For better impact, the Health Silk Road projects should come as a 'package', integrating health assistance, cooperation, healthcare facility construction and health projects

The Health Silk Road, specifically targeting public health and international cooperation in healthcare, is a crucial component of the Belt and Road Initiative. Its objectives are at least threefold: improving healthcare infrastructure in partner countries, enhancing international health cooperation, and strengthening global health governance.

First, the Health Silk Road aims to improve the accessibility, quality and sustainability of healthcare services in partner countries. Through investing in the construction and modernization of hospitals, medical laboratories and other healthcare facilities, and providing equipment and technology for healthcare institutions, the Health Silk Road has played a significant role in reducing the burden of disease, lowering mortality rates and improving overall public health.

For example, China has constructed the China-Laos Friendship Hospital in Vientiane, Laos, and the China-Cambodia Friendship Hospital in Phnom Penh, Cambodia, to enhance the capacity of these countries' healthcare systems. China has also been investing in public health and disease surveillance systems in partner countries, such as the China-aided Malaria Control Project in Cameroon, which includes the construction of a national malaria control center, laboratories, and training facilities. The China-built African Centre of Excellence for Genomics of Infectious Diseases in Nigeria aims to advance the study of genomics and contribute to the control of infectious diseases in the region. The Health Silk Road also supports the establishment and enhancement of training centers and medical schools to develop the capacity of healthcare professionals in partner countries. The China-Zimbabwe Friendship Hospital School of Nursing is such an example that helps bolster the training of local nursing professionals.

Given the increasingly important role of digital health solutions in enhancing healthcare accessibility and efficiency, particularly in remote areas, China has also been collaborating with partner countries to develop telemedicine and e-health infrastructure. In 2018, the Chinese company Huawei signed an agreement with the government of Papua New Guinea to build a telemedicine system that will facilitate remote medical consultations and improve healthcare delivery in rural areas.

Second, the Health Silk Road is committed to enhancing global health cooperation. It seeks to foster collaboration between China and participating countries across various health-related domains, including disease prevention and control, public health policy, medical research and healthcare technologies. By facilitating knowledge and technical exchanges, capacity building, and joint initiatives, the Health Silk Road has the potential to contribute to improved global health outcomes and address shared health challenges more effectively.

China has dispatched medical teams to African countries since the 1960s, providing medical services and training local healthcare professionals. The Health Silk Road has expanded this initiative, with thousands of Chinese medical personnel working in over 50 countries worldwide. China has also launched joint programs on public health. For instance, the China-Africa Public Health Cooperation Plan, established in 2018, focuses on joint initiatives in areas such as malaria and HIV/AIDS prevention and control. The China-Brazil Center for Disease Control and Prevention, established in the same year, aims to foster cooperation in epidemiological research, surveillance and laboratory testing.

As a unique medical diagnosis and treatment approach, traditional Chinese medicine is put as a priority. Nearly 100,000 overseas TCM institutions have been opened in more than 30 countries so that people in the Belt and Road countries could benefit from high-quality and inexpensive Chinese medicines. In addition, 86 TCM cooperation agreements have been signed with Health Silk Road countries and regions. In June 2018, the TCM Foreign Exchange and Cooperation Alliance was officially established to exchange and cooperate with the Belt and Road countries in TCM.

Third, the Health Silk Road helps strengthen global health governance. China has established various platforms for health cooperation, including the China-ASEAN Forum on Health Cooperation, the China-Central and Eastern European Countries Health Ministers' Forum, and the China-Arab States Health Cooperation Forum, and is increasingly active in global health forums and initiatives, such as the World Health Assembly, the G20 Health Ministers' Meetings and the Global Health Security Agenda. By engaging in these platforms, China contributes to deliberation of global health policies and sharing of best practices.

The Health Silk Road also pursues partnerships and collaborations with international organizations, governments and private sector entities to address global health challenges. For instance, in 2017, China signed a memorandum of understanding with the Bill and Melinda Gates Foundation to cooperate on global health and development issues, including infectious diseases, vaccine development and healthcare innovation. The collaboration continued following the COVID-19 pandemic, marking a strong China-US collaboration on health and medicine. In the meantime, China has increased its funding to multilateral health organizations, such as the World Health Organization, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

By engaging in various health-related initiatives, providing financial contributions, technical assistance and capacity-building support, participating in global health forums, and forging strategic partnerships, the Health Silk Road demonstrates China's growing commitment to global health cooperation and its ambition to position itself as a proactive and responsible global health actor.

Nevertheless, the construction of the Health Silk Road has encountered several obstacles. Externally, the Health Silk Road is challenged with a prominent issue of securitization in the context of China-US strategic competition. In particular, the United States has been prone to adopt security-related discourses, emphasizing the possible security threats from the extension of the Health Silk Road, especially to Western countries. Skepticism of the West toward the Health Silk Road has partially shaped the perception of countries involved in the initiative, damaging its reputation. Internally, there are issues related to interagency coordination and fragmentation that impede the Health Silk Road becoming a high-impact health initiative.

Healthy lives and well-being are essential to sustainable development and building prosperous societies. It will be wise for developed and developing countries to consider global health more as a public good. Assurance of health as a public good necessitates investment in improvement of public health on the domestic front and contributions to international collaboration on disease prevention and treatment. Such rethinking can lead to a renewed impetus for global health cooperation among countries rich and poor, particularly in times of a pandemic.

Domestically, China will need a whole-of-government approach to global health challenges. To improve its impact on the health system in partner countries, the Health Silk Road projects should come as a "package", building an effective integration plan for health assistance and cooperation, and integrating healthcare facility construction with health projects such as dispatching of medical teams and hospital-to-hospital technical cooperation. Fragmentation could be countered by ensuring that joint and individual agency strategies delineate roles, responsibilities and coordination mechanisms, and provide assessing progress toward objectives.

Zhou Taidong is vice-president of the Center for International Knowledge on Development. Dong Dandan is an associate researcher of the Center for International Knowledge on Development. The authors contributed this article to China Watch, a think tank powered by China Daily. The views do not necessarily reflect those of China Daily.

Contact the editor at editor@chinawatch.cn.