No, China Won’t Replace USAID. But Here Are Five Ways It's Rewriting the Global Health Playbook.
As Western donors retreat, many fear that China will fill the gaps and disrupt the global health order. But in practice, China offers fresh, alternative tools, and the Global South is listening.
🩺 In this Vital Signs series at China Health Pulse Newsletter, I provide essential explainers on key contexts and trends shaping health in China today. Today, I focus on a topic I’ve been mulling over for months: China’s distinctive role in the rapidly evolving global health/development landscape.
A week or so ago, I caught up with a friend and China expert at a major UK think tank. London’s spring sunshine beamed down at streets lined with bright new blossom, but it all stood in stark contrast to the the gloom of our conversation. As we traded dreary headlines, we tried to make sense of a world that seems to feel less stable by the day.
Beyond the latest tariff drama, the development landscape has been under significant pressure in recent months. Trump has been pulling back from multilateral institutions since he took office (I have published on the US’s exit from the WHO here), eagerly cutting USAID and actively signalling US retreat from global health cooperation. And unfortunately, the UK has followed suit, slashing ODA (official development assistance) funding in favour of defence spend, which other European countries have since mirrored. In global health circles, it has started to feel like a slow, unstoppable retreat.
But across media headlines, a louder story seems to have taken hold: that China is poised to fill the vacuum—and take over.
This narrative is everywhere, and it might be dramatic clickbait, but it definitely grabs attention with success (even I can never resist a look, despite my better instincts). Unfortunately, this means that it drowns out the more sensible protests and thoughtful analysis from public health experts and system designers who understand what global health actually requires.
That day, as my friend and I discussed the crux of all of this hype, we found ourselves circling back to the same, rather bleak, conclusion: that most of the conversation around China is really just the West talking to itself.
The framing is still stuck on what the West thinks China might think—rather than what China actually thinks, let alone consider what China really wants. Even less time, if any at all, is spent asking what the Global South wants.
Yes, China is indeed expanding its presence in global health, but it’s most definitely not a replacement.
Not because it can’t. Or that it lacks the ambition for it. But really because it doesn’t think about global health, development, or global power, in the way that the West does at all.
The Myth of the Vacuum
Much of today’s system has been shaped by the cultural and institutional norms of Western donors, It grew out of a period shaped by post–Cold War ideals and a belief in global public goods. But that system is fraying. Global health is becoming more fragmented, less coordinated, and more influenced by regional politics and bilateral trade-offs, and China’s role is becoming increasingly prominent.
China is building a completely different set of institutions, with different tools, a different mindset, and a different sense of the problem it is trying to solve. This does not mean that we should ignore its strategic moves or political motivations in global health. In fact, we must remain clear that Beijing will absolutely seek opportunities to serve its own best interests, first and foremost. China’s expanding health diplomacy is steadily reshaping norms across the Global South, altering the future of access, standards and trust.
Profs Thomas J. Bollyky and Yanzhong Huang wrote in Foreign Affairs recently that, as Western programmes withdraw “abruptly and chaotically from strategic regions”, China’s focus is to use aid strategically (and even exploitatively) to build influence with developing partners. They point out China’s “skepticism of international global health bodies, including its complex relationship with the WHO”.
But we must come to terms with the fact that these values mirror that held by Trump and the US today. So, instead of asking who will replace past ideals, we should be questioning how global health is being reshaped altogether. The Center for Global Development has called this the Kindleberger Trap: a moment when no single power steps forward to provide global public goods, even though the need remains.
I argue that, rather than falling back on defensive alarmism about rivalries, we need clear-eyed analysis of technical engagement—what's actually being built, and what it enables—to make the most of what’s possible now and in the future in global health. That starts from looking closely, with care, at how China sees the world. And it means engaging with a willingness to step outside familiar frameworks and an openness for alternative ways of thinking and doing.
What does China want?
A huge part of the problem in understanding what China wants, as my policy friend and I discussed with each other, is that most China watchers do not spend enough (or any) time in China. I live and work across both China and the West, and I often hear the same second-hand narratives repeated without much interrogation. Without crucial on-the-ground context, it becomes easy, almost inevitable, for even the “experts” to be blinkered from recognising specific misunderstandings. And it’s even harder to notice when the wrong template is being applied altogether.
In global health, the contrasts run deep. Let’s break down the key differences at high level.
The Past “Traditional” Western Model:
Was anchored in multilateral institutions, with programmes held accountable to global norms
Was framed around universal ideals of moral duty and humanitarianism
Was structured as technical aid, often led by NGOs or UN agencies
Was separated (at least in rhetoric) from hard power and broader geopolitical aims
The US, UK, and other major donors have spent decades shaping global health around the logic of public goods. Their approach has focused on fixing weak systems through targeted aid, largely supported by multilateral programmes. But embedded within this model sits a familiar and often-paternalistic hierarchy, which positions donors as architects and recipients as passive beneficiaries.
China’s Alternative Development Logic:
Structured through state-to-state partnerships, mostly bilateral
Linked to broader trade and infrastructure alignment, especially through BRI and the Health Silk Road
Delivered through a mix of public and private channels
Emphasis on sovereignty, mutual benefit and political alignment
In contrast, China’s development partnerships rarely sit in a neutral or purely technical space. They come hand-in-hand with politics - whether hard-won through negotiation, or led by soft power. China’s equivalent of USAID is CIDCA, the China International Development Cooperation Agency. It operates under the State Council, the organ of CCP state power, as a deputy ministerial-level agency, which inevitably binds its work firmly to China’s broader political agenda.
Apart from its political enmeshment, CIDCA is also significantly smaller than its Western counterparts. In 2023, China’s development aid contributions reached only a fraction of the US, which provided 75% all international development assistance for HIV/AIDS (including PEPFAR), 40% for malaria, and >30% for tuberculosis, as well as the largest funder of WHO, GAVI and COVAX.
China’s capacity on the ground in the Global South also remains thin—staffing, funding, and operational depth all vary significantly. Part of this reflects the fact that China is still relatively new to the aid space. But more importantly, it reflects a different conception of influence, responsibility and reputation in global engagement:
But regardless of the strengths and weaknesses of China vs the West, in order to make progress in the Global South, we need to listen far more closely to the countries being courted—on their terms, not ours.
What does the Global South want?
Media stories about health rivalry seem to imagine the world as a chess game of some sort, with pieces forcing one another into corners, eager to knock the weakest off the board. But people aren’t pawns, and the Global South isn't passively waiting to be led.
Today, governments across the African continent, Latin America and Southeast Asia are all shrewdly assessing what’s on offer. While concepts of “lift them out of poverty” still apply in many developing regions, others have become modern, and prosperous in the 21st Century, and have begun to rally against traditional, unsustainable Western aid models that come with hidden costs and stipulations of their own. And they have every right—to compare, negotiate and define the right health partnerships, in order to protect themselves and serve their populations in the most optimal way. This includes:
Who respects their sovereignty more?
Who can deliver at scale and speed, and without too many strings attached?
Whose models fit the challenges they actually face?
China is already answering. It is offering its own development experience, political philosophy and strategic interests within its Global South engagement. Many of these align closely with the recent and meteoric trajectory of its own development past. China readily brings what it knows well, which is how to scale under pressure—building systems quickly, navigating resource constraints, and effectively blending state coordination with local experimentation.
It makes sense that, in many settings, China’s contributions may very well feel more familiar to developing countries current working through similar challenges. And they very much arrive without the historical baggage that can shadow Western aid, whether colonial, racial, or ideological. Last November, at the 9th FOCAC summit (Forum on China-Africa Cooperation) President Xi Jinping made this clear, with language that placed China’s ties with its African “brothers” at the heart of the bilateral diplomatic agenda.
No country speaks for the rest, but many in the Global South are readily shaking China’s hand: rising up against dependency, speaking up for agency, and welcoming the USAID/Western donor gap not as a vacuum, but as an opportunity for change.
Five Areas Where China’s Approach Fits
In this section, I want to firmly set aside the rivalry narrative. The focus here is technical—because that’s where global health is built, and where it matters most.
My opinions here reflect my own experiences and observations. I eagerly welcome critical discussion from readers, to stay open to perspectives that push the thinking further. But I believe that when we centre the people delivering and receiving care—and measure outcomes by changes in health and actual lives—the noise tends to recede. Biases don’t quite vanish, but they somehow recalibrate. And that’s where better decisions can begin.
Over time, I’ve noticed specific points of alignment between China’s health system approaches and the needs of many countries across the Global South. Some stem from shared development pressures and the experience of building under constraint. Others point toward the future: how technology might reshape access, how public and private sectors can move together, and how traditional practices might be preserved within modern systems.
My goal is to highlight what I think is actually useful and what I believe can technically fit, rather than comparing, judging or chalking up more scores between China and the West. Here are five areas I’ve found especially relevant—each drawn from observation and grounded in delivery:
1. Care Without Clinics: China's Remote-First Health
2. Sovereign Health Data: Building Local Control
3. Integrated Power: Public–Private Health Expansion
4. Reinvented Community Care: China’s Barefoot Doctor Model
5. Respect for Traditional Knowledge: Blending Views of Medicine
1. Care Without Clinics: China's Remote-First Health
A key area of divergence lies in how healthcare is built and delivered. Traditional Western health aid tends to begin with infrastructure: clinics, hospitals, outreach teams, and in-person service delivery, often led by health workers traveling village to village. China’s approach increasingly bypasses these physical entry points.
By now, China is well known for building infrastructure, extremely quickly and efficiently, in developing nations. Its Belt and Road Initiative has already sunk deep roots across the Global South. Roads, ports, factories, and hospitals now dot much of the African continent and Southeast Asia. But a quieter, and arguably more important, contribution is emerging in its global health footprint: the export of remote-first, digitally enabled care.
In its own rapid health system development over recent decades, China has pushed for remote-first solutions to reach its vast population and uneven geography. Digital platforms like internet hospitals now streamline the full continuum of care—from online consultation, to e-prescriptions and digital pharmacy fulfilment, to remote insurance reimbursement. During the COVID-19 pandemic, these services became essential. Lockdowns disrupted mobility, but demand surged, accelerating growth for platforms such as WeDoctor and Ping An Good Doctor, which delivered care to tens of millions under constrained conditions.
All of this makes sense for the Global South, where thin budgets, health worker shortages and geographical barriers make traditional systems hard to scale:
Internet hospital pilots and partnerships in Southeast Asia and East Africa
Telemedicine hubs deployed in rural districts where health workers remain scarce
AI diagnostic tools integrated into frontline triage in low-capacity health systems
This changes the game, reducing both cost and time while optimising for efficiency. But it also shifts the centre of gravity. Countries adopting these Chinese health tools are also (whether consciously or not) adopting China’s own frameworks for consent, transparency, data privacy and ownership, and absorbing China’s standards and assumptions about governance. These may offer operational efficiency, but they also define the rules around privacy, traceability, and long-term control, and don’t necessarily leave room for countries to shape their own needs.
2. Sovereign Health Data: Building Local Control
Western aid programmes have long championed open data standards, cross-border disease surveillance networks, transnational health security frameworks, designed to support collective resilience and scientific collaboration. These systems depend on transparency, interoperability, and the assumption that sharing sensitive data with multilateral bodies is both necessary and safe. Global South countries are expected to cede data control to Western institutions and multilateral bodies, and many are unwilling and resistant.
China’s approach is different—and in many ways, much more appealing. It recognises data as a national security asset, not a global commons, and sees prioritisation of national control over health information as a core element of public security and governance. China’s Health Silk Road initiatives offer bilateral partnerships to help to build sovereign digital health infrastructure. This promises modern digital health tools, without requiring full alignment with Western data transparency norms or multinational governance: data stays within national borders, rules are set by local governments, and international transparency is optional.
This can be a preferred model for governments wary of external oversight or skeptical of Western data governance norms. It offers digital tools without requiring alignment with global accountability frameworks. It echoes China’s own domestic philosophy, where health data is tightly integrated into broader systems of public security and political control.
But these strengths come with tradeoffs. While China’s approach protects formal sovereignty, it doesn’t guarantee insulation from influence. Bilateral data partnerships carry significant risks—particularly when Chinese companies or platforms manage system architecture, cloud infrastructure or AI diagnostics. Sovereignty may be preserved in principle, but it’s unclear whether it can become outsourced in practice.
There is obvious danger of exploitation by China, but it depends on whether the partner country sees China as a lesser, more worthwhile, or even more trust-worthy risk compared to Western counterparts. China’s offer may come with fewer ideological strings, and may also feel more predictable, or simply more respectful, than Western alternatives shaped by years of conditionality, surveillance anxieties, or postcolonial critique.
China navigates this dynamic with strategic precision. It employs warm language of friendship and brotherhood, drawing on shared values of development, and frames its digital health partnerships around mutual respect and non-interference. At the 2024 FOCAC, China signed an agreement with Ethiopia and UNIDO to establish a China-Africa-UNIDO Digital Health Demonstration Centre. The project aims to strengthen Ethiopia’s digital health infrastructure, including telemedicine services, and is being positioned as a regional model.
All of this is worrying for the West. Not only in terms of shifting power dynamics and influence on the world stage, but also in an increasingly narrow window for shared oversight and global accountability. As digital health becomes more central to care delivery, those risks extend beyond privacy and into the core functioning of public health itself.
3. Integrating Power: Public–Private Health Expansion
Another major distinction in China’s global health approach lies in its blending of public and state financing with policy tools and private-sector execution, into a collective, coordinated system. Pharmaceutical companies, insurance platforms, logistics firms and hospital chains may all operate alongside state-led agreements. This diverts completely from the traditional Western approach, which has tended to channel health aid through multilateral agencies or NGOs, guided by public-sector oversight and institutional safeguards.
This is also why China’s lacking development funding, from CIDCA, or other, is less significant than it might seem. Yes, in 2023, China’s official bilateral health development assistance (funds that flow directly to recipients rather than through international organization) fell to its lowest level since 2010. But we need to stop calculating statistics with Western blinkers. Public sector and government isn’t the only source, and China’s numbers are very much made up in the private sector.
This blended model has underpinned some of China’s most visible efforts in the Global South. Chinese health companies, including pharmaceutical manufacturers, insurers, logistics providers, platform operators, work directly alongside Chinese government bodies. This leads to models that can move quickly, scale easily and embed long-term presence through trade, infrastructure, and standards.
China’s integrated models prioritises local production, because they reflect its own development logic: health security depends on domestic capacity. It’s no wonder that Global South partners are eager to adopt strategies which do not depend on external procurement and reduces long-term dependency on Western supply chains. Many developing countries were burned by vaccine nationalism during COVID-19, with lasting resentment and distrust of Western talk about ideology and global goods while protecting supplies for their own nations. China’s strategy feels less ideological and more practical: local production enables local control over standards, timelines and distribution. Even if they embed Chinese ideology and governance alongside them. Even if it creates China dependency and locks in Chinese standards across supply chains.
In Zambia in 2024, China's Jijia International Medical Technology Corporation has partnered with the Zambian government to build the country's first cholera vaccine manufacturing facility, aiming to produce three million doses annually. Across Africa and Southeast Asia, Chinese firms have co-invested in pharmaceutical plants in Egypt, Senegal, and Morocco; supported vaccine manufacturing hubs in Indonesia and Malaysia; and launched joint ventures to produce diagnostic tools and digital health platforms.
4. Reinvented Community Care: China’s Barefoot Doctor Model
One of the most overlooked features of China's global health strategy comes from its own past.
China’s barefoot doctor programme was launched in the 1960s under Chairman Mao, during a time of widespread poverty and an overwhelmingly rural population. Health professionals were scarce, hospitals were distant, and formal systems could not scale fast enough. The barefoot doctors were designed to fill that gap: offering coverage over perfection. These “peasant-doctors” were young people recruited from farming villages, who trained for three to six months in a mix of Western and Chinese medicine to deliver babies, administer antibiotics, teach hygiene, refer patients, and rely on herbal remedies when modern drugs were scarce.
Within a decade, over 1.5 million barefoot doctors served across the country. China’s ratio of health workers to population jumped from 1:8,000 to 1:760. The iconic programme became internationally emblematic of what decentralised, community-based care could look like. In 1978, the WHO’s Alma-Ata Declaration on Primary Health Care cited China’s approach as a best-practises model for developing countries. Brazil developed its Agente Comunitário de Saúde programme; Iran launched its Behvarz model and Thailand introduced village health volunteers. China had created a precedent: that community trust and local reach could outperform expensive, centralised systems for delivering basic health.
This logic continues to guide China’s health engagement abroad today. The same emphasis on scale, simplicity, and community trust appears in its support for frontline health worker programmes across the Global South:
Training large cadres of local health workers through short, focused programmes
Prioritising prevention and mass outreach over high-cost interventions
Delivering care through local institutions, often supported by digital platforms and public health campaigns
As far back as the 1970s, China sent doctors to Tanzania to train practitioners for rural health capacity-building. More recently, in Cambodia, China has helped strengthen rural health outreach and disease prevention for Children. These efforts often blend simplified technologies such as mobile diagnostic kits, solar-powered refrigeration with soft infrastructure like hygiene education and task-shifting from doctors to community health workers.
Of course, China’s barefoot doctor model was far from flawless. Training quality varied, supervision was inconsistent, and the pressure to improvise without proper equipment could all undermine safetyand limit scope. But the broader lesson remains: when the goal is mass access under constraint, systems built from below can work.
Western countries have not, at least in recent memory, built health systems under the same urgency,. The UK’s NHS stands out for its high-functioning primary care gatekeeping system, and as someone who has worked within it, I remain proud of its many strengths. But the reality is that much of it remains ill-suited to the conditions and priorities of low- and middle-income countries today.
For countries grappling with workforce shortages, rural-urban divides, and post-pandemic gaps in public trust, China’s comfort with scale, improvisation and non-elite delivery channels offers something trulydifferent. While Western models often prioritise formalisation and top-down control, China’s experience shows how improvisation and mass mobilisation—flawed as they may be—can deliver care when little else is in place.
5. Respect for Traditional Knowledge: Blending Views of Medicine
Many developing countries hold rich cultural history, which applies very much also to their understanding of health and healing. Traditional medicine can play a central role in how people understand their bodies, how families recognise illness, and how patients seek care. But I do think that Western health systems have rarely engaged with this reality. I am sure that it’s not out of malice or intention, but very much through instinctive and institutional habits: scientific standardisation and evidence-based protocols for what can be measured, controlled and certified. This overlooks, or even erases traditional practices more familiar to many developing populations, particularly rural communities, whose longstanding herbal remedies, massage therapies or birth rituals, are all treated as secondary, unscientific or even dangerous. This means that the health systems that the West helps to build, are not built to acknowledge, let alone preserve acknowledge.
China’s approach is completely different, because Traditional Chinese Medicine (TCM) has always remained a central and formal part of its own national health system. China’s policymakers, system builders, doctors, and industry leaders are all more comfortable in working within pluralistic medical environments. Acupuncture and herbal therapy are practiced in public hospitals, taught in medical schools and reimbursable on public health insurance, whether for chronic pain, stroke rehabilitation or anxiety. These sit right alongside antibiotics and surgical care in Chinese hospitals every day.
This familiarity gives China more than a certain fluency when engaging with countries that also maintain strong traditions, leaving space for local roots to remain intact, whether in Africa or Southeast Asia. In Nigeria, for instance, herbal medicine and therapeutic massage remain widely trusted, especially in maternal care. Traditional birth attendants in Lagos blend spiritual and herbal practices that carry legitimacy within their communities.
China does not attempt to replace these systems with TCM. It offers a blended model that implicitly affirms their right to exist. In many of its partnerships, China’s health infrastructure arrives without demands for full biomedical conversion. That absence of conditionality allows space for countries to determine how tradition and modernity coexist, without being told which parts must be shed.
I have rarely, if ever, seen this point about traditional medicine being brought into the conversation about global health and development, but it’s definitely something I’ve thought about for a long time. As a Western-trained doctor raised with herbal remedies and traditional treatments passed down from grandparents, perhaps it makes sense that I sense these gaps and overlaps more instinctively. I recognise that my cross-cultural experience changes what questions feel important in the first place.
Of course none of this is simple. Traditional medicine has (many) limits, and I am often the first to stand up and request data about efficacy and outcomes. Some traditional practices have weak evidence, some resist accountability, and are some are actively harmful. Western-trained scientists and policymakers, myself included, aren’t not naturally taught to see this clearly. But in many places, legitimacy in healthcare comes not just from what works, but from what feels right. Trust, cultural legitimacy, and lived experience are essential in medicine – not only in building relationships, but in driving uptake, adherence and health outcomes.
Final Reflections
China’s approach to global health is evolving fast. Its delivery models feel more practical, and its partnerships more familiar to many governments navigating post-development transitions. In a world where multilateral cooperation is fraying, China’s offer holds clear appeal across the Global South.
But this coherence has limits. China’s development institutions remain underpowered. As mentioned, CIDCA operates on a fraction of USAID’s budget, and many programmes depend on ad-hoc coordination rather than sustained institutional partnerships. On the ground, projects often face bottlenecks, staffing shortages, and weak monitoring systems. Collaborations with private firms may bring speed and flexibility, it’s true, but their additional roles also significantly increase risks of fragmented delivery and competing agendas.
China’s official language casts recipients as “friends and brothers,” but its health assistance always tracks its broader political and economic goals. Multilateral programmes receive less attention. Cross-border disease threats and aid to the poorest countries are lower on the list.
And then there is the governance question. As China expands its influence, it brings political assumptions about data ownership, system control, surveillance and the role of the state. In some countries, China’s model offers pragmatic relief: tools that work under pressure. In others, it may entrench systems that limit reform or transparency down the line. Either way, it deserves more attention and more nuanced analysis than most headlines allow.
Global health needs to remain a technical domain where impact happens in hospitals, clinics and research labs. Meaningful outcomes depend upon true expertise, consistent funding, painstakingly built relationships and long term collaborations. Western institutions can do better, by first understanding what China and the Global South need and want, and then refine their own strategies in order to match expertise and relevance. Whatever comes next, whether China-led, Western-led, or otherwise, care must actually reaches the people who need it.
🩺 The Vital Signs series provides essential explainers on key contexts and trends shaping health in China today. Today’s post focuses on China’s role in the rapidly evolving global health/development landscape.
Global health and development is really the area that I am most passionate about, above all. Thus far, the China Health Pulse Newsletter has covered geopolitics, technology and health industry market access, but I’m looking forward to writing more about the development space and the Global South in future posts. Stay tuned.
Thank you Ruby for this careful, analytic and comprehensive article. You point out many important issues and facts that the mainstream media simply does not cover. I hadn't known that Britain, too, had slashed aid funding. Something else that didn't make the msm. the final part about recognising the importance of traditional medicine is a very important factor, considering how China has successfully integrated TCM into treatment protocol across the country.
Thanks, Ruby. Bookmarked.