Expanding From North-South to South-South: The Evolution of a Twinning Relationship in Global Health

This article investigates the transition of North-South development partnerships toward more balanced dependence structures, using a case study in global health to illuminate the Southern partner’s strategic evolution. While extant nonprofit literature emphasizes how Southern partners reduce the perceived cost of dependence through antagonistic approaches, our analysis reveals how a Southern partner reduced reliance not by resisting, but by engaging with the established North-South dynamic to foster South-South cooperation. We trace this evolution through key stages, highlighting changes in the Southern partner’s resource profile as key enablers of these shifts. Our study connects nonprofit literature on North-South, triangular, and South-South cooperation, emphasizing how diverse resource profiles underpin and facilitate these partnership models. As unbalanced dependence structures are inherently unstable, evolutions toward more balanced dependence structures are of interest to recipients and donors alike and to the stakeholders they seek to serve.