Background
Methods
Study design
Study participants
SECTOR | MALAWI | TANZANIA | |||
---|---|---|---|---|---|
LOCAL | CHINESE | LOCAL | CHINESE | ||
Health | 9 | 8 | 3 | 14 | 34 (58.6%) |
Government (ministry, embassy) | 11 | 1 | 6 | 2 | 20 (34.4%) |
Academic/research | 2 | 2 (3.4%) | |||
NGO | 2 | 2 (3.4%) | |||
TOTAL PARTICIPANTS | 20 (34.4%) | 9 (15.5%) | 13 (22.4%) | 16 (27.5%) |
LOCAL | CHINESE | LOCAL | CHINESE | ||
---|---|---|---|---|---|
Health team – physician, nurse, other medical staff | 8 | 13 | 21 (36.2%) | ||
Health facility staff – project director, manager, administrative | 9 | 3 | 12 (20.6%) | ||
Ministry or embassy representative | 11 | 1 | 6 | 2 | 20 (34.4%) |
NGO representative | 2 | 2 (3.4%) | |||
Other (disease specific program, research center) | 2 | 1 | 3 (5.1%) |
Data collection
Ethical considerations
Data analysis
Theme | Subtheme | Codes |
---|---|---|
Communication | strained working relationships | barriers to aid, attitudes of Chinese workers, language barrier, culture, training, politics |
language barriers | language barrier | |
varying social norms and mores | culture, value | |
patronization of African HCW | attitudes of Chinese workers, aid person, burnout | |
Cultural Perspectives and Historical Context | lack of cultural relativity | culture, value, attitudes of Chinese health workers |
power dynamics | awareness, colonial history, corporate, politics | |
lack of historical context | barriers to aid, future, colonial history, politics | |
absence of trust | barriers to aid, attitudes of Chinese workers, trust, not observed, impact | |
Divergence between Political and Business Agendas | opportunities for private investment | corporate, politics, value |
moral hazard and adverse selection | politics, impact, trust, economic development, corporate, value | |
unequal distribution of political capital (i.e. reference how Africans feel obliged to accept donations) | colonial history, politics, economic development, corporate, impact, value | |
concealed motivation | impact, attitudes of Chinese workers, future | |
influence of multilateral organizations | politics, lack of external collaboration, colonial history, trust, value | |
Organization of Aid Implementation | countries’ policies and procedures misaligned | barriers to aid, procedures, coordination failure, capacity failure |
substandard or expired donations | idle resources, material resources, not observed, substandard, logistical failure, barriers to aid, lack of regulation | |
country needs not met | in-country needs, material resources, infrastructure, training, recommendations, economic development | |
inadequate training | training, sustainability, material resources, aid person, barriers, politics, country needs | |
Management and Leadership | poor country and donor collaboration | logistical failure, barriers to aid, lack of external collaboration |
inadequate consultation | barriers to aid, consultation | |
lack of central authority | barriers to aid, capacity failure, logistical failure, sufficient internal communication | |
Sustainability | wasted, lost, or destroyed resources | idle resources, language barriers, training, material resources, inadequate consultation, sufficient internal communication, lack of external collaboration, not observed |
lack of M&E protocol | evaluation, sustainability | |
aid worker burnout | sustainability, evaluation, burnout, attitudes of Chinese health workers |
Results
Communication
“language is an obstacle, including cultural concepts, … including some etiquette, customs, … Our gesture(s) and way of expression may not be easy for [Africans] to understand.” – Chinese Participant
Cultural perspectives and historical context
“You [China] just came here to build, just making money here, has not brought benefits to the locals. This is why they took Africa as a new colony.” – African Participant
Divergence between political and business agendas
“If you want to change—if you want this aid, you have to make sure you include this in your law … aid with strings attached … . Politically, you have to … receive it with a smile. Yeah. Even if it’s a plastic smile.” - African Participant
Organization of aid implementation
“ … it'd be great if there is a clear responsibility … (an) organizational structure. (For) China … as an international donor … it will be almost impossible to clearly understand all the internal organizational structures in (a country) … it's also difficult to find the right person or right division to talk to … (unless) there is a clear responsibility and framework established internally in government.” – African Participant
Management and leadership
“I see a gap in (Chinese) understanding (our) system and (our) situation. So I think … If we could find a way that they learn a little bit … . They should be told how .. the system work(s), what is the policy, what are the regulations, when it comes to the health organization - how the hospital is organized, how do we get material, what are the challenges, and possible challenges in working … .” – African Participant
Sustainability
“ … looking ahead in the long-term [needs], for sustainability. So [China should be] taking into consideration the approach of working more broadly, working through a task force or a committee, to be more inclusive. Ensuring that there is transparency … to get better buy-in, a longer-term plan which everybody [China and recipient country] can buy into, so the plans have action available to all stakeholder.”- African Participant