title: China's role as a global health donor in Africa: what can we learn from studying under reported resource flows?
abstract: BACKGROUND
  There is a growing recognition of China's role as a global health donor, in particular in Africa, but there have been few systematic studies of the level, destination, trends, or composition of these development finance flows or a comparison of China's engagement as a donor with that of more traditional global health donors.
  
  
  METHODS
  Using newly released data from AidData on China's development finance activities in Africa, developed to track under reported resource flows, we identified 255 health, population, water, and sanitation (HPWS) projects from 2000-2012, which we descriptively analyze by activity sector, recipient country, project type, and planned activity. We compare China's activities to projects from traditional donors using data from the OECD's Development Assistance Committee (DAC) Creditor Reporting System.
  
  
  RESULTS
  Since 2000, China increased the number of HPWS projects it supported in Africa and health has increased as a development priority for China. China's contributions are large, ranking it among the top 10 bilateral global health donors to Africa. Over 50% of the HPWS projects target infrastructure, 40% target human resource development, and the provision of equipment and drugs is also common. Malaria is an important disease priority but HIV is not. We find little evidence that China targets health aid preferentially to natural resource rich countries.
  
  
  CONCLUSIONS
  China is an important global health donor to Africa but contrasts with traditional DAC donors through China's focus on health system inputs and on malaria. Although better data are needed, particularly through more transparent aid data reporting across ministries and agencies, China's approach to South-South cooperation represents an important and distinct source of financial assistance for health in Africa.
authors.affiliation: Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, 3rd Floor, New York, NY, USA. kag12@nyu.edu.|Center for Global Development, 2055 L St NW, Fifth Floor, Washington, DC, 20037, USA. kag12@nyu.edu.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grépin
authors.affiliation: Center for Global Development, 2055 L St NW, Fifth Floor, Washington, DC, 20037, USA. vfan@hawaii.edu.|University of Hawaii at Manoa, 1960 East-West Road, Biomed D204, Honolulu, HI, 96822, USA. vfan@hawaii.edu.
authors.forename: Victoria Y
authors.initials: VY
authors.lastname: Fan
authors.affiliation: School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA. gordon.shen@yale.edu.
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Shen
authors.affiliation: Institute for Global Health, Peking University, Beijing, China. lucy_chen@bjmu.edu.cn.
authors.forename: Lucy
authors.initials: L
authors.lastname: Chen
mesh_terms: D000349:Africa; D002681:China; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D005378:Financial Support; D014943:Global Health; D006801:Humans; D007391:International Cooperation; D012959:Socioeconomic Factors; D014481:United States; D014492:United States Public Health Service / Q000191:economics / Q000458:organization & administration*