China’s engagement with development assistance for health in Africa

Background As an emerging donor in health related development across the world, particularly towards Africa, the People's Republic of China (PRC) has been increasing its influence within the field of global public health over the past few decades. Yet between the period of 2000 and 2013, little is known about the scope, scale and priority of China's grant-making programs. Methods Based on data sourced from the China Aid Database (version-1.2), descriptive analyses were applied to analyze the features of 531 health related projects that were undertaken between 2000 and 2013. Spearmen correlation was also performed to assess the relationship between China's export and aid to recipient countries. Results The total value of China's grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD, with 531 projects undertaken. During the five year period between 2004 and 2008, China had a contribution of 1.54 billion USD, which increased to 3.8 billion USD during the five year period between 2009 and 2013 - an 146.26% increase. In terms of specific diseases, China is most concerned with building an African public health system through donations targeted towards general health (313 projects), combating Malaria (115 projects) and maternal, neonatal and child health (MNCH), (12 projects). When it comes to recipient countries, if counted in total value, Zimbabwe received the most financial assistance from China, totaling 1.08 billion USD and 19 projects, while Angola and Tanzania received more projects - 30 and 29 projects respectively. In terms of the channeling of aid funding, most projects were targeted towards infrastructure, equipment and medicine (304 projects in total), followed by medical teams (189 projects). Moreover, there is a statistically significant relationship between aid to Africa and Chinese exports to Africa. Conclusion During the past decade, Chinese aid projects played an important role in the African public health system through providing funding for infrastructure, equipment and medicine, training health professionals, as well as disease treatment. However, very limited attention was paid towards disease prevention, health promotion and awareness initiatives, and health education. Furthermore, serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.