What role will China play in global health and how will we work together?

China has historically been a recipient of development assistance and funding, but this is changing with the country’s economic development, continuing rise, and with increasing pressures on aid budgets of other donors.

Alongside trade, investment and infrastructure, health is becoming an area to watch. How will China engage, and how should existing donors work with this new entrant to the global health scene? Itad is evaluating an innovative DFID programme, the Global Health Support Programme, which is supporting China’s engagement in global health and providing evidence on how China and the UK can collaborate.

China – an emerging development model? 

China’s phenomenal economic development over the last thirty years has led to staggering changes within China and, due to the country’s size, contributed significantly to changes in global indicators, including poverty reduction, health and social indicators.

Starting in the 2000s, China’s approach to economic development started to attract attention as a possible alternative to dominant development theories, with innumerable attempts to decipher how China has its managed transition from a poor and isolated country and managed its process of economic development. Alongside this focus on economic development, researchers and development agencies have started to ask whether China might not be doing something right in other areas too – in areas such as improving health.

Analyses of the state of China’s health and healthcare from the late 2000s onwards show increasing interest in China’s experience of improving population health and reforming its health system, but also a change in the framing of this debate. Whereas in the mid-2000s, China’s health system reforms were judged, officially, to have been a failure, the government has since kicked off substantial reforms aiming to increase access to treatment and reduce the economic burden of healthcare seeking, including poverty arising as a result of spending on health, and the country has recorded strong performance on the MDGs. While it is hard to assess the results of many policies and initiatives, the tide of international opinion appears to be changing.

The emergence of ‘rising powers in development’, such as the BRICS, and regional powers such as Mexico and Indonesia, comes at a time when many traditional donors’ aid programmes face pressure from austerity policies or are being curtailed for ideological reasons. The UK Department for International Development has ceased bilateral aid to China, and in 2011 signed a new MoU with the Chinese Ministry of Commerce on China-UK partnership for global development – cooperation based on an idea of ‘China for the world’. Other agencies and donors are also exploring how to work with China as an emerging donor through various forms of ‘trilateral’ cooperation.

What is Itad doing?

Itad is carrying out the evaluation of the Global Health Support Programme (GHSP), a programme under the new MoU. The programme is supporting greater overseas Chinese engagement in health through capacity building, policy support and piloting of overseas health interventions by Chinese agencies. The evaluation has been tracking the GHSP as it has been implemented, and is looking at a number of main components of work underway: developing capacity of Chinese agencies to engage in global health and overseas programming, analysing aspects of China’s experience of improving population health as a basis for expanding the scope of China’s health aid, supporting coordination in China’s approaches to global health through policy support and development of a Chinese global health network, as well as on the ground health interventions by Chinese agencies in Tanzania (malaria control) and Myanmar (maternal and child health). The programme will finish in mid-2018, and the evaluation will run until then.

As a frontrunner in a new kind of collaboration with China and Chinese agencies, the GHSP has the potential to generate useful lessons not just for cooperation in global health, but more broadly. As China gains confidence as a global actor with a story to tell of its own successes, and becomes increasingly willing to commit funds and people to overseas engagement, collaborative projects now underway, such as this, are likely to be important steps in exploring how to build functioning collaborations and working relationships for the provision of global public goods with an emerging donor of increasing importance.

Lewis Husain, July 2017

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