Health Diplomacy: In Africa, China’s Soft Power Provides a Healing Touch

Much has been made about China’s commercial push into Africa. But a less-publicized facet of its foreign policy strategy there is actually helping millions of Africans. Sometimes dubbed "health diplomacy," China has been offering much-needed medical aid to African countries for over half a century as a soft power strategy to strengthen bonds with African governments. This tactic has, in turn, paved the way for Chinese companies to profit in Africa. In addition, the Chinese government has been able to influence the way African countries have supported China on the international stage, including the United Nations and the World Trade Organization.

The medical help that China has been providing includes sending doctors overseas to staff clinics, building hospitals and clinics, and training African medical staff in China. Though Africa has had to depend on foreign countries to alleviate some of its dire health issues, China may be the only country to send government-paid medical workers to work and stay in Africa for extended periods of time. That level of commitment has proven to be an important facet of its soft power foreign policy strategy. Many other medical organizations working in Africa are sponsored by charities or private groups, not governments.

Soft power is the ability to co-opt other countries by getting other nations to want what you want. Political scholar Joseph Nye coined the term "soft power" in the late 1980s and then later wrote a book called Soft Power: The Means to Success in World Politics.

"Using medical teams as a ‘soft power’ strategy is a new term for something that China has been doing for decades," notes Elizabeth Larus, professor of political science at the University of Mary Washington.

Aid For Influence

It’s not just China that has been implementing soft power as a tactic. The U.S. and other democratic governments do this too but their mission encompasses other goals. "Soft power consists of democracy, human rights and humanitarianism, culture, and [advancing their] high-tech sector," Larus says. "China’s soft power does not consist of democracy and human rights, but can promote soft power by using medical teams." In fact, China is known to provide assistance to African countries with almost a "no-strings-attached" policy, making the nation very popular with some controversial African governments.

Deborah Brautigam, professor at the School of International Service at American University, notes "China does this all over in the South Pacific and the Caribbean. Not as much in the Middle East but they do. They have aid programs in Syria and in Egypt." Cuba also implements a similar exchange with Venezuela, consisting of medical aid for oil, she adds.

"It’s very important for China to build relationships with Africa," Brautigam says. "There are 53 countries in Africa, each has a vote in the United Nations and most have a vote in the World Trade Organization (WTO). It’s important for China to befriend these nations because they want support in these international bodies. They want support on Taiwan, Xinjiang, and Tibet. They regard these as internal issues and they think aid helps."

In China’s first public white paper on foreign aid published in April this past year, China reported that 51 (out of the 53) countries in Africa received aid from China. Nearly 46% of its funds in 2009 were distributed to Africa, outweighing the funds that went to other parts of Asia.

By the end of 2010, China has sent 17,000 medical workers to 48 African countries, treating 200 million patients, according to China’s Ministry of Health. In 2009 alone, 1,324 medical professionals worked at 130 institutions in 57 developing countries. Of that number, more than 1,000 Chinese doctors were in 40 African countries, reports China Radio International.

Foreign Aid Expansion

Since the program began in 1950, China has contributed $US39 billion (256 billion yuan) in foreign aid, according to The Guardian newspaper. More than 40% were allocated to "aid gratis," or grants, while the other 60% were distributed between interest-free loans and concessional loans. Concessional loans are used to finance major capital projects with the aim of generating profit. The money is used in the construction of transportation, communications and electricity infrastructure, while less than 9% has been given to developing oil and mineral resources, writes The Guardian. The money for the concessional loans is raised on the market by the Export-Import Bank of China, while grants and interest-free loans are distributed from government finances. "Now that China has more money, they’ve expanded their foreign aid program even more so with loans," Brautigam says.

"Concessional loans are relatively new instruments introduced in 1995," Brautigam continues, "but the mutual benefit is they’re tied to Chinese companies and foster Chinese exports." She also estimates that China’s biggest expansion in their foreign aid sector is in concessional loans, accounting for the bulk of aid that has doubled between 2006 and 2009.

The majority of the foreign aid funds have gone into building hospitals and clinics, establishing malaria prevention and treatment centers, dispatching medical teams as well as training local medical workers, and providing medicines and equipment. By the end of 2009, China built over 100 medical facilities with over 30 hospitals currently under construction all over the world.

Around 30 malaria prevention and treatment centers have been built in Africa countries and approximately $US30 million (190 million yuan) of anti-malarial medicines have been distributed. China has helped build hospitals in the Central African Republic, Guinea-Bissau, Zimbabwe, and Chad. They’ve also financed the building of the Ta’izz Revolution Comprehensive Hospital in Yemen and another hospital in Laos.

When China didn’t have much money early on in its foreign aid outreach, China sent medical teams abroad instead of providing funds, according to Brautigam. She adds that China had started sending their doctors overseas when the country didn’t have much money. Now that China has money, health diplomacy is still a very effective relationship-building strategy. "It’s very popular and people really appreciate [the Chinese doctors] treating their illnesses," Brautigam says.

In 1963, the first Chinese medical team arrived in Algeria, the first year that the country was founded and there was a dire need for health care in the fledgling nation. "In the 1960s, Mao tried to position China as the leader of the Third World," Larus notes. "Taiwan has been sending medical teams to poor countries for decades as well. So some of the impetus for sending medical teams is historic. Some of it is competition with Taiwan for diplomatic partners, although China and Taiwan have called a truce since the election of Taiwan president Ma Ying-Jeou."

According to Brautigam, most of the Chinese provinces are partnered with an African country to provide doctors. Some provinces staff more than one nation. Many of the host nations provide accommodation for the Chinese medical teams, who are employed by the government. Depending on the level of income in the country, the contracts vary. "There isn’t one standard package," Brautigam says. Doctors are sent for a two-year rotation but Brautigam has noticed that it’s been harder and harder to convince Chinese doctors to agree to go to Africa. "They don’t always feel the need to be a Peace Corps volunteer but some do," she adds. Brautigam’s observed that in some cases, rural Chinese doctors have been recruited to fulfill the provincial obligation to staff African clinics.

China’s Important Step

Another aspect to the Chinese medical assistance program is that Chinese companies have begun to sponsor medical missions themselves. Last year, the first large-scale private charity mission sponsored by Chinese companies doing business in Africa took place. It was called "an important step in Chinese companies’ reward for African people," in a press release from HNA Group, a Chinese company that was involved in the project. Called the 2010 China-Africa Brightness Action, Anhui Foreign Economic Construction (Group) and HNA Group, along with the Beijing Tongren Hospital, sent more than 20 medical personnel on a charter flight to Malawi and Zimbabwe to perform 1,000 cataract surgeries in one week.

In the future, China is showing no signs of letting up on its medical aid to Africa. Chen Zhu, China’s Health Minister, announced at an international conference on China-Africa cooperation on health held in February 2011, that China plans on sending 3,000 medical specialists to developing countries in the next five years. They will also provide medical equipment and medicines for 100 hospitals. In addition, there are plans to train 5,000 medical personnel, according to an article in the People’s Daily Online. While China has focused on the prevention of malaria, tuberculosis, AIDS, and other diseases in the past, the government plans on broadening its focus on maternal and pediatric health.

"All aid has a diplomatic component," Brautigam says. "The mutual benefit is all tied to Chinese companies and getting businesses started to foster Chinese exports. Today, their soft power strategy is working pretty well. Soft power builds up positive aspects of their image." And as medical aid is a vital component of China’s soft power strategy in Africa, it’s demonstrated itself as a very influential tool to pave the way for Chinese businesses to expand in one of the most potentially lucrative markets in the world.

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