Tracking development assistance for health from China, 2007-2017

Accepted/In Press date: 18 August 2019

Published date: 8 October 2019

Additional Information: Funding Information: Additionally, we used project-level data on Ebola funding from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) Financial Tracking Service website to supplement our data based on the support that China provided during the Ebola crisis,26which was channelled through MOFCOM. Funding Information: Second, due to data availability, we are not yet able to track development assistance disbursed through NGOs, the military, and the Central Committee of the Communist Party of China, or at the local government level, or the health-related emergency aid from the Red Cross Society of China. China has only a few NGOs operating abroad, including the China Foundation for Poverty Alleviation. We were unable to disaggregate the health share of their annual expenditures listed in their publicly available annual report. However, according to the few available financial reports, we observed that DAH disbursed through this channel is less than 1% of the total DAH disbursed.44 Similarly, we were not able to disaggregate the health-related emergency aid from the Red Cross since the majority of its aid projects were for emergency settings such as in flood zones and after earthquakes, and the available reported data were not disaggregated. Their department account only listed development aid in 2013 and 2016, and DAH disbursed through this channel is less than 0.1% of the total DAH disbursed.45 Furthermore, although we did not include DAH disbursed through the Communist Party of China and the military due to data availability, we noted that the International Liaison Department of the Communist Party of China and the People’s Liberation Army Navy provided some development aid projects related to health, including the hospital ship ‘Peace Ark’.46 47 Our DAH estimates are also restricted to aid disbursed through the central government level, thus excluding the disbursements for medical teams and a few other health aid projects that are implemented by local governments, especially provincial governments. Typically, the medical teams are funded by three sources—central National Health Commission, provincial National Health Commission and provincial hospitals.48Due to significantly diverse salary and stipend data provided by the hospitals, we are unable to track this proportion. For the local government level, we compared the total foreign aid disbursed by the central government and total foreign aid disbursed by the local government using information from the finance yearbooks. We found that the local government only started disbursements after 2010, and this was estimated to be at most 0.77% of the central government aid budget.23 Therefore, we restricted our estimates to central government disbursements. These exclusions may result in an underestimation of contributions of DAH from China. Funding Information: While China has increased DAH disbursement dramatically for the past decades, it remains a recipient of DAH. China received a total of $802.3 million in assistance from the Global Fund from 2003 to 2013, and in 2014 graduated from the Global Fund’s support.42 In 2016, a total of $244.5 million in assistance was given to China through major bilateral donors including Germany, USA, and UK, and multilateral agencies including the World Bank and Asian Development Bank, and the Bill & Melinda Gates Foundation.35 Nonetheless, the relative volume of DAH received by China is lower than DAH contributions from China. Funding Information: We identified four Chinese government agencies that are the primary agencies responsible for the disbursement of DAH. The identification of these agencies was informed by a white paper on foreign aid published by the Chinese State Council in 2011 and other research.13 15 21 The four agencies were the National Health Commission (NHC), the Ministry of Commerce (MOFCOM), the Ministry of Education (MOE) and the Export-Import Bank of China (EXIM). We excluded other government entities from the analyses based on six reasons: (1) The Ministry of Finance and the People’s Bank of China did not disburse development aid bilaterally, mostly contributing to multilateral agencies and the South-South Cooperation Fund has not yet disbursed funds. (2) The China Development Bank, Silk Road Fund and China-Africa Development Fund disbursed loans, but the loans were not concessional and therefore not considered as DAH. (3) The Red Cross Society of China mostly disbursed aid in emergency situations, and our definition of DAH precludes emergency response humanitarian support; and the limited number of non-emergency projects are usually through Ministry of Commerce. (4) The Ministry of Foreign Affairs, Ministry of Human Resources and Social Security, National Development and Reform Commission, All China Woman Federation, Ministry of Science and Technology, Ministry of Agriculture, Ministry of Civil Affairs, and State Oceanic Administration had no health-related aid disbursements based on literature review. (5) For non-governmental organisations including the China Foundation for Poverty Alleviation and Lifeline Express, the disbursement data available were incomplete and not disaggregated. (6) The Chinese embassies and consulates and the Chinese Centre for Disease Control and Prevention also disbursed DAH, although the disbursements were administratively reported under other government agencies that we included —the Ministry of Commerce and the National Health Commission. eTable 2 in the online supplementary file provides additional details on the basis of inclusion or exclusion of each government agency in the analysis. Publisher Copyright: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Keywords: Health economics, Health policy, Health systems

Local EPrints ID: 475075

URI: http://eprints.soton.ac.uk/id/eprint/475075

DOI: doi:10.1136/bmjgh-2019-001513

ISSN: 2059-7908

PURE UUID: 1a906b63-2d26-4569-9327-643ab744a867

ORCID for Paul H. Lee: orcid.org/0000-0002-5729-6450

Date deposited: 09 Mar 2023 19:02

Last modified: 18 Mar 2024 04:09