China's provincial diplomacy to Africa: applications to health cooperation

There is a prevailing view of China as a unitary actor in its relationships with African countries. This view is incomplete: on the contrary, China is a collection of provinces, autonomous regions and municipalities with myriad strategic ties to African countries, with decentralization shaping the current form of Chinese government and its level of efficiency. In this paper, factors have been explored for why Chinese provinces have played a role in foreign cooperation in health of African countries, in addition to trade and foreign direct investment. Incentives and disincentives for Chinese provinces to engage internationally in foreign cooperation and health assistance have been identified. The concept of paradiplomacy for health has been presented and this typology has been applied to the example of Chinese medical teams. Finally, we draw linkages between China and other members of Brazil, Russia, India, China, and South Africa.