At a panel session during the 4th Conference of the Consortium of Universities for Global Health (CUGH) held in Washington, DC, a group of distinguished speakers and leaders on health in China – from the China Medical Board, top universities and the Ministry of Health – were tasked with discussing and elaborating on China's role in global health. The speakers briefly discussed China's history in international health activities (their first deployment of medical teams to Africa dates back to 1963!), different kinds of partnerships in global health - particularly among universities, and examples of current and upcoming initiatives. In sum, the panel suggested a promising future for China’s role in global health.
But when a question was raised (by me) about the size of financial/development assistance for global health from China, either to Africa or globally, none of the distinguished panel members had an answer. One speaker mentioned, as a ballpark figure, that for its medical teams China had given 500 million RMB annually. Another preliminary estimate from a study of multiple ministries finds that for health aid to Africa the central government had given 5.3 billion RMB over 5 years.
So why the fuzzy numbers? One panelist explained that the causes are lack of transparency, combined with bureaucracy of different ministries, not only the Ministry of Health, working in global health. Another panelist commented on the extensive decentralization of global health assistance to different provinces and subnational governments. One metropolitan government, for example, was responsible for all health aid to a single Middle Eastern/North African country, a remarkable division of labor. Together, the size of development assistance for health from China has been very difficult to measure.
Given China’s well-established and growing role in global health, the need to accurately describe the scale and scope of the country’s health aid internationally and to Africa is increasingly important. In order to allocate funds efficiently and equitably, global health policymakers need to know how much countries are spending on healthcare and for what, and where those sources of funds come from. Knowing the full expenditures – from all sources and donors – is a critical component to improving value for money, an issue we've raised in our Value for Money Working Group.
A good starting point for donor information is the Institute for Health Metrics & Evaluation’s (IHME) recently released report on global health financing, which reveals to some extent where funds are being allocated and for what. But, while relatively comprehensive, the IHME report doesn’t quantify south-south development assistance for health, perhaps its most major weakness. Information on Chinese health aid will be increasingly essential to include in this important report.
The speakers at the panel noted that the recommendation had already been made (unclear by whom exactly) to the Chinese government to use an information system to which each ministry and subnational government must report their global health activities. If the Chinese government becomes more transparent on its contributions to global health (e.g. by acting in line with the International Aid Transparency Initiative), China will strengthen its role as an emerging leader in global health and help to ensure that country allocations are optimized to achieve global goals for disease control. Moreover, Chinese transparency in global health could serve as a model for other sectors for which China provides development assistance (watch out for forthcoming work on China in Africa by my colleague Vij Ramachandran and others at AidData).
The author thanks the panel members, Denizhan Duran, Jenny Ottenhoff, and Gordon Shen for excellent comments.