What can global health institutions do to help strengthen health systems in low income countries?

Weaknesses in health systems contribute to a failure to improve health outcomes in developing countries, despite increased official development assistance. Changes in the demands on health systems, as well as their scope to respond, mean that the situation is likely to become more problematic in the future. Diverse global initiatives seek to strengthen health systems, but progress will require better coordination between them, use of strategies based on the best available evidence obtained especially from evaluation of large scale programs, and improved global aid architecture that supports these processes. This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programs that are essential for effective functioning of health systems. At national level, it is essential to increase capacity to manage and deliver services, situate interventions firmly within national strategies, ensure effective implementation, and co-ordinate external support with local resources. Health systems performance should be monitored, with clear lines of accountability, and reforms should build on evidence of what works in what circumstances

Neoliberalism and the revival of agricultural cooperatives: The case of the coffee sector in Uganda

Agricultural cooperatives have seen a comeback in sub‐Saharan Africa. After the collapse of many weakly performing monopolist organizations during the 1980s and 1990s, strengthened cooperatives have emerged since the 2000s. Scholarly knowledge about the state–cooperative relations in which this “revival” takes place remains poor. Based on new evidence from Uganda's coffee sector, this paper discusses the political economy of Africa's cooperative revival. The authors argue that donors' and African governments' renewed support is framed in largely apolitical terms, which obscures the contested political and economic nature of the revival. In the context of neoliberal restructuring processes, state and non‐state institutional support to democratic economic organizations with substantial redistributional agendas remains insufficient. The political–economic context in Uganda—and potentially elsewhere in Africa—contributes to poor terms of trade for agricultural cooperatives while maintaining significant state control over some cooperative activities to protect the status quo interests of big capital and state elites. These conditions are unlikely to produce a conflict‐free, substantial, and sustained revival of cooperatives, which the new promoters of cooperatives suggest is under way

Intensifying Political Geographies of Authoritarianism:Toward an Anti-geopolitics of Garment Worker Struggles in Neoliberal Cambodia

Cambodia’s recent crackdown on freedoms of expression, association, and assembly coincides with the wider geopolitical ascent of illiberal democracy. Scholarly and public discourse suggests that we are now witnessing a global authoritarian turn, possibly linked to the current conditions of late neoliberal capitalist development where deprivations linked to state rollback have engendered a corrective state rollout. The language of the global authoritarian turn, however, echoes earlier unhelpful and totalizing readings of neoliberal expansion as a process of top-down diffusion. To counter this, this article argues for a recentering of local geographies in understanding authoritarian neoliberalism and a renewed focus on the bottom-up dynamics of its articulation in specific contexts. Drawing from a detailed study of garment worker activism, this article unravels the two-way relationship that unfolds between the intensified experiences of capital and resistance in Cambodia and the intensifying political geography of authoritarianism that reverberates as a result. Forwarding an antigeopolitical reading of authoritarian neoliberalism in Cambodia, the article recasts the current crisis underway in Cambodia, disrupting the notion of an authoritarian turn. Rather than the top-down imposition of a new model of autocratic government, the crackdown is shown to represent an intensification of existing authoritarian neoliberalism provoked by geopolitics from below. Here, intensification reflects a demographic and spatial shift in the concentration of authoritarian strategies toward Cambodia’s garment workers. Key Words: anti-geopolitics, authoritarianism, Cambodia, neoliberalism, resistance