Factors influencing the allocation of China's development assistance for health.

Background: China has been described as a "rogue" donor suspected of using foreign assistance to obtain raw materials, promote exports, and strengthen its business links with aid recipient countries. However, the factors influencing China's development assistance policy have rarely been analysed, particularly those related to its health aid. This study explores the factors that could affect the allocation of China's development assistance for health (DAH) from three key aspects: recipient need, recipient merit, and donor interest.

Methods: Analysis was based on cross-sectional data of China's DAH from 2006 to 2014. This study explores the following characteristics of the 82 recipient countries identified in the data: the association between China's allocation of DAH and recipient need (measured by Gross Domestics Product [GDP] per capita and all-cause Disability-Adjusted Life Years [DALYs]), recipient merit (measured by government effectiveness and human rights violations) and donor interests (measured by China's export, United Nations voting alignment, and recipient natural resources). A stratified analysis was conducted to understand these associations in different development contexts and the factors that influenced each type of DAH.

Results: Multivariate Spearman correlation suggested that the most significant factors influencing China's allocation of DAH were the recipient countries' GDP per capita ( r  = -0.31941, P  = 0.0049) and human rights conditions ( r  = -0.23227, P  = 0.0435). Health workforce was associated with medical team deployment ( r  = -0.20929, P  = 0.0715), while malaria DALYs was associated with anti-malaria center establishment ( r  = 0.46473, P  < 0.0001). According to the sub-group analysis, donor interests such as trade and natural resources only slightly influenced DAH allocation.

Conclusion: Recipient need and merit strongly influence China's DAH allocation while donor interests only slightly influence DAH allocation in certain development contexts.