China’s anti-malaria development assistance for health to sub-Saharan Africa and its influencing factors: A panel analysis

Abstract

Background Malaria is a serious global health concern, with sub-Saharan Africa remaining the most burdened region. Despite China’s emphasis on overseas anti-malaria development assistance for health, its contributions to malaria prevention and control in sub-Saharan Africa are understudied. In this study, we examined the current situation of China’s anti-malaria development assistance for health and its influencing factors to support strategy development for optimising the practice in the future. Methods We estimated the funding amounts based on AidData’s Global Chinese Development Finance Data set, version 3.0. We employed panel regression to explore the influencing factors, with the project funding amounts as the dependent variables and the indicators of the recipient countries’ level of health and health system, economic and political characteristics, and relationship with China as the explanatory variables. We conducted semi-structured interviews to acquire insights and elaboration from relevant agencies. Results Between 2000–21, China provided anti-malaria assistance to 36 sub-Saharan African countries with 279 projects and an estimated sum of USD 319.81 million. The main projects were infrastructure construction (USD 181.22 million) and medicine donation (USD 122.14 million). The allocation of the total amount was correlated with the universal health coverage service coverage indexes (coefficient = –0.200; 95% confidence interval (CI) = –0.305, –0.095, P < 0.001) and the accountability rating in the public sector (coefficient = 0.121; 95% CI = 0.030, 0.212, P = 0.009). Such findings suggested China’s assistance tended to be directed to those countries with poorer capacity in the primary health system and better capacity for governance. Conclusions China has made considerable contributions to malaria prevention and control in this region, yet the findings also pointed out the lack of systematic emphasis on capacity building. To strengthen the independent capacity and resilience of the recipient countries, it would be more effective for China and other donors to expand the types of anti-malaria projects and pay more attention to sustainable health system strengthening, including workforce training and primary care facility empowerment. These measures are only possible with increased funding.