Understanding China’s shifting priorities and priority-setting processes in development assistance for health

Author:

Guo Bingqing1ORCID,Fan Victoria2,Strange Austin3ORCID,Grépin Karen Ann1

Affiliation:

1. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong , 7 Sassoon Road, Pok Fu Lam, Hong Kong SAR, Peoples’ Republic of China

2. Senior Fellow, Center for Global Development , Washington, DC 20036, The United States

3. Assistant Professor, Department of Politics and Public Administration, Faculty of Social Sciences, The University of Hong Kong , Hong Kong SAR, Peoples’ Republic of China

Abstract

Abstract Over the past two decades, China has become a distinctive and increasingly important donor of development assistance for health (DAH). However, little is known about what factors influence China’s priority-setting for DAH. In this study, we provide an updated analysis of trends in the priorities of Chinese DAH and compare them to comparable trends among OECD Development Assistance Committee (DAC) donors using data from the AidData’s Global Chinese Development Finance Dataset (2000–2017, version 2.0) and the Creditor Reporting System (CRS) database (2000–2017). We also analyse Chinese medical aid exports before and after the start of the COVID-19 pandemic using a Chinese Aid Exports Database. We further explore the potential factors influencing China’s shifting priority-setting processes by reviewing Chinese official documents following Walt and Gilson’s policy analysis framework (context–actors–process–content) and by testing our conjectures empirically. We find that China has become an important DAH donor to most regions if measured using project value, including but not limited to Africa. China has prioritized aid to African and Asian countries as well as to CRS subsectors that are not prioritized by DAC donors, such as medical services and basic health infrastructure. Chinese quarterly medical aid exports almost quintupled after the start of the COVID-19 pandemic. Noticeably, China has allocated more attention to Asia, eye diseases and infectious disease outbreaks over time. In contrast, the priority given to malaria has declined over the same period. Regarding factors affecting priority shifts, the outbreaks of SARS and Ebola, the launch of the Belt and Road Initiative and the COVID-19 pandemic appear to be important milestones in the timeline of Chinese DAH. Unlike stereotypes of China as a ‘lone wolf’ donor, our analysis suggests multilateral processes are influential in informing and setting Chinese DAH priorities.

Publisher

Oxford University Press (OUP)

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