Chinese aid and nutrition improvement in Sub-Saharan Africa

ABSTRACT

The efficacy of foreign aid, especially escalating Chinese aid, has been controversial. Considering the widespread malnutrition in Sub-Saharan Africa and the substantial concerns about Chinese aid, we investigate whether and how Chinese development assistance improves the nutrition of the African recipients, particularly children and women. We match Chinese aid projects and Demographic and Health Surveys (DHS) covering 24 SSA countries during 2000–2016. We address the causality by comparing the individuals who lived near a Chinese aid project that was effective at the time of the interview to those who were not exposed to Chinese aid projects while a nearby Chinese aid project would be initiated after the interview. We measure malnutrition by hemoglobin haemoglobin and anemia anaemia which are more relevant and reliable than other indicators. Our results show that Chinese aid significantly increased hemoglobin haemoglobin and decreased the likelihood of anemia anaemia, and the effects are more pronounced among children. In contrast to the popular expectation, health aid does not significantly improve nutrition conditions, at least in the short run. Instead, other aid projects that promote earnings and job opportunities substantially reduced malnutrition among children and women. Heterogeneity analysis further shows that Chinese aid strongly improved nutrition mainly among disadvantaged residents.

KEYWORDS:

• Chinese aid
• Africa
• health
• nutrition
• anemia anaemia

JEL CLASSIFICATION:

• F35
• I15
• O55

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality. September 8^th, 2020.

² This body of literature is too large to review here but synthesized by Alderman and Fernald (2017).

³ See Currie and Almond (2011) and Almond, Currie, and Duque (2018) for excellent surveys of the related literature. Similarly, the adverse economic shocks during pregnancy and childhood also negatively affect a large set of health and socioeconomic outcomes (Douglas et al. 2007; Rosales-Rueda 2018; Hyland and Russ 2019; Karbownik and Wray 2019; Singhal 2019).

⁴ https://www.who.int/data/gho/data/indicators/indicators-index. Accessed January 20, 2022.

⁵ https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-jme-stunting-prevalence. Accessed January 20, 2022.

⁶ Our analysis does not include adult men and children between 5 and 15 since DHS program does not conduct blood tests for them.

⁷ The center centre of each enumeration area is geo-referenced but slightly displaced to protect the anonymity of the observed units.

⁸ Hemoglobin Haemoglobin is a protein in red blood cells that carries oxygen to the body’s organs and tissues and transports carbon dioxide. Low hemoglobin haemoglobin is used to diagnose anemia anaemia and indicate the risk of iron deficiency.

⁹ Anemia Anaemia is characterized by low hemoglobin haemoglobin concentration in the blood..

¹⁰ ‘Anaemia’ World Health Organization. Accessed January 20, 2022. http://www.who.int/nutrition/topics/ida/en/.

¹¹ The interviewers draw a droplet of blood to obtain the individual’s hemoglobin haemoglobin value after a consent statement is read to the respondent for agreement (in the case of children, consent is required by a parent/responsible adult).

¹² A recent study shows that the correlation between stunting and malnutrition is weak (Scheffler et al. 2020).

¹³ In the AidData, the precision of the coordinates is coded into eight categories, ranging from 1 for exact coordinates to 8, where the coordinates are actually the seat of an administrative division or the national capital. We follow Isaksson and Kotsadam (2018a) to keep only the projects with precision codes 1 (precise coordinates) or 2 (deviation not exceeding 25 km). We choose 50 km radius as the threshold in our main specification as in Isaksson and Kotsadam (2018a), and we examine the spillover radius of Chinese aid projects in section 4.3. If the radius of the buffer zone is too large, it may put many people into the treatment group, although they did not actually benefit from the Chinese aid projects. By contrast, if the buffer zone is too small (e.g. 25 km), it may underestimate the actual impact of the projects in its vicinity. Moreover, since an aid project with precision code 2 allows a maximum deviation of 25 km, a radius of 25 km may yield non-negligible errors.

¹⁴ The health aid sector includes about 40.5% of medical team projects, 19% of hospital projects, 25.3% of medicine projects, as well as 15.2% of mixed assistance projects.

¹⁵ Other projects contain education projects, water supply and sanitation projects, women in development projects, government and civil society projects, business and other services, general environmental protection, and so on..

Additional information

Funding

This work was supported by the National Science Foundation for Young Scientists of China (Grant No. 71903095) and National Social Science Foundation of China (22&ZD157).