Portal de Periódicos da CAPES

China's provincial diplomacy to Africa: applications to health cooperation

2014; Taylor & Francis; Volume: 20; Issue: 2 Linguagem: Inglês

10.1080/13569775.2014.907993

1469-3631

Gordon C Shen, Victoria Y. Fan,

HIV/AIDS Impact and Responses

AbstractThere is a prevailing view of China as a unitary actor in its relationships with African countries. This view is incomplete: on the contrary, China is a collection of provinces, autonomous regions and municipalities with myriad strategic ties to African countries, with decentralization shaping the current form of Chinese government and its level of efficiency. In this paper, factors have been explored for why Chinese provinces have played a role in foreign cooperation in health of African countries, in addition to trade and foreign direct investment. Incentives and disincentives for Chinese provinces to engage internationally in foreign cooperation and health assistance have been identified. The concept of paradiplomacy for health has been presented and this typology has been applied to the example of Chinese medical teams. Finally, we draw linkages between China and other members of Brazil, Russia, India, China, and South Africa.Keywords: ChinaAfricaBRICSprovincesparadiplomacydecentralizationglobal healthaid development assistance AcknowledgementsWe thank Cheryl Schmitz and Nora Kleinman for their helpful comments. We also thank the International Health Exchange and Cooperation Center of China's National Health and Family Planning Commission for the invitation to present an earlier draft of this paper at the Fourth China Health Forum on 17 August 2013.FundingAt the time this paper was written Gordon C. Shen was supported by the Fulbright–Fogarty Fellowship in Public Health, the U.S. Department of State's Bureau of Educational and Cultural Affairs as part of its flagship Fulbright Program, and the Fogarty International Center, through the Fogarty Global Health Fellows Program Consortium [5R25TW009340-01].Notes1. The Next 11 (N-11; Bangladesh, Egypt, Indonesia, Iran, Mexico, Nigeria, Pakistan, Philippines, Turkey, South Korea, Vietnam) might be the next generation of developing economies, after BRICS, to transition from receiving aid for health to spending more on health domestically and even giving aid for health cooperation. In spite of the favourable attention N-11 countries have been receiving as the next generation of states with promising economic growth, administrative divisions within BRICS countries are comparable to N-11 countries in terms of economic size, commodity output, trade, and labour capital.2. Nye (Citation2005) said coercion (i.e. security), payments (i.e. commerce, trade), and attraction (i.e. soft power diplomacy) can induce changes in other's behaviour. There is a diverse range of examples relevant to this study, including ideational exchange, human resource development, education, and language exchanges.3. Zhou Enlai's 'Eight Principles for China's Aid to Third World Countries' include equality and mutual benefit; respect sovereignty and never attach conditions; provide interest-free or low-interest loans; help recipient countries develop independence and self-reliance; build projects that require little investment and can be accomplished quickly; provide quality equipment and material at market prices; ensure effective technical assistance; and pay experts according to local standards. These principles were reiterated in the Busan Partnership for Effective Development Cooperation, among other occasions.4. Crude petroleum and oils obtained from bituminous minerals constitute as 74% share of China's top five imports from Africa in 2006.5. Provincial outward FDI (in millions) and trade (in billions) are reported annually by the Ministry of Commerce. The Ministry of Commerce's statistical bulletin also contains African recipients of China's outward FDI and trade, but the linkages between Chinese provinces and African countries are not clear.6. Examples of blocs of African countries include the AU, the African Group, the African–Caribbean–Pacific Group, the Leader Developed Countries (LDC) Group, the Small and Vulnerable Economies Group, and the G90.7. The first documented Chinese overseas health assistance is the dispatch of Chinese medical teams to Algeria in March 1963 following Algeria's resistance against French colonialism, which itself resulted in a shortage in the Algerian health workforce. China's focus areas in health assistance has since diversified to include building malaria prevention and treatment centres, clinics, and hospitals, providing medicines and equipment, and training African health workforce in Africa or providing scholarships for training in China. These are found in Appendix 2.8. China has technical know-how to share with African countries based on its history of combating infectious diseases and improving public health. It has accelerated healthcare reform domestically since 2009, so there is ample room for mutual learning around health system efficiency, quality of care, and universal health coverage. AidData's Tracking Chinese Development Finance to Africa has data related to hospitals, equipment, pharmaceuticals, medical teams, training workshops, and scholarships. However, we did not include them in Appendix 2 because they are not consistently classified by Chinese province of origin. It should also be noted that this discussion precludes the participation of China's private sector, even though we recognize their engagement in social ventures, research and development, and global health spending in order to fulfil their corporate philanthropic and social responsibility missions. The drugs, medical supplies, and equipment have the potential to independently improve health service delivery systems in Africa.9. China (since 1978) and Russia (since 1992) have made the transition from a socialist to market economy. This transition involved major economic and political reforms. Economic reform measures China and Russia have in common are liberalization of price system, macroeconomic stabilization, enterprise restructuring, and privatization. Institutional reforms are legalities adopted to support the market economy.10. Newly appointed Chinese President Xi Jinping made his first tour to Africa in March 2013 with visits to South Africa, Tanzania, and the Republic of Congo. His predecessor, Hu Jintao, made a total of 4 tours to 18 African countries during his term in office.