China’s medical teams in Africa: navigating the neoliberal health quagmire

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From 1963 to 2023, China dispatched 24,000 members of its foreign aid medical teams to Africa, with 45 medical teams currently operating across 100 work sites in 44 African countries. These teams have established counterpart cooperation with African hospitals, supported the establishment of specialty centers, trained local medical personnel, and improved the health and well-being of people in recipient countries. 

Through various activities such as clinical teaching, surgical demonstrations, academic exchanges, health lectures, epidemic prevention education, remote guidance, and medical tours, they have also contributed to upgrading the medical technology level in these countries. 

However, in several East African countries, present-day regulations often require doctors to obtain professional qualifications issued by national medical associations in order to practice medicine. This requirement poses challenges for many members of the current medical teams, particularly due to language barriers and difficulties in obtaining qualification certificates. 

Consequently, some members hold only volunteer certificates and are limited to auxiliary roles. This contrasts with the experiences of earlier medical teams, particularly during the Nyerere period in Tanzania, where the absence of strict licensing requirements allowed them to engage more freely in medical practice. This difference in treatment is not attributed to variations in skill level between former and current team members or changes in government attitudes towards China, but rather to the evolving medical ecology in Africa.

The development of African healthcare ecology has undergone four main stages since the entry of Western colonizers. 

The first stage was characterized by missionary medicine, viewing healthcare as a means of religious salvation and colonization. The second stage, colonial or imperial medicine, operated in conquered territories to serve colonial interests. Post-colonial medicine, the third stage, saw the continuation of colonial influences alongside efforts towards national health system development. The current stage, democratic political medicine, reflects a balance between pragmatism, human rights, and neoliberalism. 

However, the predominance of neoliberal values in healthcare systems has created challenges for non Western medical teams, as African countries have adopted Western medical standards requiring extensive training and licensing for medical practice. 

The Prevalence of Neoliberalism and the Embarrassing Situation of Medical Teams in Africa

The licensing of physicians mentioned previously is just one aspect of the neoliberal medical ecology. Neoliberalism advocates for the medical field to operate under market logic, believing that monopolies without market competition lead to inefficiency. Consequently, healthcare in Africa has witnessed significant privatization in recent decades. 

Due to limited pharmaceutical production capacity and market competition, modern medicine in Africa heavily relies on expensive imports. Some African countries permit doctors in public hospitals to practice multiple professions, allowing them to open pharmacies, clinics, and even hospitals to address the scarcity of national health resources. 

However, under neoliberal influences, some medical practitioners exploit this by diverting hospital drugs to their own pharmacies for substantial profits through false prescriptions. Moreover, egoism among doctors within public hospitals, coupled with the pursuit of welfare benefits not aligned with social development, has resulted in frequent medical strikes and a mass exodus of medical and public health personnel to higher-paying sectors.

Neoliberalism also emphasizes the pursuit of advanced technology and talent. Despite Africa’s overall medical standard lagging behind, its professional standards for physicians and pharmaceutical quality are comparable to those of the World Health Organization, Europe, and the United States. 

However, the insistence on adhering to Western standards has hindered the provision of basic medical care to the African population. With the absence of local pharmaceutical companies and lower drug standards compared to the West, Africa relies on expensive imported medicines, leading to significant resource waste and hindrance to meeting basic medical needs.

As African countries’ economy develops, their medical and healthcare systems progress as well. Consequently, the expectations placed on foreign aid medical teams in Africa have evolved. Some African countries now request high-precision equipment, technology, and specialized center construction, rather than solely relying on experts. 

For instance, the Ebola epidemic prompted demands for disease control laboratories. While China previously provided personnel assistance, it now offers sophisticated technology, such as mobile P3 laboratories, within a short timeframe. However, establishing these laboratories requires careful consideration of personnel training, biosafety, and regulatory frameworks, posing challenges for African Union countries.

Neoliberal values also emphasize the population’s right to choose healthcare, leading to the proliferation of private medical institutions and medical tourism in Africa. While private hospitals offer top-notch services, they often cater to the wealthy elite and are predominantly controlled by foreign capital. As a result, health inequality persists, with the general population relying on underfunded public hospitals. The preference for overseas medical treatment among African elites further exacerbates the neglect of domestic healthcare infrastructure.

This neoliberal-led healthcare system presents a dilemma for China’s medical teams in Africa. While they aim to assist African healthcare systems, they are confronted with the realities of neoliberal dominance, where profit-driven practices and healthcare inequality prevail. This disconnect between perception and reality has prompted a crisis of values among China’s medical aid workers, as they navigate the complex landscape of African healthcare.

The Awakening of Medical Autonomy in Africa and Opportunities for Medical Teams in Africa

Healthcare autonomy has always been a crucial aspect of Africa’s pursuit of independent development. In the early years of independence, amid the Cold War, most African countries explored paths suitable for their own medical and health development, despite economic constraints. For instance, Tanzania implemented a free medical policy and primary health care measures during the socialist villagization movement of Ujamaa, while Kenya introduced external capital to push forward healthcare privatization reforms.

Additionally, many African countries, including South Africa, Ethiopia, Tanzania, and Uganda, revitalized traditional medicine as part of their healthcare strategies. With the recent economic development of Africa, characterized by rich natural resources, abundant labor force, and a large market potential, the continent has made significant strides in healthcare. 

This progress includes building hospitals, establishing pharmaceutical companies, training local medical personnel, preventing and controlling infectious diseases, improving child nutrition, maternal and child health, and developing a certain degree of medical and healthcare resources and service capacity. 

Consequently, Africa’s sense of autonomy in healthcare has strengthened, particularly in the search for development strategies, disease control, multilateral cooperation, and the promotion of traditional medicine. However, the lack of clear health development strategies and realistic goals can hinder self-development and pose challenges to aid efforts in Africa. 

European and American aid, in particular, often focuses on medicines, vaccines, disease treatment, and epidemiological control, neglecting health system development. This has perpetuated Africa’s dependency on external medical resources and hindered the establishment of a self-sufficient health system. 

Nonetheless, Africa’s increasing sense of autonomy in healthcare presents opportunities for Chinese medical teams. These teams aim to assist in the formulation of practical health development strategies and disease prevention measures that benefit the general population. 

Through initiatives like disease control centers and public health interventions, China’s involvement in Africa’s healthcare has been pivotal. Notably, China’s assistance during the Ebola epidemic and its contribution to establishing the Africa CDC exemplify the potential for multilateral cooperation in public health governance. 

Moreover, Africa’s autonomy in healthcare extends to traditional medicine, deeply rooted in African culture and consciousness. Traditional medicine, emphasizing comprehensive treatment and accessibility, has played a significant role in dealing with various diseases and has become a crucial option for African people seeking independent medical treatment. 

China’s recognition of traditional medicine has led to cooperation with African countries in this field, with agreements signed to collaborate on laws and regulations, healthcare, education, training, research and development, and industrial cooperation. As China’s medical aid to Africa evolves, there is potential for transformation from bilateral to multilateral cooperation, involving international organizations, local NGOs, and medical organizations from other donor countries. This reflects Africa’s increasing autonomy and the diversified approach to healthcare cooperation on the continent.