Abstract

China’s recent constitutional changes have led to international headlines and debate. However, the founding of a new ministry-level agency—the China International Development Cooperation Agency (CIDCA)—has attracted little attention, despite the effect it might have on China’s foreign aid policy and global health strategy.

China has been involved in foreign aid since 1950, focused primarily on developing nations in Africa and other regions. Between 2000 and 2013, more than US$104·35 billion was invested in Africa alone,1 on a par with US spending. Specifically, in the field of global health, China has dispatched medical teams, constructed facilities, distributed drugs and medical devices, and trained local health workers in more than 66 countries during the past 55 years.2

However, China’s efforts have been criticised for insufficient coordination and transparency. Before the 1980s, Chinese foreign aid primarily served a political purpose, whereas since the 1990s, it also has been driven by commercial interests.3 The Ministry of Commerce has served as the primary aid agency for the past 20 years, supported by the Ministries of Finance, Foreign Affairs, and Health.4 Unfortunately, there has been no clear delegation of responsibility. Furthermore, although two white papers were issued regarding foreign aid by the Chinese government in 2011 and 2014, information has remained scarce. This leading role of commerce in aid implementation has led to international suspicion regarding China’s primary motivations.

CIDCA, officially established on April 18th, 2018, will hopefully help to address these concerns and foster international cooperation. This agency has been assigned the task of establishing guidelines, plans, and policies, as well as coordinating, overseeing, and evaluating current and future Chinese foreign aid projects.5 However, it remains to be seen whether CIDCA can effectively implement change and provide increased transparency. More importantly, there are questions regarding the extent to which the agency is politically motivated. Members of the National Development and Reform Commission, as well as the Ministries of Commerce and Foreign Affairs, have been chosen for key leadership positions within CIDCA. These appointments indicate that the agency, although promoting development in general, might also serve Chinese diplomatic interests with a continued, if reduced, focus on commercial gain. Fortunately, the opening of the South–South Cooperation Fund to universities, non-governmental organisations, and international organisations appears to be an initial step in the right direction.

We declare no competing interests.