China's Global Health Activities in Africa: Historical Perspectives and Case Studies

In this study, the authors describe the evolution of the People's Republic of China's global health activities and related policies in Africa from the 1960s through the present and provide field case studies of two African nations-Sierra Leone and Kenya-that have received health aid from China. They then analyze China's use of global health support in Africa as a tool of soft power. The need to understand China's global health activities has intensified, given that Western, particularly U.S., foreign health aid policies are changing, prompting questions about whether China will shift its policies to strengthen its soft power in Africa and away from the decade-old Belt and Road Initiative's overarching Sino-centric trade focus. This analysis of China's health aid history, its current role in African health aid, and its recent reform called for by President Xi Jinping's Global Development Initiative is intended to help U.S. policymakers understand China's decisionmaking and implementation strategy for foreign aid. The analysis of the advantages and weaknesses of China's approaches can offer lessons to both donor countries and African countries that receive global health aid from China. The authors offer policy recommendations for the United States and for African countries.