China Has Invested Heavily in Rwanda’s Healthcare and USAID’s Closure Opens More Doors for Chinese Influence Health Systems 14/02/2025 • Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Chinese assistance is recognised at the entrance to Masaka Hospital in Kigali KIGALI, Rwanda – Behind blue scaffolding walls marked “China Aid for shared future”, a massive expansion of Masaka District Hospital is underway. The hospital will expand from 330 to at least 830 beds, and it is destined to become the country’s top teaching hospital, with completion set for July. China has provided a $42 million grant to the Rwandan government to expand the hospital, but it has a long association with Masaka, assisting to build it in 2011 and providing medical specialists for it since 2018. The Chinese government is financing a $42 million expansion of Masaka District Hospital in Kigali “The construction of the Masaka District Hospital is one of the largest China-aided projects in Rwanda, and it marks a milestone in health infrastructure cooperation between the two countries,” Chinese Ambassador to Rwanda Wang Xuekun said at the start of construction in 2023. Chinese support is evident throughout Masaka. A billboard at the entrance features nine Chinese specialists currently based at the hospital. A room offers Chinese medicine. (“Acupuncture,” explains a nurse.) China sends new medical staff to the hospital every year, says Dr Jean Damascene Hanyurwimfura, Director-General of the hospital. A billboard at Masaka Hospital displays the Chinese doctors currently stationed at the hospital China is Rwanda’s biggest trading partner. By 2022, the Rwanda Development Board had registered investments worth $182.4 million from China, an increase of 30% over the previous year. Huge PEPFAR investment There is a small US Agency for International Development (USAID) sign at the hospital’s entrance. “The US has helped us in training and mentoring doctors and nurses in maternal and child health,” said Hanyurwimfura. “But since this month, that has stopped. It is not having such an impact yet because the people have been trained, but in future, there will be a gap.” This follows the decision by incoming US president Donald Trump to suspend all foreign aid for 90 days from 20 January, followed by the dismembering of USAID by Trump appointee Elon Musk. However, Rwanda has received significant funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) since 2004. By 2020, it had received $1.45 billion from the plan. In 2022/ 23, it received over $67 million. PEPFAR’s investment in Rwanda up to 2020 totalled $1.45 billion. Unlike many other PEPFAR recipients, Rwanda delivers integrated health care, not a vertical programme focussed on HIV so PEPFAR funds have helped to build the country’s healthcare system and employ health workers. After the initial shock following the US funds freeze, US Secretary of State Marco Rubio clarified that life-saving humanitarian programmes could continue. On 1 February, a waiver notice was sent to PEPFAR implementing agencies and country coordinators clarifying that “life-saving HIV care and treatment services” covered HIV testing and counselling; prevention and treatment of opportunistic infections including tuberculosis, laboratory services; procurement and supply of medicines, and prevention of mother-to-child transmission services. Despite walking back its freeze, the Trump administration’s dismantling of USAID means that the US staff ensuring payments and delivery of antiretroviral medicines is no longer there, so PEPFAR projects worldwide are experiencing disruptions. In addition, support for certain key activities, such as services for sex workers and men who have sex with men, has been axed. The US withdrawal from the World Health Organization (WHO) may also impact on Rwanda’s health sector. The WHO has supported Rwanda in various initiatives, most recently providing financial and technical support to address its outbreak of Marburg virus. The US funds a quarter of WHO’s emergency response so activities these will need to be cut back. China’s ‘Health Silk Road’ China appears reluctant to step up at a multilateral level to fill the gap left by the US, baulking at the 20% increase in WHO membership fees at the recent executive board meeting – even though that had been agreed to by members in 2022. But it is likely to assist countries left in the lurch by the US on a bilateral level, particularly those like Rwanda where it has invested substantially over a long period. Between 2003 and 2018, China’s outbound foreign development investment in Africa has surged from $75 million to $5.4 billion, up 7100%, according to researchers Nader Habibi and Hans Yue Zhu. While China named its multilateral cooperation programme the Belt and Road Initiative (BRI), which indicated its focus on helping poorer countries with infrastructure development, over the past few years it has referred to the “Health Silk Road (HSR), which is regarded as a key element of China’s new BRI agenda”, according to Habibi and Zhu. Elements of the HSR include “high-tech telecommunication infrastructure, medical equipment and healthcare services”, they note. “Amid increasing geopolitical competition, and facing escalating US efforts to contain China’s global role, the Chinese government is using the HSR initiative in Africa and elsewhere to expand its global influence,” they argue. China’s President Xi Jinping addresses the Forum on China-Africa Co-operation At the opening of the Forum on China-Africa Co-operation in Beijing last September, China’s President Xi Jinping pledged to support the continent in 10 different ways, one being health. “China is willing to establish a China-Africa Hospital Alliance with Africa and build a joint medical centre.,” said Xi. “China will send 2,000 medical teams to Africa, implement 20 medical and anti-malarial projects, promote Chinese companies to invest in drug production, and continue to provide assistance to the epidemic in Africa to the best of its ability,” said Xi. “China will support the construction of the Africa Centers for Disease Control and Prevention and enhance the public health capabilities of African countries,” he added. To implement its “Ten Partners Initiative” China will provide $50 billion in investment over the next three years. US loses ‘soft power’ The dismantling of USAID has opened doors all over the world for China – not just in Africa. China moved fast to assist a Cambodian project that is clearing land mines and unexploded bombs a few days after the USAID freeze, according to Newsweek. Huge gaps in funding for Latin America following the aid withdrawal also offers opportunities for China to assist in a range of countries including Brazil, Colombia and Perua. This week, Central Asia’s poorest country, Tajikistan, reported that its HIV, TB, malaria and maternal and child programmes had been disrupted. “Until a mechanism for USAID’s further activities is determined, we will look for other ways to continue our work.” Minister of Health and Social Protection of the Population Jamoliddin Abdullozoda told a media briefing this week. “Through its Health Silk Road initiative, strategic personnel placement, and growing influence among developing nations, Beijing is carving a path to global health leadership that doesn’t require writing big cheques to Geneva [for WHO membership],” argues Professor Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, and a professor at Seton Hall University. Image Credits: Kerry Cullinan, US Embassy in Rwanda. 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