China’s contribution to various medical aid projects is an aspect of its involvement in Africa that is often overlooked. Recognised as a form of soft power, sometimes dubbed “health diplomacy”, it is structured differently to the network of NGOs and charities that citizens of other countries have established, independent of their governments. Instead, China is one of the only countries that sends government-paid medical workers to Africa for extended periods.

This form of soft power is – perhaps surprisingly – not as new as China’s commercial interest in the continent. The first Chinese medical team arrived in Africa in 1963, to assist in Algeria, a brand new nation that urgently required health care.

Now that China has the financial means – and fewer governmental channels than it did in Mao’s era – it provides most of its assistance in financial terms. The figures – as is often the case with China – are impressive. China’s worldwide aid contribution totalled US$39 billion since the country first launched its foreign aid program in 1950, an article in The Guardian reports. Other estimates indicate that the amount of aid provided doubled between 2006 and 2009 alone. But what exactly constitutes aid, and where have the majority of the billions been spent in recent years? An article published in Wharton Business School’s online journal reports on the use of foreign aid funds:

“More than 40% [of foreign aid funds] were allocated to “aid gratis,” or grants, while the other 60% were distributed between interest-free loans and concessional loans. Concessional loans are used to finance major capital projects with the aim of generating profit. The money is used in the construction of transportation, communications and electricity infrastructure, while less than 9% has been given to developing oil and mineral resources, writes The Guardian. The money for the concessional loans is raised on the market by the Export-Import Bank of China, while grants and interest-free loans are distributed from government finances.”

These are the same loans that allow China to negotiate for the right to resource extraction at extremely favourable rates, but the conditions of Sino-African business arrangements are a separate matter. It is the categorisation of concessional loans as “aid” that is misleading — and worrying. In the context of somewhere like Zambia – where a large proportion of the population is concerned about the extent and nature of Chinese involvement in their country – applauding China for “aid contributions” when more than half of these funds are used for making hardnosed business deals is extremely problematic.