Is there a strategy in China’s health official development assistance to African countries?

Chinese health official development assistance (ODA) to Africa has largely increased since the beginning of the 2000's. Even if China now ranks among the top ten bilateral donors for health aid in Africa very little is known about the determinants of Chinese health ODA to African countries. Our objective is to study the factors associated with Chinese health ODA to sub-Saharan Africa in the 2000-2013 period. We investigate the role of three types of factors that might influence the allocation of Chinese health aid: the needs of recipient countries, their merits and the self-interest of China. Chinese health ODA is measured using the 1.2 version of the AidData database constructed by the William & Mary University, the Brigham Young University and the non-governmental organization Development Gateway. In total, 389 health aid projects were financed by China in Africa between 2000 and 2013, accounting for a total amount of 2011 US$789 million. On these 389 projects, 194 (59%) correspond to the dispatch of medical teams, 109 (24%) to the sending of medical equipment or drugs and 77 (16%) to health infrastructure construction or rehabilitation. The annual number of health projects financed by China in Africa has increased sharply after the 3rd Forum on China-Africa Cooperation (FOCAC) in 2006. We study the factors associated with the number of health projects and the amount of ODA received each year by African countries between 2000 and 2013. We stratify the analysis by types of projects (medical team dispatches/infrastructure and medical equipment or drugs projects) and by sub-periods (2000-2006/2007-2013). We use Poisson regressions to estimate both the number of projects and the amount of ODA received as Poisson regressions were shown to outperform OLS and Tobit models in the presence of heteroskedasticity and many zero observations. Pooled regressions, rather than fixed effect regressions, are used in order to exploit both inter and intra-country heterogeneity for the identification of factors associated with the allocation of Chinese health aid. We replicate the analysis using the shares of health projects and health ODA amount received by African countries each year using the fractional probit method relevant for the case of proportions as dependent variables Our results show that the motives of Chinese health aid have changed over the 2000-2013 period. In particular, Chinese political and economic interests, as measured by recipient countries' UNGA voting alignment with China and openness rate to China, were less important in Chinese health aid allocation decisions over the 2007-2013 period that followed the 3rd FOCAC compared to the 2000-2006 period. On the contrary, taking into consideration health needs of recipient countries became more visible in Chinese health aid allocation decisions after 2006. Then, Chinese health diplomacy seems to have evolved from a rather "selfish" aid focused on political and economic self-interests to a more altruistic aid focused on health needs of recipient countries. The empirical analysis also highlights the complementarity of Chinese health ODA with its ODA in other sectors and that the allocation of Chinese health aid in African countries does not appear to be heavily related to health aid provided by traditional bilateral donors, suggesting that health aid cannot be seen as a way for China to promote its international visibility.