Question of the Week: China in Africa Part III

This is the third Question of the Week post about Chinese involvement in Africa. Last week, we focused on the debate of whether Africa or China itself benefits more from Chinese aid. The week before that, we discussed the challenges of measuring China’s aid to Africa and the country’s South-South aid philosophy. This week, we look at the benefits and drawbacks of Chinese health aid to Africa.  

The China-Africa relationship is in the news once again. At last week’s Forum on China-Africa Cooperation (FOCAC), Beijing promised to disburse $20 billion in manufacturing and agriculture loans, bring 1,500 medical professionals to the continent, provide 18,000 Africans with scholarships, and more.

Rhetoric at the highest levels of government underscored the debates over China’s involvement in Africa. Chinese President Hu Jintao emphasized the mutually beneficial nature of the China-Africa relationship, arguing that China-Africa cooperation “meets the fundamental interests of China and Africa and conforms to the global trend of peace, development, and cooperation.” South African President Jacob Zuma, meanwhile, declared, “Africa’s commitment to China’s development has been demonstrated by supply of raw materials, other products and technology transfer. This trade pattern is unsustainable in the long term. Africa’s past economic experience with Europe dictates a need to be cautious when entering into partnerships with other economies.”

China’s pledge to send 1,500 healthcare professionals to Africa highlights an ongoing area of focus of Chinese foreign aid. As early as 1963, China gave health assistance to newly independent Algeria. As the Knowledge@Wharton Network reports, using information from Chinese sources, “By the end of 2010, China [had] sent 17,000 medical workers to 48 African countries…In 2009 alone, 1,324 medical professionals worked at 130 institutions in 57 developing countries. Of that number, more than 1,000 doctors were in 40 African countries…”

Like much of its other assistance to Africa, Chinese health aid arguably has a notable commercial element. Beginning in the 1990s, Chinese health aid to Africa started on a for-profit track, according to Council on Foreign Relations senior fellow Yanzhong Huang.  As Huang writes, “Instead of treating foreign aid as purely a ‘political task’ or providing only ‘one-way’ free aid, China now emphasized the economic aspect of foreign aid and used it to promote mutual benefits and trade. Accordingly, the medical teams in some recipient countries began to charge fees for medicines and services, and to use the revenue to purchase medical products made in China (which was counted as China’s foreign aid).” Indeed, the distinction between China’s health aid and commercial activity can be ambiguous; for instance, “It is not clear whether a $6 million hospital built by a Chinese company in Kinshasa, Democratic Republic of the Congo, in 2004 was a grant or linked to a commercial activity,” says David Shinn, a former U.S. ambassador to Ethiopia and Burkina Faso.

However, for-profit health assistance may benefit Africa all the same. “These for-profit ventures may not exactly conform to the same idea of health diplomacy as the donated clinics, but they do further the objective of providing healthcare in under-served areas of Africa to help improve China’s stature on the continent. Few patients will necessarily know whether a particular clinic comes from China as a non-profit or for-profit enterprise; the patients instead recognize that they now have access to health care,” argues Jeremy Youde, assistant professor of political science at the University of Minnesota, Duluth.

A hallmark of Chinese health aid to Africa is antimalarial efforts. China has contributed 30 antimalaria clinics to Africa, and the country has a long and complex history of work on antimalarial drugs. “China is exploring cost effective ways to help the Third World and is interested in making distinct contributions…Malaria suits these requirements. It is not that expensive. It is cheaper than fighting AIDS,” says Joseph Cheng, politics professor at Hong Kong’s City University. Treating malaria also represents a profit opportunity for Chinese companies. Particularly after 1999, “Health aid was repackaged to promote the exports of Chinese pharmaceuticals,” writes Yanzhong Huang of the Council on Foreign Relations.

China’s work with malaria in Africa highlights the challenges that both sides face in establishing effective foreign-supported healthcare programs. On one hand, China’s antimalaria efforts have provided the continent with much-needed services and healthcare options. “To help Africans fight malaria, China has adopted several measures, such as dispatching CMTs [Chinese medical teams], conducting training programs, providing free facilities and drugs, and building antimalarial centers,” Peking University professor Li Anshan reports. He adds that “Antimalaria efforts are a major task for CMTs, which usually distribute free medicine to patients. Cotecxin—the most effective antimalarial drug produced in China—and acupuncture [which alleviates a limb ailment associated with malaria treatment] have enjoyed a great reputation in Africa.”

However, China’s antimalaria programs and drugs have come under scrutiny. Problems include reportedly insufficient training for African medical professionals in China-sponsored malaria treatment centers, as well as inadequate clinical trials for some antimalarial drugs. Some African medical facilities are thus unable or unwilling to use the drugs, according to the Financial Times. Additionally, counterfeiting threatens the credibility of Chinese-made medicines.  Fake antimalarial drugs, apparently made in China, have serious consequences for public health efforts in Africa, as The Guardian reports. In addition to endangering patients’ health, widespread use of ineffective antimalarial drugs also creates drug resistance.

What do you think?

This is the third and final Question of the Week post about Chinese involvement in Africa (you can read the first post here and the second post here). Please let us know what you think about China’s involvement on the continent. Does it lead to positive outcomes or does it actually impede development? Are the costs to Africa too high? Are its critics unjustified? Use the Comments section below, and stay tuned for new Question of the Week posts soon. You can also receive updates from the Development Channel by email.