In 2013 China and Africa celebrated a golden jubilee of health care cooperation, a fiftieth anniversary marked by fruitful sharing of knowledge, ambitious sanitary programs, countless material, technical and financial donations and sincere collaboration – the fruit of sustained commitment by both parties. In 2012, China and Africa made a number of new commitments during the Forum on the China-Africa Cooperation (FOCAC) conference in Beijing, notably for the improvement of access to health care in Africa, commitments that both parties aimed to implement through a three-year Action Plan (2013-2015). 2014 was another crucial year for Chinese sanitary assistance to West Africa.

By Fousseni SAIBOU

China-Africa cooperation, now older than fifty years is better than ever before.
Formerly dominated by the Western presence, this cooperation took a decisive turning point from the year 2009 with the economic boom of China, which has now become the second world economic power after United States of America. The volume of Sino- African trade in 2013 for the first time exceeded 200 billion US dollars, from only 250 million dollars in 1965. This makes China the leading commercial partner of the black continent. Africa and China owe the dynamism of their cooperation to win-win partnership, which they have always aimed to develop between them.

China is not the only one to take advantage of this partnership as some people may think. Africa too wins at it. Thanks to this partnership, Africa not only has a safe outlet for its raw materials, but also benefits from Chinese development aid in several domains such as infrastructure, health, human resources, agriculture, culture. China indeed has had an aid policy towards Africa since the middle of the 1950s. This aid has since 1976 seen a gradual increase. For example, it jumped from 44 million dollars in 2005 to 88 million in 2009.  

At the end of this Forum on China-African Cooperation (FOCAC) meeting in 2012, China made a commitment to increase its aid for Africa. Health is one of the sectors benefitting from Chinese assistance. Almost all the African partner countries have already received support from China in this domain and West Africa is the largest beneficiary of the last three years (2013-2015).
 

Fighting Ebola: Strengthened sanitary cooperation in West Africa
 

2014 was a very painful year for countries of West Africa due to the sudden appearance of the Ebola hemorrhagic fever epidemic. Guinea, Sierra Leone and Liberia were the most affected countries; 99 % of the affected persons come from these three neighboring countries. By July 2015 the Ebola virus had infected 25 699 people and caused 11 000 deaths. This record exceeds by far that of all the epidemics declared in Central and East Africa between 1976 and 2015 (2 500 contaminations and 1 600 deaths). Overwhelmed and unable to deal with this unprecedented sanitary disaster in West Africa, countries in the region, especially the most affected ones, have no choice but to request outside help. Many countries offered their assistance but among them China was the largest contributor. Its reaction was spontaneous with a contribution of 120 million dollars of financial, technical, material and human resources assistance to the three most affected countries and to ten other countries of the sub-region. This was an historic effort. China transported by charter flight a mobile laboratory to Sierra Leone. Liberia benefited from an Ebola treatment center equipped with 100 beds, and a plane was chartered by China to bring provisions to these countries.

All these means deployed by China hugely contributed to pushing back the Ebola epidemic in the most affected countries and to avoid its spreading to other countries of the sub-region.  The example of Cote d’Ivoire, immediate neighbor of Liberia is a case in point. There has been no known reported case in the whole country until today. During a visit to China in November 2014, the Ivoirian Minister of Foreign Affairs Charles Koffi Diby acknowledged that the sincere, rapid and effective assistance of China is one of the important factors that enabled his country to be spared by the epidemic. The end of the epidemic was declared in Liberia on 3 September 2015 by the World Health Organization (WHO). The other two countries will not take long to recover. In Sierra Leone, no new case has been reported in the four weeks between September and October 2015. And the national center for the fight against Ebola in Sierra Leone hopes by late November to be able to totally eradicate the virus.

The Ebola epidemic caused 6.2 billion dollars of losses in the affected countries in terms of Gross Domestic Product (GDP). Guinea, Sierra Leone and Liberia have started to think of their reconstruction and recovery, and China promised to assist them in this process. On 10 July 2015 in New York during the summit of donors organized by the UN, China, through its permanent representative Liu Jieyi made a commitment to supply the multi-partner response fund with 5 million US dollars. The Chinese Minister of Foreign Affairs, Wang Yi, reaffirmed China’s commitment to them during his visit to Sierra Leone, Liberia and Guinea in August 2015. He confirmed that China will assist Sierra Leone to set up a treatment and research center on tropical diseases. The Chinese Ebola treatment unit in Liberia will continue to serve the local population.

The appearance of the Ebola epidemic revealed the weaknesses of health care systems in African countries, especially the most affected ones, e.g. (lack of qualified personnel, and adequate equipment, low subsidies for public hospitals, and dilapidated and limited health care infrastructure). In this light China has stated its commitment to continue to support Africa in general in many areas, and in the health care sector, it is going to contribute to the implementation of systems to fight diseases and improve capacities to respond to public sanitary crises.

This strong commitment of the Chinese government in the fight against the Ebola epidemic has aroused the admiration of the international community and in particular the affected countries, and particularly contributed to the strengthening of China-West Africa cooperation.
 

Equipping hospitals with ultramodern devices for the welfare of communities
 

In half a century China has constructed thirty hospitals and around thirty malaria treatment centers throughout the African continent. Togo has the privilege to benefit from two health care centers thanks to this cooperation. These are the Lomé Commune Regional hospital built in 2010 and the Regional hospital of Kara built in 1994.

New premises of the regional hospital Lomé Commune built and equipped by China in 2010.

Construction and equipping of the Regional Hospital of Lomé Commune cost the Chinese government 13.7 million dollars. In 2013 the center received additional equipment amounting to 600 900 dollars.
 

Equipment donated by China to Regional Hospital Lomé Commune.

"China has done a lot for our health care center" declared Sir Sadikou Yakoubou, Manager of the Regional Hospital Lomé Commune.

Mr Komi Gozo and his family use the services of the Regional Hospital of Lomé Commune regularly. He is happy with the health care benefits there. When we approached him he exclaimed: “I thank China for this jewel she brought to our community. To get medical treatment we are no longer obliged to make long distances, or to go to private hospitals and clinics where treatments are very expensive to us. I got rid of my hernia thanks to the operation which I had in this Chinese hospital. I would advise everyone to come here”.

Every year, the Chinese government supplies these two Togolese hospitals with a set of anti-malaria medicines, as well as other diverse medicin and medical equipment amounting to of 87 050 dollars free of charge.

Benin too benefits from the same support. The army training hospital of Parakou, situated in the northern part of the country 500 km from Cotonou, officially delivered to the Beninese authorities on 3 April 2014,is one of the China’s contributions. This hospital has been operational for two years, but with only some areas of specialization. The installation of specialists and equipment by the Beninese state has not yet been completed.

In Benin China supports three other health care centers with medical teams, medicine and equipment. For example China equipped the departmental hospitalof Lokossa with a scanner, which unfortunately has since broken down. Mr Gafarou Wassi, head of the division for Africa, Asia and the Middle East of the cooperation department of the Ministry of Health of Benin, pointed to the lack of spare parts and trained technicians for undertaking maintenance.

China made a commitment during the FOCAC conference in 2012 to continue equipping hospitals it had constructed in Africa in order to insure their sustainable development and to attain the modernization of hospitals and laboratories. The General Hospital of Gagnoa located in the Mid-West of Cote d’Ivoire, inaugurated on4March 2013 by President Alassane Ouattara and Zhang Guoqinq, the Ambassador of China in Cote d’Ivoire, is indicative of this commitment.
 

 
Zhang Guoqing and Alassane Ouattara during the inauguration ceremony of the General Hospital of Gagnoa, Cote d’Ivoire, in March 2013. 
 

The full extent of this infrastructure investment in Gagnoa is estimated to be around 14 million US dollars, of which China provided 10 million dollars and Cote d’Ivoire 4 million dollars. This hospital has several units (emergency, resuscitation, pediatrics, surgery, obstetric gynecology, medical imaging, and related technical unit) 104 beds all equipped with ultra modern materials.

 

General hospital in Gagnoa, Cote d’Ivoire, inaugurated in March 2013.

Since April 2015, Mr Médji  BAMBA has been Mayor of  the town of Gagnoa, capital of the region of Goh. When we met he said that the existence of this Chinese hospital in his town is very strategic “The department has 50 000 inhabitants. This population uses the services of this hospital.  And the specificity of this hospital is the fact that its technical capacity is efficient and updated. Considering the Middle East region of Cote d’Ivoire within a radius of 150 to 200 km, in case of emergency of any kind, they now bring patients here instead of sending them to Abidjan. In case of bad accidents this technical capacity can intervene. This too means this hospital is vital for the region and even the sub-region.’’

 

Equipment donated by China to the general hospital of Gagnoa, Cote d’Ivoire.

The gyneco-obstetrics department was experiencing a strong influx on the day of our visit. The persons in charge of the center had to make use of beds from the surgery section to accommodate all the patients. The strong interest of the population in the services of the hospital is undoubtedly due to the technical capacity of the center and to the multiple sessions for raising awareness that the Director of the Hospital, Dr Meité Djoussoufou, and his team conduct periodically.

Appoline DOUCOURE, 40 years old, is a beans seller at the market of Gagnoa. Since the hospital opened she and her four children are no longer practicing self-medication because with this hospital they get can obtain good treatment and are healthier than ever before, as she is very happy to point out. Hence she can better run her business and increase her income. 

Mobilizing human resources

In August 2013 China and Africa celebrated fifty years of health care cooperation. The first Chinese medical team was sent to Africa (Algeria) in 1963. In all 20 000 Chinese health care professionals have worked in public hospitals in 45 African countries. They have been able to treat more than 230 million patients in various domains such as surgery, traumatology, general medicine, gynecology, pediatrics, ophthalmology, acupuncture, anesthesia, radiology, biology and pharmacy.

1 500 Chinese medical doctors were expected in Africa between 2013 and 2015 in agreement with the framework of commitments made by China during the FOCAC conference in 2012. With regard to the human resources China deployed within the framework of the fight against the Ebola epidemic in West Africa, this quota could be exceeded significantly. Complete units of about 1 000 anti-epidemic experts and medical professionals of the Chinese army were sent to Guinea, Sierra Leone and Liberia. Parallel to this commitment against Ebola, China medical missions to other West African countries. Togo for example welcomed the 21st mission on 11 September 2015. These multiple medical missions in West Africa allowed hospitals there to improve their performance. Eleven Chinese medical missions went to the regional hospital of Kara. The first nine missions realized 73 775 consultations, 44 754 hospitalizations, 4 489 surgical operations, 20 565 radiology and 9 988 acupunctures.
 

Ophthalmologic consultation session
 

Apart from malaria, China also contributes to the fight against HIV/AIDS, tuberculosis, bilharziasis and many other pathologies in West Africa. Reproductive healthand vaccination are also not neglected. China recently made a contribution of 5 million US dollars to Gavi, the Vaccine Alliance and is also contributing to research for producing vaccines against several diseases, notably Ebola.
 

Training, research and experience sharing priorities for both sides

Within the framework of their partnership, 19 Chinese universities are collaborating with 29 universities in 23 African countries. Hundreds of Chinese professors are active in African universities. Chinese medical doctors trained their West African counterparts on the ground during their various missions on the continent.
 

This training provided by China culminated in 2014, when then Ebola epidemic was at its most critical stage in West Africa. About 13.000 health care workers were trained by these doctors sent by China in the affected countries. The Chinese staff, in synergy with these trained African health care workers were able to detect more than 4 900 samples of the Ebola virus and treated 900 patients. This achievement corresponds to one of China’s commitments to Africa in the FOCAC Action Plan for 2013-2015, i.e. training three thousand nurses and one thousand doctors in Africa.
 

Medical team made up of Chinese and Togolese doctors.

Apart from this training, China grants internships to hospital staff and post-doctoral internships to doctoral researchers of the sub-region for long periods. It also facilitates them in their careers by supplying them with equipment for research at the end of their internships. For example since 2013 China has welcomed three waves of trainees of the General Hospital of Gagnoa. The last one, composed of five persons, returned from China in October 2015.

Acupuncture is a medical practice which is very developed in China. Its experimental use for several years in Africa is improving health conditions for West African communities.

Acupuncture operation in the REGIONAL HOSPITAL Lome Commune.

According to Doctor Raymonde GOUDOU COFFIE, president of the assembly of the ministers for health of Economic Community of West African States (ECOWAS), the successful example of China regarding the use of both traditional and modern medicine in health care is a way forward to be explored for Africa.

 Permanent assessment: Sino-African sanitary cooperation

For their joint objective for greater quality healthcare, China and Africa made a commitment to strengthen their exchanges in the medical domain. The FOCAC 2012 Action Plan earmarked the development of a high-level China-Africa seminar on sanitary development.  And this promise has been kept, given that on 26-28 March 2015 the fifth edition of the Sino-African Seminar on Sanitary Cooperation took place in Beijing, China. This seminar, organized jointly by the Research Center on Public Health at Tsinghua University and the import-export  Chamber of Commerce of sanitary and medical products from China gathered more than 350 dignitaries and senior health officials from China and Africa, including from government, academia, the private sector and international organizations. The objective was to think about the opportunities and the challenges of Sino-African health cooperation. A final document entitled "Strategic Recommendations of Beijing" was adopted by the participants. The document proposes strategies to strengthen intercontinental cooperation in view of attaining a sustainable impact, and it emphasizes universal health coverage and access to basic medicine.

This event was preceded by the first conference of the Ministers of Health that took place on 15-18 August 2015, likewise in Beijing. This conference aimed to coordinate new efforts needed to support long term progress in health care in Africa, and to prepare the future directions of China-Africa health cooperation. This gathering coincided with the celebration of the 50th anniversary of the first Chinese medical mission to Africa. Representatives of all countries present adjudged the preceding fifty years of the Chinese medical presence in Africa satisfactory, and now the objective was to redefine the partnership by taking the priorities of the continent into account. This meeting gave birth to the Beijing Declaration, in which Chinese and African leaders proclaimed a new era of health cooperation defining a road map to jointly solve the main difficulties that African countries are still faced with, in particular the fight against HIV/AIDS, malaria, bilharziasis, reproductive health and vaccination. The second edition of this forum of Ministers for Health took place from October 2015 in Cape Town South Africa. 

Doctor Robert Zanou, assistant manager of programming the Ministry of Health of Benin took part in this meeting. " We used to say that health has a cost. No! Health has no cost, but health has to be an investment. So African countries need to now know that they have to invest enough in health so that the rates of the diseases known as people diseases, such as AIDS, malaria, tuberculosis etc. can be reduced. They largely focused on that”, he declared.

At the end of this meeting, China has once more taken on new commitments for the next three years. Its most important announcement was the construction of 100 new hospitals on the continent.

All these ambitious projects initiated by China will help West African countries to reach the goal of universal health coverage. However, in some fields challenges still remain that need to be addressed.

Technology transfer lagging behind

Infrastructure constructed by Chinese companies in Africa, e.g. roads, hospitals, stadiums, and administrative structures, should be an opportunity for the African workers hired for these projects to learn Chinese knowhow. It must be the same for African doctors who regularly collaborate with Chinese experts through medical missions, training, and internships. It is undeniable that Africa benefits from all these actions from China, which contribute to its development, but Africa would benefit more if technology transfer was written into China-Africa partnership agreements, and there were really implemented. Otherwise African countries cannot reach the level of development to which they all aspire.

This technology transfer seems unfortunately to be lagging, especially in health care matters, and this contributing to maintaining Africa in a permanent dependent state to China. This is particularly apparent with pharmaceuticals and the medical treatment of non-transmittable diseases, mainly cancer. In the Beijing Declaration, which marked the end of the activities of the 1st forum of the China-Africa Ministers for Health in 2013, the representatives of Africa insisted on technology transfer, which according to them is the only way to guarantee medical autonomy of Africa. So it is important that Africa succeeds in producing generic medicines on its own to make them more accessible to people, and therefore ensure their better health.

In 2013 Cote d’Ivoire succeeded in completing its first kidney transplant, a medical revolution in this country. China can also assist other countries of the sub-region to take the same important steps in medicine, i.e. the transplantation of vital organs, via technology transfer.

“The important thing is to be able to solve all health problems in Africa.  Because it is very expensive if we must move abroad to get treated. The ideal thing would be that China allows her technology to be set up in West Africa’’, said Doctor ETIEN Yao Toussaint, a general practitioner at the Gagnoa Hospital.

To facilitate this technology transfer, some hospital managers proposed promotion of telemedicine, i.e. the use of telecommunication and information technologies in order to provide clinical health care at a distance, in health care infrastructure constructed by China in Africa.

Hepatitis forgotten by China-Africa healthcare cooperation

Over the last few years West Africa has experienced a decline in HIV/AIDS prevalence and a reduction of mortality rates connected with malaria and tuberculosis. This was achieved largely due to efforts by the Global Fund to Fight AIDS, Tuberculosis and Malaria and by China, which annually mobilizes huge financial resources to fight against these three diseases. All this attention dedicated to the fight against these diseases, however, means that certain other dangerous diseases have been largely forgotten, namely hepatitis which causes cancer and liver cirrhosis in Africa.

Hepatitis B (VHB) remains the most widespread in West Africa with a prevalence of 10-15 % of the population. The lack of reliable figures in West Africa shows the little interest afforded to this pandemic, which many experts consider as very acute. Despite the existence of a vaccine, Hepatitis B remains a silent pandemic which continues to decimate working populations and children, but it does not really seem to moving their leaders. Only some few countries such as Cote d’Ivoire and Senegal have national programs to fight hepatitis. Countries such as Togo recently made some effort to introducing hepatitis vaccines into their extended program of child vaccination. Yet for many people the cause is hopeless; a majority of infected patients die without being able to obtain treatment, because treatment is too expensive. In Senegal for example, one year of antiretroviral medicine for Hepatitis B costs approximately 4 000 US dollars, while half of the population lives on less than two dollars a day. Only those who have the double infection of HIV/VHB enjoy the antiretroviral drugs free of charge.

Some non-governmental organizations and associations have pointed out that if particular attention is not dedicated to this pandemic in the same way as AIDS, malaria and tuberculosis, West Africa risks an unprecedented disaster in a few years’ time. To save West Africa from hepatitis, China and her African partners have a big challenge to take up toward insuring free access to the vaccine for Hepatitis B, in making access to antiretroviral drugs free by implementing national programs and by setting up centers for research and treatment.

They can also intensify awareness among the population and organize regular high-level meetings on the state of progress of the fight against it in West Africa within the framework of a new Sino-African agreemen.

“Any aid in this domain would be welcomed, because only some pathologies are accounted for by the European partners. There are some other diseases such as Hepatitis B which are more dangerous than AIDS and can be stopped if we find a partner’’, Doctor ETIEN Yao Toussaint pointed out.

Hospitals in West Africa have many other serious problems, such as the acute lack of kidney dialysis equipment. In Togo and in Cote d’Ivoire, patients suffering from kidney failure are obliged to move to the capital to again access to hemodialysis. The mayor of Gagnoa is concerned about this situation, and calls on the Chinese government to equip the hospital of his town with a dialysis unit. ’’We also need that our hospital be improved through more equipment, such as that of the hemodialysis. A dialysis unit needs to be set up to help the hospital be more effective, for everything is concentrated in Abidjan. In Gagnoa, for example if it happens that you suffer from this disease, your life expectancy is only two months’’, he said.

Important decisions are expected at the FOCAC Summit in December 2015. According to local and traditional health care authorities in Benin, Togo and Cote d’Ivoire, China and Africa have to seize this occasion to reflect on the diverse health problems in Africa and especially on how to fight against the three root causes of the epidemics in West Africa, namely poverty, unhealthiness and illiteracy.