Abstract

Foreign aid directed toward the health sector, or health diplomacy, is a form of soft power that ultimately may assist with the fulfilment of the foreign policy goals of the donor country. China’s health aid to African States (which spans more than half a century) seeks to offer an alternative to normative western aid in its discourse of mutually sustainable self-development and historically in its more horizontal approach to health care. This research, based on a review of the literature and semi-structured interviews conducted at the Third International Roundtable for China–Africa Health Cooperation in Beijing, and with pertinent stakeholders in Antananarivo, Madagascar, aims to identify the actual sustainable self-development being fostered by Sino-African health diplomacy. Regardless of the horizontal structure of China’s health aid to African contexts, the foreign policy development discourse emanating from Beijing and the work of thousands of Chinese in African States since the mid-1960s, this research finds that Chinese health aid to Madagascar, as with western health aid, has resulted in a fragmented health care system – and, ultimately, an increased dependency on foreign aid – rather than in the growth of sustainable self-development.