Publication: China Brief Volume: 5 Issue: 21

China’s relations with Africa have steadily deepened and strengthened since the founding of “new China” in 1949. Evolving from ideologically-driven interactions during the Cold War, today’s China-Africa relations combine pragmatic economic and political means to achieve China’s objective of establishing a world order that is peaceful and conducive to continued economic growth and stability at home. In the 1960s and 1970s, China supported liberation movements in several African countries, gave aid to socialist nations to build stadiums, hospitals, railroads and other infrastructure, and cemented relations through a steady stream of expert engineers, teachers, and doctors. Today, Chinese officials travel to Africa accompanied by bankers and businesspeople, promoting political and economic commerce that expands China-Africa ties in a sustainable fashion. While trade and diplomacy are driven by China’s newfound economic strength and subsequent demand for raw materials, China continues to support longstanding programs that deliver aid to underserved African citizens, such as sending teams of doctors and providing medicines. Following the framework set out by the first China-Africa Cooperation Forum in 2000, China-Africa relations are set to advance through a combination of traditional financial aid and technical support programs, along with rapidly growing bilateral trade and investment.

China is an appealing partner for many African countries for a variety of reasons. China’s approach to bilateral relations and economic development, characterized by Joshua Cooper Ramo as the “Beijing Consensus,” provides an alternative to development and political economic reforms espoused by “the West” and typified by the “Washington Consensus” of the World Bank and IMF. Beijing’s consistent respect for other nations’ sovereignty and steadfast refusal to criticize or involve itself in the internal affairs of African nations earns it the respect of leaders and elites who have benefited from poor governance and opaque political systems and are reluctant to implement painful economic or political reforms demanded by the West. African leaders’ embrace of the Beijing Consensus reflects perhaps what is most attractive about Beijing’s “soft power:” a long-standing history of friendly ties, provision of appreciated, “no-strings-attached” financial and technical aid to both elites and the most needy, and growing commerce between the world’s largest developing nation and the continent with the most developing nations.

China’s Soft Power and the “Beijing Consensus”

“Soft power,” following Joseph Nye’s formulation, includes a country’s culture, political values, foreign policies, and economic attraction as essential components of national strength, providing the capacity to persuade other nations to willingly adopt the same goals. While China’s culture prevailed for centuries from the Tang Dynasty through the mid-Qing, it no longer competes with cultural icons emanating from the United States. Undeterred, Chinese leaders and businesspeople have leveraged China’s strengths, which include a pragmatic approach to international relations based on the principle of non-interference in domestic affairs. China’s economic development model, the Beijing Consensus, refutes Western notions of political liberalization or economic reforms as indispensable for long-term, sustained development. China has effectively exported its notion of economic development with Chinese characteristics to its African trading partners, encouraging them to develop their economy through trade and investment in infrastructure and social institutions, without dictating terms for political or economic reforms. With an expanding manufacturing sector, China’s growing need for raw materials, energy and new markets for cheap consumer goods make its economy relatively complementary to many African ones. While the light industrial manufacturing sectors in many African nations are suffering from growing imports from China, the dominant extractives industries are benefiting from Chinese capital investment as well as a seemingly bottomless market. China’s respect for national sovereignty is attractive not only to Zimbabwe’s Mugabe, but scores of other African nations that are reluctant to implement economic and political reforms considered necessary by Western donor institutions and countries.

The principle of non-interference does not mean that China rejects political and economic reform per se in Africa. Indeed, China is careful to support African-led efforts to develop sound governance and sustainable development throughout the continent. Recognizing that good governance and political reforms are vital to the long-term development of African nations, 19 nations have joined the “New Partnership for Africa’s Development” (NEPAD), a consensus framework of the member countries to promote sustainable development, good governance, poverty reduction, and stop the marginalization of African economies in an increasingly globalized world. While China supports NEPAD, it repeatedly stresses that it does so through the framework of the China-Africa Cooperation Forum, thereby avoiding the potentially awkward position of having to support the key structural elements that are ultimately necessary for NEPAD’s success: transparency, democracy, free press, civil society, independent judiciary, and rule of law—all areas where China has resisted substantial reform and has relatively little to contribute technologically.

The strength of China’s African relations and the source of much of its soft power stems from more than just the relatively recent growth in trade and investment. Throughout its history of cooperation with African nations, China has emphasized that it has “given what it could” in terms of financial aid and technical support and it continues to do so even as its ability to promote relations through economic incentives—primarily trade, tourism, and investment—has grown. Technical support, without political “strings attached” (other than affirmation of a “one China policy”) has remained a significant aspect of China’s support for African states. Under the auspices of the China-Africa Cooperation Forum, China has committed to contributing to the development of human resources in Africa by establishing a fund that is jointly administered and used by various Chinese ministries (Foreign Affairs, Commerce, Education, Science and Technology, Agriculture and Health) in order to train African personnel. As of 2003, over 6,000 Africans had been trained as part of the program (Beijing Review, January 20, 2005). Scholarships for over 1,500 African students are annually awarded by China, while many Chinese universities have established relationships with African institutions (Xinhua, December 16, 2003). These programs create enduring bonds between Chinese and African institutions and individuals. While university scholarships promote closer ties between China and African elites, China has also promoted “health diplomacy” with African partners, establishing a relationship between Chinese doctors and millions of ordinary Africans, and earning the gratitude of many African leaders eager to be seen providing public goods to their citizens.

Medical Teams and Health Diplomacy as Soft Power

China has a long history of conducting active “heath diplomacy” programs with African and Middle Eastern countries. China’s early relations with many African nations included significant aid in the form of infrastructure, scholarships for African elites to study in Chinese universities and the deployment of teams of doctors. Today, these institutions remain, either as direct government support or under the auspices of the China-Africa Cooperation Forum. While China’s growing trade and infrastructure investments in Africa have been the subject of increasing discourse, there has been little discussion of a long standing and still influential segment of China’s soft power in Africa: health diplomacy.

Today, China regularly conducts cooperation in the field of health, including numerous ministerial visits with African leaders to facilitate the regular exchange of medical teams and training for medical professionals. China also provides medicine and medical equipment free of charge to several African countries, and has active programs to jointly prevent and treat infectious diseases including malaria and HIV/AIDS. In 2002, the Chinese Ministry of Health conducted a two-part international training course in techniques for the prevention and treatment of malaria and tropical diseases, in which 30 students from 17 African countries participated (1st International Training Course on Malaria Control, September 10, 2002). That same year, as part of the China-Africa Cooperation Forum, China convened a Sino-African forum on traditional medicine and pharmaceuticals which was attended by participants from 21 African countries (World Health Association, October 31, 2002).

China deployed its first medical team in 1964 at the invitation of the Algerian government. Since then, China has cumulatively sent over 15,000 doctors to more than 47 African countries and treated approximately 180 million African patients In 2003, China deployed a total of 860 medical personnel in 35 teams to 34 countries (Xinhua, December 16, 2004). Chinese doctors that are part of the medical teams, known as yiliaodui, normally spend up to two years in-country. Many doctors have served on medical teams more than once. Additionally, Chinese military medical units have been deployed on UN Peacekeeping operations in Africa, providing medical assistance to other peacekeepers (many of whom are from African nations), as well as civilians. The PLA Navy’s number 401 hospital in Qingdao has also sent medical teams to Zambia in the past. Civilian medical cooperation is institutionalized with the health bureaus of individual Chinese provinces, thus maintaining long-term commitments to provide medical workers and aid to specific countries (see table below).

This long term medical cooperation builds person-to-person relations between Africans and Chinese, and brings benefits to both sides. Like the many sports stadiums, highways, and other infrastructure such as the Tanzania-Zambia Railway built in 1976 (and refurbished this year) by the Chinese, the medical teams are publicized by both Chinese and African leaders as a tangible public good. Yet China’s capacity to send large numbers of medical doctors to Africa is limited, and the program faces an uncertain future over the long term. Many provincial budgets are increasingly stretched by a shrinking tax base since rural tax reforms have been implemented. The health needs of many Chinese are also not being met and government doctors are increasingly called upon to deal with public health issues at home. Additionally, given that the Chinese medical system is increasingly privatized, more doctors are less inclined to accept a two-year posting in Africa, particularly because they currently subsidize their meager government stipend with income generated through patient fees and medicine sales. Medical bureaus in some wealthy provinces have reportedly been forced to recruit doctors from inland provinces in order to fulfill their yilaodui obligations.

African support for the program remains strong, however, as evidenced by the willingness of participating countries to sign bi-annual treaties that invite the teams and settle the terms of the mission. According to the treaties negotiated between China and the countries receiving medical teams, all but the poorest of the recipient countries pay the medical team’s expenses, such as international airfares, doctor and support staff stipends (including Chinese cooks!), as well as the cost of some medicine and equipment that is brought by the team. For the poorest countries, China covers the costs of the team’s travel and the equipment and medicines that the teams import with them, permitting the hospitals where they work to sell the drugs to help the countries cover the cost of hosting the medical teams. Granted, while many countries offset the costs of paying the expenses and salaries of the medical teams with grants and loans from China or other donor nations, host nations repeatedly demonstrate their appreciation by continuing the program and covering the expenses of the team out of national budgets. Medical teams are also regularly given national awards in Africa and China for their contribution.

China’s influence and sound relationships in Africa are the result of many years of investment in building relations through aid, trade, and cultural and technical exchange—not just the byproduct of China’s recently booming economy and soaring demand for African raw materials. China’s strong sense of national sovereignty and willingness to conduct commerce without political “strings” certainly contribute to its success. The ability to “see no evil” is a convenient aspect of the “Beijing Consensus,” and its rejection of unpalatable aspects, such as economic “shock therapy” or political reform, make China all the more welcome in many African capitals. China’s approach to Africa, including the way it conducts business and the provision of aid, technical support, and the dispatch of medical teams, are all key components of China’s influence on the continent.


Chinese Provincial Health Bureau Medical Team Cooperation with African Countries* (see PDF for table)