China's hidden role in malaria control and elimination in Africa.

Background: Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China's expanding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China's contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa.

Methods: Our research used AidData' s recently released Global Chinese Development Finance Dataset V.2.0 providing comprehensive coverage of all official sector Chinese development financing across Africa, from which we identify 224 Chinese-funded malaria projects in Sub-Saharan Africa (SSA) committed between 2002 and 2017. We conducted an analysis of the spending patterns by year, country and regions within Africa and compared it with data on population-adjusted malaria prevalence, sourced from the Malaria Atlas Project.

Results: Chinese-financed malaria projects Africa mainly focused on three areas: the provision of medical supplies (72.32%), the construction of basic health infrastructure (17.86%) and the deployment of anti-malaria experts (3.57%). Moreover, nearly 39% of the initiatives were concentrated in just four countries: the Democratic Republic of Congo, Central African Republic, Uganda and Liberia. Additionally, China's development financing amount showed a weak negative correlation (-0.2393) with population-weighted malaria prevalence. We concluded that the extent and direction of China's support are not adequately tailored to address malaria challenges in different countries.

Conclusion: With China's increasing engagement in global health, it is anticipated that malaria control will continue to be a prominent priority on its development assistance agenda. This is attributed to China's vast expertise in malaria elimination, coupled with its substantial contribution as a major producer of malaria diagnostics and treatments.