The Forum on China-Africa Cooperation Summit: What is it and why does it matter to global health?

FOCAC: What is it?

The Forum on China-Africa Cooperation (中非合作论坛 or FOCAC) is an official forum between China and Africa, with the highest level of engagement taking the form of a summit held every three years. The third FOCAC summit was held in Beijing on September 3-4, 2018 and was attended by heads of government or other top officials from every African country except for eSwatini (formerly known as Swaziland), which retains diplomatic ties with Taiwan. The theme of the 2018 summit was “China and Africa: Toward an Even Stronger Community with a Shared Future through Win-Win Cooperation.”

FOCAC Summit 2018: What were the key takeaways?

At this year’s forum, President Xi announced that China will provide $60 billion to African countries over the next three years and write off some debts for Africa’s “poorest countries” (the names of which were not specified).  This sum, $60 billion, is the same amount of assistance announced three years prior at the 2015 summit, although the composition of the funding has shifted (see below table). This shift is probably aimed at curbing China’s growing reputation of engaging in “debt-trap diplomacy,” despite evidence that Chinese loans are not in fact “a major contributor to debt distress in Africa.”

Source: Xi Jinping’s speeches at FOCAC 2015 and FOCAC 2018. Note: Table contents collected by Lina Benabdallah. Table reformatted and edited for this blog.  

Summit attendees adopted “The Beijing Declaration — Toward an Even Stronger China-Africa Community with a Shared Future” and the “FOCAC Beijing Action Plan (2019-2021)” to guide their official engagement over the next three years until the next summit in 2021.

Global health and FOCAC Summit 2018: Why is FOCAC relevant to global health?

President Xi announced eight major initiatives that China plans to implement with African countries, one of which focuses on health. Specifically, President Xi said that “China will upgrade 50 medical and health aid programs for Africa with a focus on flagship projects such as the headquarters of the African Center for Disease Control and Prevention and China-Africa Friendship Hospitals.”

In parallel to the second day of the FOCAC summit, China’s first lady Peng Liyuan served as the keynote speaker at the China-Africa meeting on HIV/AIDS prevention and control, attended by 37 spouses of African heads of state and government as well as WHO Director-General Dr. Tedros Adhanom Ghebreyesus and UNAIDS Executive Director Michel Sidibé. At the meeting, the first ladies launched a joint 3-year initiative, set to begin in 2019, focused on health promotion and HIV prevention advocacy, particularly among young people.

In advance of the summit there are typically several sub-forums that meet around specific topics, including one focused on health. Two weeks prior to the summit, ministers from African countries and China in addition to representatives from international organizations gathered in Beijing for the High Level Forum on China-Africa Health Cooperation (中非卫生合作高级别会议).  The theme of the forum was “Deepen China-Africa Health Cooperation, and Jointly Build the Health Silk Road.” Topics included Africa’s pharmaceutical industry, health systems improvement, and disease treatment. At the end of the forum, the participants signed the China-Africa health cooperation 2018 Beijing initiative, “which focuses on building a strong public health surveillance and response system in Africa and supporting the response to public health emergencies.”  The document also includes a special focus on HIV prevention in young people and key populations, a likely impetus for the first ladies’ new initiative.

China’s global health engagement: How does the 2018 Summit fit into China’s broader strategy?

China’s global health engagement is not new; it sent its first medical team to Algeria in 1963. However, China has provided health aid and support with increasing frequency and scale over the last several years. According to a study looking at bilateral health aid contributions to Africa from 2000-2012, China was the ninth largest health donor; over half of China’s total official assistance during this period went to Africa.

Although the Belt and Road Initiative is often touted as solely an infrastructure-focused endeavor, the broader theme of connectivity also has implications for global health and global health security. Just over a year ago in August 2017, China convened a High-Level Meeting on Health Cooperation towards the Health Silk Road where China signed a memorandum of understanding (MOU) with the World Health Organization and other agencies such as UNAIDS, Global Fund, and Gavi in addition to surrounding Silk Road countries. The participants also jointly signed on to the Beijing Communiqué, which in the absence of an official Chinese overarching global health aid strategy serves as a “policy statement on its global health priorities.” However, the March 2018 announcement of a new State International Development Cooperation Agency (SIDCA), which is tasked with being the administrator of the expansive list of projects under the Belt and Road Initiative, is expected to bring reforms to the way in which Chinese aid overall operates, including global health.

Final thoughts

The FOCAC 2018 Summit—as with most of China’s high-level forums—involves a decent amount of pomp and circumstance. However, these declarations and high-level forums give us an opportunity to see China’s priorities. FOCAC reaffirms health as a focal point of China’s diplomatic engagement with Africa, and comes as development assistance for health (DAH) continues to stagnate. The 2018 FOCAC summit and its relevant side meetings reaffirm that China is positioning itself to lead in this area.

Kaci Kennedy, Policy Associate, the Center for Policy Impact in Global Health, Duke University