Embedded Files
Helpful prior knowledge and learning objectives
Helpful prior knowledge and learning objectives
Helpful prior learning:
Section 1.1.1 The economy and you, which explains what an economy is and how it is relevant to students’ lives
Section 1.1.2 The embedded economy, which explains the relationship between the economy and society and Earth’s systems
Section 1.3.9 Power in the economy, which explains where power comes from and how it shapes economic relationships
Section 7.1.1 Global exchange as a system, which describes global exchange as a system with parts, relationships, functions and emergence
Section 7.1.2 History of global exchanges, which describes how global exchange systems have evolved over time, shaped by changes in technology, power, and environmental factors
Section 7.1.3 What moves across borders? which describes what flows across borders and explains how visible global flows are linked to less visible social and ecological effects
Section 7.2.1 Why do countries trade and restrict trade? which describes different forms of protectionism and explains arguments for and against freer trade
Section 7.2.5 Who writes the rules of global exchange? which explain who shapes the rules of global exchange and how various sources of power influence which rules are written and whose interests they reflect
Section 7.3.1 Unequal global value exchange, which explains how unequal prices and unequal wages systematically transfer value from periphery countries to core countries
Section 7.4.3 Reforming the rules of global debt and finance, which describes the different alternatives Global South countries have built to existing global financial institutions, across tax governance, development finance, and debt
Section 7.4.4 Alternatives to trade liberalisation, which explains why industrial policy matters for development, why Global South countries face barriers to using it, and what regional alternatives have proposed
Section S.1 What are systems?, which explains what a system is, the importance of systems boundaries, the difference between open and closed systems, and the importance of systems thinking
Section S.2 Systems thinking patterns, which outlines the core components of systems thinking: distinctions (thing/other), systems (part/whole), relationships (action/reaction), and perspectives (point/view)
Learning objectives:
explain how South-South cooperation in ares such as medical training, digital infrastructure, technology transfer, and political coordination aims to reduce Global South dependence on Global North markets, finance, and technology
evaluate whether a specific South-South cooperation arrangement functions as horizontal exchange or new hegemony, using evidence of capacity, interests, voice, profit, and exit
In 2002, Timor-Leste became an independent country after decades of Indonesian occupation. It had almost no trained doctors of its own. The following year, a group of young Timorese men and women travelled to Havana, Cuba to begin six years of free medical training at the Escuela Latinoamericana de Medicina (ELAM, Latin American School of Medicine). In return, the trained doctors agreed to go back to Timor-Leste after graduating and practise medicine in an underserved community.
They were among thousands of students from across the Global South enrolled at ELAM, established by Cuba in 1998. By the mid-2020s, ELAM had trained more than 30,000 doctors from over 100 countries. Cuba used its surplus of trained medical professionals, developed through decades of public investment, as a form of international solidarity.
The two sections just prior to this one examined forms of South-South cooperation on debt and finance, as well as trade relationships. This section looks at other areas of cooperation.
Figure 1. Escuela Latinoamericana de Medicina (ELAM), Latin American School of Medicine
(Credit: Dezona via Wikipedia,, CC BY-SA 4.0)
What are some more examples of South-South cooperation?
What are some more examples of South-South cooperation?
The following examples cover four areas: medical training, digital infrastructure, technology transfer, and political coordination.
Cuba's medical cooperation
Cuba's medical cooperation
Cuba's international medical cooperation began before ELAM. From the 1960s onward, Cuba sent medical teams to countries in crisis, starting in Algeria and extending across Africa and Latin America. Cuba built this capacity through decades of public investment in its own health system, and sharing it with countries that lacked trained doctors. The ELAM programme, launched in 1999, extended this into long-term training.
Not all of Cuba's medical cooperation has taken this form. Under agreements between Cuba and Venezuela that began in 2000 and were later formalised under the ALBA alliance from 2004 (Section 7.4.4), Cuba sent medical teams to Venezuela. In return, Venezuela supplied Cuba with oil at below-market prices with favourable payment terms, and paid the Cuban state for the doctors' services. Some critics of this arrangement have argued that the low wages paid to Cuban doctors made it harder for Venezuela to build its own medical workforce, since some Venezuelan doctors left to work abroad instead. Cuba also maintains separately negotiated medical agreements with governments in Africa and the Caribbean.
India's digital public infrastructure (DPI)
India's digital public infrastructure (DPI)
In the 2010s, India built a set of publicly owned digital systems known collectively as the India Stack (Figure 2). The main components are a biometric identity system called Aadhaar, a real-time payment system called the Unified Payments Interface (UPI), and a framework for sharing financial data between institutions called the Account Aggregator. India built these systems as open public infrastructure. Any bank, business, or state agency can build services on top of them.
The dominant digital payments systems work differently. US platform companies such as Google Pay and Meta own their payment systems privately, charge fees on transactions, and collect user data (Section 7.3.5). Chinese platforms such as Alipay and WeChat follow the same commercial logic under different ownership. In India's model, a non-profit organisation owned by a group of banks runs the payment infrastructure, under the oversight of the central bank. Private companies can build services on top of it, and users pay no transaction fees.
Figure 2. Three main elements of the India Stack.
India has shared this model with other Global South countries through bilateral agreements between states and through the G20. Several countries in Africa and Southeast Asia have begun building similar payment and identity systems with Indian technical assistance.
Critics raise two concerns about this model. First, Aadhaar links to state services and benefit payments. This gives India's government detailed data about where people move and what they buy. Critics say this could let the government watch its citizens closely. They also say the regulations that control the system have not kept up with its fast growth. Second, India actively shares its DPI model with other countries through diplomacy and technical help. Some see this as India offering a public alternative to commercial payment systems. Others see it as a way for India to gain influence and make other countries more dependent on India.
Pharmaceutical, agricultural, and energy technology transfer
Pharmaceutical, agricultural, and energy technology transfer
Brazil and India are two of the world's largest producers of generic medicines. Generic medicines are copies of off-patent drugs produced without paying royalties to the original developer. Both countries have supplied African countries with antiretroviral drugs and other essential medicines at prices far below those charged by Global North pharmaceutical companies. Antiretroviral drugs are medicines that slow the progress of HIV. Generic competition in antiretroviral drugs drove the price of first-line HIV treatment from over $10,000 per person per year in 2000 to $100 by 2016, with Indian manufacturers producing the lowest-priced versions.
Figure 3. Illustration of the role of Indian generic drugs in treatments from Doctors without Borders.
(Credit: MSF & GS Lowry Design)
Brazil's public agricultural research agency, Embrapa, has run programmes in Africa since the 2000s. It shares research and farming techniques developed for tropical conditions. Embrapa adapts these methods from Brazil to farming conditions in the Sahel and the Horn of Africa. Brazil also transfers bioenergy technology to African states through separate cooperation programmes. This includes decades of experience turning sugarcane into ethanol fuel. Embrapa shares its knowledge with African states and farming communities for free. This is in sharp contrast to how most agricultural technologies and knowledge is transmitted through licensing fees, often to companies in the Global North.
Figure 4. Embrapa office in Ghana
(Credit: Valter Campanato/ABr, CC BY 3.0 br)
Another example of South-South cooperation in this area is Via Campesina, the international peasant movement. It organises cross-border exchange of seeds, farming techniques, and land governance models between farming communities across the Global South. This exchange involves no formal agreement between states. Its scale is small compared to the state-level programmes described above.
Figure 5. The G77 is the largest intergovernmental organisation of developing countries.
(Credit: Wikipedia)
The G77 as a political solidarity bloc
The G77 as a political solidarity bloc
Southern countries founded the Group of 77 (G77) on 15 June 1964, at the first session of the UN Conference on Trade and Development (UNCTAD), to coordinate their positions in international negotiations. It now has 134 members, making it the largest intergovernmental organisation of Global South countries. Its main function is to build shared positions for UN negotiations on trade, finance, climate, and global governance. It does not run programmes or disburse funding.
The G77 played a significant role in the 1974 New International Economic Order (NIEO) declaration described in Section 7.4.1. It also played a significant role in the 2023 UN General Assembly vote to move international tax rule-making from the OECD to a UN body where every country has a single vote (Section 7.4.3). In both cases, the G77 provided the political coalition that made a majority possible.
The G77 has very different income levels, economic structures, and political situations. This makes it difficult to maintain unified positions over time. The interests of the bloc's largest members do not always align with those of small island states or very low-income countries. China is not a formal G77 member but coordinates regularly with the bloc. In UN negotiations, diplomats call this grouping the G77 and China. China's economy is far larger than that of most G77 members and it can shape which positions the bloc is able to put forward.
Is all South-South cooperation mutual?
Is all South-South cooperation mutual?
South-South cooperation was one of the seven original demands in the 1974 NIEO declaration (Section 7.4.1). The logic was that Global South countries could not escape unequal global exchange if they depend on Global North markets, finance, and technology. Building stronger relationships with each other was meant to reduce that dependence and give Global South countries more collective power to set their own terms.
But does cooperation between Global South countries automatically deliver on that promise, or can it recreate the same unequal terms it was meant to escape? As in any relationship, a large power imbalance can turn cooperation into extraction, even when both sides describe it as solidarity.
Horizontal exchange is cooperation in which everyone involved, including the workers and communities delivering it, has a genuine say in the terms and benefits according to their own priorities, even if what each side contributes is different. New hegemony is cooperation in which whoever holds more power in the arrangement sets the terms for everyone else and gains disproportionately, even if they use the language of solidarity to describe it.
Telling the two apart is not always straightforward. The following questions can help assess specific arrangements:
Does the cooperation build the recipient's own capacity, or does it create lasting dependence on the other side's technology, systems, or political support?
Do the terms of the exchange reflect the recipient's own interests and priorities?
Do the communities involved have a genuine say in how the cooperation works, rather than only receiving what is offered to them?
Does whoever holds more power in the arrangement gain profit, resource access, or political advantage at the other side's expense?
Can the recipient change or leave the arrangement without serious cost?
Figure 6. South-South cooperation, like all relationships, can span a continuum from more reciprocal, horizontal exchange, to a new hegemony where power asymmetries exist and are used to the advantage of the more powerful party.
Activity 7.4.5
Activity 7.4.5
Concept: Power
Skills: Thinking skills (critical thinking, transfer)
Time: 40 minutes
Type: Individual, pairs, or small group
Horizontal exchange or new hegemony? A case analysis
This section described five South-South arrangements. Use the five questions from Is all South-South cooperation mutual? to assess each one.
The five questions:
Does the cooperation build the recipient's own capacity, or does it create lasting dependence on the other side's technology, systems, or political support?
Do the terms of the exchange reflect the recipient's own interests and priorities?
Do the communities involved have a genuine say in how the cooperation works, rather than only receiving what is offered to them?
Does whoever holds more power in the arrangement gain profit, resource access, or political advantage at the other side's expense?
Can the recipient change or leave the arrangement without serious cost?
The five arrangements:
Cuba's medical cooperation (compare the ELAM programme with the Cuba-Venezuela agreement)
India's digital public infrastructure
Technology transfer in pharmaceuticals, agriculture, and energy
Via Campesina's farmer networks
The G77 and China
If you are working individually, choose at least three of the five arrangements. If you are working in a group, divide the five arrangements between you and share your findings before you work on the discussion questions.
For each arrangement you choose, work through the five questions. You do not need a definitive answer to every question. Where the section does not give enough information to answer, say so. Then mark where the arrangement sits on the continuum below. Be ready to explain your placement. The discussion questions will help you synthesise your understandings.
Figure 6. South-South cooperation, like all relationships, can span a continuum from more reciprocal, horizontal exchange, to a new hegemony where power asymmetries exist and are used to the advantage of the more powerful party.
More questions to consider:
Which arrangement scores most clearly as horizontal exchange? Which scores most clearly as new hegemony? Which is genuinely ambiguous? Explain your reasoning.
Did any of your answers surprise you? If so, which one, and why?
Is it possible for an arrangement to benefit the recipient and also serve the other side's interests at the same time? Does that make it less horizontal?
Compare your placement on the continuum with someone who assessed the same arrangement. Where do you disagree, and what extra information would help you agree?
Click on the arrow to see sample responses, but give it a go yourself first!
These are sample answers. Your responses may be different and that's fine. Discuss with a partner, small group, or your teacher if you're unsure.
Cuba's medical cooperation.The ELAM programme scores closer to horizontal exchange. Cuba bears the full cost, and students return to serve their own countries. This builds the recipient's own capacity rather than creating dependence. The Cuba-Venezuela agreement scores differently. Venezuela paid the Cuban government for the doctors' services, and Cuba received oil on favourable terms. This suggests the Cuban government benefits from the exchange, since it is the government, not the doctors themselves, that receives the oil and payment. It also raises a capacity question. Some critics argue the low wages paid to Cuban doctors made it harder for Venezuela to build up its own medical workforce, since trained Venezuelan doctors left to work abroad instead. The section does not say whether communities in either country had a genuine say in how the cooperation was designed. It also does not say how easily either side could exit. This is a good example of how a single country's cooperation can include arrangements at different points on the spectrum.
India's digital public infrastructure. This is a genuinely ambiguous case, and the section frames it that way deliberately. Sharing India's DPI model could build other countries' own capacity, or it could create dependence on Indian systems and technical support. Aadhaar shows one clear hegemony signal within India itself. The state controls the underlying identity data, and citizens have no real say over that. But the section does not say whether adopting countries have a genuine say in how the shared systems work. It also does not say how easily they could switch away from Indian technical assistance. India's diplomatic promotion of the model suggests possible political advantage for India. The section does not call this profit in a direct sense, though.
Technology transfer in pharmaceuticals, agriculture, and energy. These examples sit at different points. Embrapa's agricultural knowledge and Brazil's bioethanol technology transfer both score closer to horizontal exchange. Brazil shares this knowledge for free, with no licensing fee and no described profit to Brazil. Generic medicines are more mixed. They deliver real capacity in the form of affordable treatment. But the section does not say whether recipient countries gained the ability to produce these medicines themselves. It also does not say whether they remain dependent on Indian and Brazilian manufacturers. The mention of patents and licensing fees is useful here too. It describes what technology transfer usually looks like without this kind of cooperation. This helps explain why Embrapa's free knowledge-sharing stands out.
Via Campesina's farmer networks. This arrangement scores consistently close to horizontal exchange across all five questions. It has no government or company involved to extract value or set one-sided terms. The farming communities involved are the same people organising the exchange, so they clearly have a say in how it works. And because there is no formal agreement, there is nothing to exit from. This is the clearest case in the section.
The G77 and China. This case does not fit the five questions as neatly as the others. The G77 is a political coalition, not a technology or service transfer, so questions about capacity and dependence apply less directly here. The section does say that the interests of the bloc's largest members do not always align with smaller members' interests. It also says that China's support can shape which positions the bloc puts forward, even though China is not a formal member. Both of these suggest some members carry more influence over the bloc's shared positions than others.
Ideas for longer activities and projects are listed in Subtopic 7.5
Checking for understanding
Checking for understanding
Coming soon!
Further exploration
Further exploration
Why students from the US and around the world study medicine in Cuba — A short video in which US doctors trained at ELAM explain their choice. As you watch, consider: what does the existence of this programme reveal about how the US medical system is organised, and who it leaves out? Difficulty level: easy.
How Cuban doctors vital to Latin America are being squeezed out by the US — A Guardian article examining the impact of US pressure on Cuba's medical cooperation programmes. It explains how Cuban doctors have served communities that wealthier doctors would not, why the US is blocking their deployment, and what this means for countries with no alternative provision. Difficulty level: easy.
Towards a New International Economic Order — A short talk by economist Fadhel Kaboub to the UN Department of Economic and Social Affairs, arguing that Africa's strategic minerals and future market size give it real bargaining power to change its colonial economic role. Note: addressed to a policy audience; some terms may need looking up. Difficulty level: medium.
Sources
Sources
Arsenault, C. (2012, December 31). Cuban doctors prescribe hope in Venezuela. Al Jazeera. https://www.aljazeera.com/news/2012/12/31/cuban-doctors-prescribe-hope-in-venezuela
Bandura, R., McLean, M., & Smutny, C. (2024, August 26). Approaches to digital public infrastructure in the Global South. Center for Strategic and International Studies. https://www.csis.org/analysis/approaches-digital-public-infrastructure-global-south
Cornelli, G., Frost, J., Gambacorta, L., Sinha, S., & Townsend, R. M. (2024). The organisation of digital payments in India – lessons from the Unified Payments Interface (UPI). In Faster digital payments: Global and regional perspectives (BIS Papers No. 152, pp. 61–73). Bank for International Settlements. https://www.bis.org/publ/bppdf/bispap152.htm
Embrapa. (2024). Embrapa Africa: Programme overview. Brazilian Agricultural Research Corporation. https://www.embrapa.br
G77. (2024). About the Group of 77. The Group of 77 at the United Nations. https://www.g77.org/doc/
International Renewable Energy Agency. (2016). Bioethanol in Africa: The case for technology transfer and South-South co-operation. https://www.irena.org/Publications/2016/Oct/Bioethanol-in-Africa-A-Case-for-Technology-Transfer-and-South-South-Cooperation
iSPIRT. (2023). India Stack: A public digital infrastructure framework. iSPIRT Foundation. https://indiastack.org
Kaboub, F., & Adow, M. (2026, March). Africa's just transition opportunity: Decolonising economic transformation for climate resilience. Earth4All Deep-Dive Paper 20. Earth4All. https://www.clubofrome.org/wp-content/uploads/2026/02/20-Earth4All_Deep_Dive_JustTransition.pdf
MSF. (2016). Untangling the web of antiretroviral price reductions (18th ed.). Médecins Sans Frontières Access Campaign. https://msfaccess.org/untangling-web-antiretroviral-price-reductions-18th-edition
Reed, G. (2010). Cuba answers the call for doctors. Bulletin of the World Health Organization, 88(5), 325–326. https://doi.org/10.2471/BLT.10.010510
Via Campesina. (2007). Nyéléni Declaration on food sovereignty. Via Campesina. https://viacampesina.org
Terminology
Terminology
Coming soon!
Page updated
Google Sites
Report abuse