, in recent years the growth in their assistance spending has accelerated. According to the Global Health Strategies Initiative(GHSI) recent research report, between 2005-2010, Brazil’s assistance spending grew by 20.4% annually, India’s by 10.8% annually, China’s by 23.9% annually, and South Africa’s by 8% annually. Russia’s assistance increased substantially early in the same period, before stabilizing at around USD 450 million per year. Brazil and Russia prioritize health within their broader assistance agendas. China, India and South Africa are all contributing to some degree, but their formal programs focus on other issue areas.
The BRICS countries are employing approaches to foreign assistance that are different from traditional donors and shaped by domestic experiences. They have made health advances over the past few decades, and their policymakers feel this equips them with unique perspective on improving health outcomes in developing countries. As a result, all of them except for Russia openly reject “Western” approaches to foreign assistance in favour of models anchored in domestic programs and their own political and social philosophies.
Aside from Russia, the BRICS countries do not like to see themselves as donors. Instead, they see themselves as developing country partners that are sharing best practices and helping other countries build self-sustaining growth. Most of their health assistance programs focus on infrastructure, human resources training or health systems strengthening. China provides the most prominent example: its assistance program overtly emphasizes mutually beneficial programs that seek to build long-term economic development.
This aligns with China’s approach to its own development, which favours infrastructure, investment and market-driven growth, albeit with strict government oversight. Because they still face major health and economic challenges, continued investments in global health will likely be made in the context of issues at home. At the same time, they are likely to have greatest global impact in areas where their own health issues overlap with those of other countries.
As with Western donors, economic and political interests are influencing the BRICS countries as they expand their development and health assistance programs. There is no question that their health and development programs and policies are guided by broader strategic priorities. Other approaches have generated criticism: both India and China may tie some assistance to the purchase of domestically produced goods. It is important to note that many traditional donors are influenced by politics and economics.
According to several studies on global aid, between 1970 and 1994, 78% of the UK’s bilateral aid and 57% of France’s bilateral aid went to former colonies, and the UK recently announced it was refocusing aid on Commonwealth countries. Meanwhile, much of the US aid is used to procure domestically produced goods and services. Four out of the US Government’s five food assistance programs procure their food aid in-country, and the US requires that 75% of its commodities are shipped on US-flag vessels. Rough estimates suggest that in fiscal year 2004 more than 90% of US food aid expenditures were spent in the US. Innovative domestic health programs and policies in the BRICS countries are increasingly influencing health practices worldwide.
According the report of the GHSI, given its small international assistance program, South Africa’s influence in global health has largely been through examples produced in its efforts to combat HIV/AIDS and TB particularly in recent years as it has strengthened its domestic programs. Similarly, India’s low-cost health service delivery programs and recent success interrupting polio transmission offer templates for countries trying to get to the most difficult-to-reach populations. Brazil’s commitments to health equity, HIV treatment and nutrition programs have all been recognized as models for success in resource poor countries.
The BRICS countries are taking steps to prioritize health as an essential element of development and foreign policy more broadly, and to coordinate these efforts through the BRICS forum. The production of high-quality, lower-cost health technologies by these countries are improving access in resource-poor countries. The growing investment in early-stage research and development (R&D) by them could have a similar long-term impact. Arguably one of the most impactful examples of the BRICS countries contributions to health is the role that Indian companies have played in expanding global access to vaccines and essential medicines.
The United Nations Children’s Fund (UNICEF) disclosed that, between 60% to 80% of the vaccines the organization has purchased for the world’s poorest countries come from India, and millions of people living with HIV/ AIDS have access to affordable ARVs because of Indian companies. These products have saved millions of lives, though complex legal and intellectual property rights issues remain unresolved.
At the same time, all of the BRICS countries are investing heavily in science and technology. According to the GHSI report, China, for example, has pledged to increase R&D expenditures to 2.5% of GDP by 2020, while India has just launched a US$1 billion innovation fund focused on problems afflicting developing countries.
Some of these innovations have grown out of commercial interests, and others from efforts to address domestic health challenges. Yet the health challenges of the BRICS countries are often similar to those in many developing countries, their innovations could quickly reach and benefit populations in need. As they continue to prioritize innovation, they could expand the supply of health technologies that are appropriate and affordable for developing country settings, while pushing down prices across the globe.
The BRICS countries have declared health collaboration a priority, but they have not yet begun to work collectively to enhance the impact of their assistance programs. Despite increased foreign assistance budgets, their investments are still limited compared to those of the US and Western Europe. Collective action could help them to have greater impact, and they acknowledged this at one of their meetings in 2011.
However, to date, there have been no notable joint efforts although India’s proposal that they will create a development bank funded by developing countries could be a step in this direction. By working together to leverage their respective knowledge and experiences, these countries have the potential to do more on health than any could do on their own.
In the final analysis, with the above in mind, there are also other global political, economic and social sectors in which the BRICS countries will play a prominent role for the betterment of millions of people in the developing world in particular and in the world in general.