Global health partnerships, governance, and sovereign responsibility in western Kenya

by Hannah Brown

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The delivery of resources to citizens in the global South is increasingly managed through international partnerships. As systems of plural governance, such arrangements are characterized by alignments, accommodations, and conflicts between partners’ respective interests. This article focuses on partnerships between the Kenyan Ministries of Health and organizations funded by PEPFAR (the President's Fund for AIDS Relief), drawing on fieldwork with Kenyan government health managers. These partnerships were based on a separation between the ability to provide resources and the right to administer them. For Kenyans, partnerships animated a politics of sovereign responsibility in which they often felt a deep sense of managerial disenfranchisement. For their foreign collaborators, partnership relations legitimized the interventions they organized. This politics of sovereign responsibility reconfigured the importance of the state on the basis of its role in delivering resources within global relations of inequality.