Estimating Chinese bilateral aid for health: an analysis of AidData's Global Chinese Official Finance Dataset Version 2.0

Abstract

Background: Although it is difficult to quantify, previous estimates suggested that China's global health aid has increased sharply since the early 2000s. Unlike many donors, China has no official aid reporting obligations, nor does it voluntarily disclose detailed aid information. Our study aimed to create a standardised estimate using commonly accepted definitions of aid and frameworks for categorising health projects.

Methods: We categorised AidData's Chinese Official Finance Dataset health-related projects according to health aid frameworks from the Organisation for Economic Co-operation and Development (OECD) and the Institute for Health Metrics and Evaluation (IHME). Only projects that complied with the definition of official development assistance were included. We analysed the project count and financial value to assess China's priority health aid areas.

Findings: Between 2000 and 2017, China funded 1339 health-related aid projects, or 13% of its total aid project portfolio. Most of these projects were located in sub-Saharan Africa. According to the OECD framework, the priority focus areas of these projects were: medical services, such as specialty equipment and tertiary services (n=489, 37%); basic health care, such as basic medical services and drugs (n=251, 19%); malaria control (n=234, 18%) and basic health infrastructure (n=178, 13%). Under the IHME framework, health systems strengthening accounted for 74% (n=991) of total projects, primarily due to China's contributions to human resources for health, infrastructure and equipment. The only other major allocation under the IHME framework was malaria (n=234, 18%). When we estimated missing financial values under the OECD framework, China was the fifth largest health aid donor to African countries from 2002 to 2017, after the USA, the UK, Canada and Germany.

Conclusion: Our findings enable a better understanding of Chinese health aid in the absence of transparent aid reporting, which could contribute to better coordination, collaboration and resource allocation for both donor and recipient countries.

Keywords: health economics; health policies and all other topics; health policy.

Figure 1

Projects included in analysis. ODA, official development assistance. OOF, other official flows.

Figure 2

China’s aid flow. (A) China’s aid flow by sectors, measured by cumulative aid project count between 2000 and 2017; (B) China’s health sector aid flow by year (2000–2017), measured by aid project count; (C) breakdown of flow types among China’s top aid sectors (2000–2017). Include all official finance. From left to right, ranked by project count with education being the largest sector and emergency response being smallest sector. ODA, official development assistance. OOF, other official flows.

Figure 3

China’s health aid priorities, measured by cumulative aid project count between 2000 and 2017. (A) Top recipients of China’s health aid (2000–2017); (B) top subsectors of China’s health aid under OECD framework (2000–2017); (C) top subsectors of China’s health aid under IHME framework (2000–2017). HSS, health system strengthening; IHME, Institute for Health Metrics and Evaluation; OECD, Organisation for Economic Co-operation and Development.

Figure 4

Chinese health aid financial estimates. (A) Chinese health aid financial estimates by year (2000–2017); (B) moving average of Chinese health aid financial estimates by OECD and IHME framework; (C) top subsectors of Chinese health aid projects by cumulative financial estimates between 2000 and 2017 under OECD framework; (D) top subsectors of Chinese health aid projects by cumulative financial estimates between 2000 and 2017 under IHME framework. HSS, health system strengthening; IHME, Institute for Health Metrics and Evaluation; OECD, Organisation for Economic Co-operation and Development; NCDs, non-communicable diseases.

Figure 5

(A) Top recipients of Chinese health aid, measured by cumulative financial estimates between 2000 and 2017; (B) cumulative bilateral health aid to African countries, 2002–2017. Values shows in millions, US$ constant 2017. China estimate is based on OECD framework (US$2371). The IHME framework estimate is US$2078. In total, there are 23 Developmental Assistance Committee (DAC) members. Membership can be found here: https://www.oecd.org/dac/development-assistance-committee/. AidData’s database does not account for disbursements to multilateral funds and therefore, our estimate and comparisons reflect bilateral aid to countries only. IHME, Institute for Health Metrics and Evaluation; OECD, Organisation for Economic Co-operation and Development.