Assembling Chinese health engagement in Africa: structures, strategies and emerging patterns

Abstract

Employing the assemblage perspective, the paper examines the relations of exteriority, heterogeneity and fluidity in the development of global health cooperation ‘with Chinese characteristics’. Through the case of Chinese health engagement in Africa, the paper (1) reviews the shifting imperatives of China’s involvement in global health; (2) identifies the major approaches, institutions and actors in the design and implementation of overseas health projects; and (3) evaluates the linkages among diplomacy, politics and economics in shaping Chinese health cooperation. The findings demonstrate how public health emergencies such as Ebola and COVID-19 have served as catalysts to push forward new developments in the assemblage of China–Africa health cooperation. In particular, the last decade has witnessed a rescaling of the Chinese state to lead international health initiatives on the one hand and to incentivise diverse sub-state and non-state actors to engage in various health-related trade and investment activities on the other. The COVID-19 pandemic has accelerated the move from a state-guided process of health cooperation to a collective project pursued by multiple official and enterprise actors. The pandemic offers an opportunity to strengthen the links between health and non-health imperatives, hence further deepening China–Africa interdependence.

Keywords:

• Global health
• assemblage
• diplomacy
• China–Africa cooperation
• COVID-19

Acknowledgements

The author thanks the two anonymous reviewers for their constructive comments on the earlier drafts of the paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 For example, in 2019, China contributed a total of $86 million to WHO (including $75.8 million as assessed contribution and $10.2 million as voluntary contribution), which is relatively small compared to the United States ($893 million), the United Kingdom ($434 million), Germany ($292 million) and Japan ($214 million).

2 The domestic outbreak of SARS in 2003 is considered a watershed event that pushed for health reform in China and prompted its participation in global health initiatives (Liu et al. 2014; Chan, Chen, and Xu 2010). A number of changes in the Chinese healthcare system have been witnessed, including (1) the establishment of a unified public health emergency management system; (2) increased investment in biotechnology, particularly pathogen identification, vaccine development, diagnostic technologies and drug production; and (3) the development of a rapid-response system for infectious disease prevention and control (Wei et al. 2016).

3 The following steps were taken to extract data for this paper. First, projects in Africa and the health category were selected. Second, projects that were not in the health category but had a health component (eg education projects but including medical students) were added to the data set. Third, projects marked as umbrella projects, pledges, cancelled or suspended were excluded. The final data set includes 615 projects for the 2000–2014 period. The author then went through each project and assigned subcategories of MTs, infrastructure, donation and training based on the project description. Additional coding was conducted to highlight the specific focus of the project (eg malaria control, general hospital construction, medical scholarships).

4 According to the China Education Yearbook, China trained 240,123 foreign medical students between 1999 and 2011. In 2011, the Ministry of Education reported 27,000 foreign students studying modern medicine and 12,000 studying traditional Chinese medicine in China (Liu et al. 2014).

5 Value based on deflated monetary equivalent to 2014 US dollars of the amount in reported currency.

6 NHFPC was created from the former Ministry of Health and the National Population and Family Planning Commission in 2013.

7 According to Micah et al. (2019), in the period of 2007–2017, 64.1% of Chinese bilateral assistance for health was disbursed by MOFCOM at a total value of $3.7 billion, and 16.1% was disbursed by NHC at $917.1 million.

8 Chinese NGOs have played a very limited role in overseas health assistance (Liu et al. 2014). Yet a number of organisations have engaged in health-related projects in Africa, such as the China Foundation for Poverty Alleviation, the Amity Foundation, Lifeline Express and the Yunnan Foundation of Folk Friendship (Huang 2014).

Additional information

Notes on contributors

Ding Fei

Ding Fei is Clinical Assistant Professor in the School of Sustainability and the School of Geographical Sciences and Urban Planning at Arizona State University. She is a development and economic geographer with research interests in the relationship among state, capital and human agency in the uneven process of China’s globalisation, and its implications for industrial transformation and local capacity building in the ‘Global South’.