China’s first batch of emergency humanitarian help to Myanmar is loaded onto an airplane in Beijing in March, 2025. In response to a request from the Myanmar authorities, China gave emergency humanitarian help to help earthquake aid efforts.
Chen Yehua/Xinhua by way of Getty Photos
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Chen Yehua/Xinhua by way of Getty Photos
Overseas help has lengthy been a method for america and China to achieve tender energy and affect—offering public providers in low-income international locations that assist them sort out poverty and illness, and fascinating with individuals to construct cooperation over the long term.
For many years, the 2 international locations had adopted separate worldwide help methods. However the Trump administration has dismantled a lot of america’ conventional overseas help programs and is charting a brand new path, whereas China has additionally been adjusting its strategy—stepping up seen contributions to world establishments whereas scaling again a few of the massive infrastructure tasks that after outlined its technique.
The result’s a second of convergence and competitors: the U.S. is transferring towards a extra transactional mannequin lengthy related to Beijing, and China is positioning itself to turn into a much bigger presence in world well being and growth.
The three phases of Chinese language help
China’s post-World Warfare II overseas help technique goes again to the Fifties when it supported the rising communist states North Korea and Vietnam. In these days, China itself was receiving help from the Soviet Union, says Carrie Dolan, an knowledgeable on Chinese language well being help on the Faculty of William and Mary.
“Part one was this anti-imperialism solidarity,” Dolan says. Then, within the Nineties, China shifted.
“Part two, we noticed help supporting Chinese language growth,” says Dolan. China framed its overseas help as mutually helpful with international locations within the world south, selling financial cooperation and growing commerce.
Within the 2010s, with Xi Jinping’s rise to energy, China sought world management and competitors with the U.S., says Dolan.
“After which section three, we’re actually seeing them transition to this tender energy, nice energy competitors.”
The best way China has given out help on this third section has largely been via bilateral agreements just like the Belt and Highway Initiative, in line with Yanzhong Huang, a world well being knowledgeable with the Council on Overseas Relations. Which means government-to-government offers, typically with massive loans from China.
“[The initiative] was extra targeted on massive scale infrastructure like ports, railways, energy vegetation, financed primarily via the bilateral loans to construct bodily connectivity and safe financial returns for China,” Huang says.
Till lately, China’s strategies stood in distinction with the U.S. on numerous ranges, in line with Samuel Brazys, professor of worldwide growth at College Faculty Dublin.
China most well-liked working instantly with governments, whereas the U.S. spent tens of billions of {dollars} funding help teams and worldwide organizations just like the United Nations to sort out points like poverty and illness.
U.S. overseas help grants, Brazys says, additionally tended to deal with long-term options and got here with circumstances for governments, akin to enhancing human rights, democracy and corruption. China typically didn’t impose restrictions on its help.
China has been adjusting its technique lately
China’s overseas help was topic to tons of criticism, together with from the U.S. and recipient international locations, in line with Huang.
Dolan’s analysis in Kenya and Sierra Leone on the efficacy of Chinese language help confirmed combined reactions from native medical officers, help and well being staff. Whereas her research confirmed individuals appreciated Chinese language help, they had been additionally involved that China wasn’t all the time contemplating native wants, and that it did not put sources into preserving the longevity of its tasks.
“We might see China purchase MRI machines, after which they arrive in, after which they set up MRI machines,” Dolan says, however as soon as the machines broke down over time, there was no system in place to get them mounted.
For example, Dolan says, she was in what was as soon as a state-of-the-art hospital financed by China in Kenya. Now she says, weeds had been rising via the ground.
Dolan says many individuals additionally felt that the massive loans from China had been predatory and made international locations economically weak. There have been additionally suspicions that China’s financial curiosity was the true motivation behind the help. In the end, Dolan and Huang say, this methodology undermined China’s purpose to construct constructive affect.
“Subordinating help to business curiosity actually eroded belief and tender energy,” Dolan says. “And we had actually opaque bilateral negotiations that enabled corruption, actually sidelining public well being.”
Which is why, Huang says, China, over the previous 5 years, has slowly moved away from the massive bilateral offers and is now funding small tasks in low revenue international locations and getting extra concerned with the United Nations.
In 2021, President Xi Jinping introduced a brand new initiative—known as the World Improvement Initiative—modeled extra carefully after what the U.S. had been doing, in line with Huang.
China started doing what it calls “small and delightful” tasks to deal with poverty and well being points.
Up to now few years, it refurbished a maternity ward in Zimbabwe, despatched medical tools to Panama, and employed locals to construct a bridge on the island of Kiribati.
Will China step into the US world well being management function?
For the reason that Trump administration’s overhaul of U.S. overseas help, specialists and lawmakers alike have voiced a standard concern: U.S. pullback would give its rival China a chance to step up its affect.
Taking a look at China’s strikes in 2025, specialists say the image is extra difficult. Jennifer Bouey, chair of the World Well being division at Georgetown College and co-author of the analysis challenge with Dolan, has checked out official paperwork and coverage papers from China and says there is a sense of alternative after the U.S. help cuts.
“China is now considering, ‘Okay, now the US is retreating from the U.N., retreating from WHO. This can be a time for China to construct its world affect, dominating the worldwide organizations, and on the identical time to have a platform to develop its financial footprint,’ ” Bouey says.
In February 2025, because the Trump administration was dismantling USAID, China’s help company stated it will be doing extra of the “small and delightful” tasks. In March, when a significant earthquake hit Myanmar, China pledged 137 million {dollars} in help, in comparison with about $9 million from the U.S. In Could, China introduced a $500 million donation to the World Well being Group, along with its yearly dues.
These strikes enable China to posture because the grownup within the room, in line with Nadege Rolland, fellow on the Nationwide Bureau of Asian Analysis.
“You are exhibiting the face of a benevolent energy that’s answerable for mankind, principally,” Rolland says. “Which aligns very properly with Xi Jinping’s imaginative and prescient for a world order that has China on the heart of it.”
Nonetheless, China spent about the identical total on overseas help in 2025 because it did in earlier years, says Bryan Burgess, who tracks China’s help spending on the Faculty of William and Mary
“They’re doing quick time period measures to win over hearts and minds, however they are not investing within the form of infrastructure and sustainability that massive ailments must get eradicated,” Burgess says.
Each he and Rolland say China will not be dashing to fill the hole left by the U.S.
“I do not assume it is absolutely able to take that function of a world well being supplier, and it is most likely began feeling the stones. That is a Chinese language expression to say, ‘we’re advancing very prudently in that route.'” Rolland says.
Nonetheless, it is clear that China will attempt to improve its affect via overseas help, as the uspresence seems to wane, she says.
The U.S. is altering its mannequin too, and it rings a bell for some
Final fall, U.S. Secretary of State Marco Rubio introduced the brand new America First World Well being Technique, claiming the previous overseas help mannequin led to a waste of taxpayer cash and wasn’t furthering U.S. political and financial pursuits.
As an alternative, the State Division says it has revamped a dozen bilateral agreements with low revenue international locations. The administration says it is hoping to create entry to sources like minerals in Africa and alternatives for American companies.
“[The U.S.] appears to be converging towards the Chinese language preexisting mannequin, on the time when China appears to be transferring away from its preexisting strategy,” Huang says.
Huang and Dolan say by commercializing help, the U.S. might face the identical pitfalls that China did.
“I feel that america ought to deal with precise well being and resist attempting to over-commercialize,” says Dolan. “As a result of this commerce first strategy, it solely compromises well being outcomes.”
