How China's Anti-Graft Purge May Shake Its Global Health Work

By Serufusa Sekidde

Chinese President Xi Jinping's pledge to spend $12 billion over the next 15 years to help the United Nations achieve its goal of eliminating extreme poverty by 2030 signals that Beijing is eager to claim a bigger role in the world of international development.

Yet Xi's pledge, made at the U.N. summit on sustainable development in New York, came as Chinese government officials are grappling with the fallout of an unprecedented anti-corruption and austerity campaign that Xi has unleashed at home. This domestic drive may have myriad consequences - good and bad - for China's overseas development assistance programmes.

China has emerged as a significant player in overseas assistance, providing some $14.4 billion in total foreign assistance between 2010 and 2012 alone. Much of this has been targeted to Africa, and Beijing has signalled that improving medical and health services is a key overseas aid priority.

One of the encouraging aspects of the corruption crack-down is that it may limit the operations of Chinese drug counterfeiters.

According to the UN Office on Drugs and Crime, 70% of all counterfeits seized globally come from China. With this new anti-corruption drive, better policing of China's State Food and Drug Administration - which in 2007 had its head executed for corruption - and the local pharmaceutical industry will ensure that fewer counterfeit drugs come to Africa. This is significant especially because, since 1999, China's health aid and trade with Africa has been repackaged to promote the exports of Chinese pharmaceuticals.

There are other potential benefits to a more austere approach to health, both for Chinese citizens and for the beneficiaries of their assistance in Africa and elsewhere.

When it comes to working in developing counties, in most cases, Chinese government officials live a Spartan life. Nonetheless this renewed spirit of austerity will inform the practices of government-funded Chinese practitioners of global health and development operating in Africa and beyond. Chinese provincial hospitals, like the one I worked at, engage in international development by routinely sending medical teams to volunteer in Africa for two-year periods. The teams and any officials accompanying them must now fly in economy class at all times. Not only that but they must use discount fares rather than the more expensive full-price ticket they sometimes used in the past. These efficiency savings, however small, will free up more welcome aid funding to be used in developing countries.

Some directives, however, fly in the face of conventional practice in international development. For example, most donors have now moved away from 'tied aid' that limits procurement to companies from the donor country. Tied aid reduces recipient governments' freedom to shop for the best deals and, according to one economic study, reduces aid's value by 15 to 30 per cent. Unfortunately, Chinese government employees are now required to use Chinese airlines when traveling abroad. China already awards its infrastructure projects, for example those for hospitals, exclusively to Chinese companies. If it is to join the ranks of best-in-class donors, it is imperative that China moves away from tied aid and goes for options that offer best value for money.

Furthermore, when traveling abroad, high-level Chinese officials are restricted to a maximum of three nights away from China. There is an onerous approval process if they need to spend more time away. While there is a case to be made about making savings by remote working and tele-conferencing this is a lost opportunity for the Chinese to engage face-to-face with counterparts from other countries and network meaningfully.

Overzealous anti-graft measures sometimes make honest workers afraid of their own shadows and unnecessarily cautious. A report from Bank of America Merrill Lynch projected that the anti-corruption campaign would cost the Chinese economy up to $100 billion in 2014, as hesitant government officials scaled back on investment decisions, to avoid unwanted scrutiny from the central government. This could stifle the operations of Chinese government institutions proving mission-critical funding and services in developing countries.

Xi's message of thriftiness and his anti-graft purge are welcomed by a Chinese people who for years witnessed government officials' appetites for luxury products and boozy banquets. However, as he tries to hammer away at the pervasive malfeasance in government, China's paramount leader may have served up a menu of unintended consequences.

What China now needs to do is to cultivate the space that allows a balance between conforming to anti-graft measures and the operational flexibility for Chinese organizations and their practitioners of global health and development to be nimble and creative in how they deliver impact in developing countries.

Serufusa Sekidde is a China-trained Ugandan doctor who works as a health and development consultant. He is on twitter @serufusa, and is a 2015 Aspen New Voices Fellow.