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Tracking development assistance for health from China, 2007–2017
  1. Angela E Micah1,
  2. Yingxi Zhao1,
  3. Catherine S Chen1,
  4. Bianca S. Zlavog1,
  5. Golsum Tsakalos1,
  6. Abigail Chapin1,
  7. Stephen Gloyd2,
  8. Jost Jonas3,
  9. Paul H Lee4,
  10. Shiwei Liu5,
  11. Man Tat Alexander Ng6,
  12. Michael R Phillips7,
  13. Enrico Rubagotti8,
  14. Kun Tang9,
  15. Shenglan Tang10,
  16. Mustafa Younis11,
  17. Yunquan Zhang12,
  18. Christopher J L Murray1,
  19. Joseph L Dieleman1
  1. 1Institute for Health Metrics and Evaluation, Seattle, Washington, USA
  2. 2Department of Global Health, University of Washington, Seattle, Washington, USA
  3. 3Ophthalmology, Medical Faculty Mannheim of the Ruprecht Karl University of Heidelberg, Mannheim, Germany
  4. 4School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
  5. 5National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, Hubei, China
  6. 6Tencent Healthcare, Shenzhen, Guangdong, China
  7. 7Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai, China
  8. 8Biotechnology, Universidad Regional Amazónica Ikiam, Ciudad de Tena, Napo, Ecuador
  9. 9Research Center for Public Health, Tsinghua University School of Medicine, Beijing, Hubei, China
  10. 10Duke Global Health Institute, Duke University, Durham, North Carolina, USA
  11. 11Department of Health Economics & Management, Jackson State University, Jackson, Mississippi, USA
  12. 12Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei, China
  1. Correspondence to Dr Angela E Micah; amicah{at}


Introduction In recent years, China has increased its international engagement in health. Nonetheless, the lack of data on contributions has limited efforts to examine contributions from China. Existing estimates that track development assistance for health (DAH) from China have relied primarily on one dataset. Furthermore, little is known about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and disaggregated those estimates by disbursing agency and health focus area.

Methods We identified the major government agencies providing DAH. To estimate DAH provided by each agency, we leveraged publicly available development assistance data in government agencies’ budgets and financial accounts, as well as revenue statements from key international development agencies such as the WHO. We reported trends in DAH from China, disaggregated contributions by disbursing bilateral and multilateral agencies, and compared DAH from China with other traditional donors. We also compared these estimates with existing estimates.

Results DAH provided by China grew dramatically, from US$323.1 million in 2007 to $652.3 million in 2017. During this period, 91.8% of DAH from China was disbursed through its bilateral agencies, including the Ministry of Commerce ($3.7 billion, 64.1%) and the National Health Commission ($917.1 million, 16.1%); the other 8.2% was disbursed through multilateral agencies including the WHO ($236.5 million, 4.1%) and the World Bank ($123.1 million, 2.2%). Relative to its level of economic development, China provided substantially more DAH than would be expected. However, relative to population size and government spending, China’s contributions are modest.

Conclusion In the current context of plateauing in the growth rate of DAH contributions, China has the potential to contribute to future global health financing, especially financing for health system strengthening.

  • Health economics
  • Health policy
  • Health systems

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  • AEM and YZ are joint first authors.

  • Handling editor Seye Abimbola

  • AEM and YZ contributed equally.

  • Contributors AEM and JLD conceived of the analysis. AEM and JLD managed the implementation of the analytical strategy. YZ produced the estimates. YZ, AEM, CSC and BSZ created figures and tables. AEM and YZ wrote the first draft of the manuscript. SG, JBJ, PHL, SL, MTANg, MRP, ER, KT, ST, MZY, YZ, CJLM and JLD provided critical feedback on the first draft of the manuscript. GT and AC managed the estimation process. CJLM and JLD acquired funding for the research. All authors read and approved the final manuscript.

  • Funding The Bill and Melinda Gates Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.