Through the Eyes of Chinese Medical Teams: the Fragmented Landscape of Healthcare in Africa
How Neoliberal Policies Shaped the Fragmented and Unequal Healthcare System in Africa?
This was originally an academic article published in “Wenhuazongheng“ (文化纵横)， a Chinese journal focusing on sociology.
Media reports have consistently portrayed Chinese medical aid teams in Africa as embodying an international humanitarian spirit through their fearlessness in the face of hardship and boundless love. However, few people are aware of the actual conditions they face when carrying out medical assistance. The author of this article provides rare first-hand information based on fieldwork conducted in several East African countries between 2015 and 2019, depicting the current state of Chinese medical aid teams in Africa and revealing the practical problems and challenges in their medical aid practices.
The article argues that, unlike the humanitarian assistance between socialist countries in the past, the African medical ecology currently faced by Chinese foreign aid medical teams has been shaped by decades of global neoliberal trends. This has ensured the development of doctors' professional freedom, private hospitals, and medical tourism, but it has also weakened the possibility for ordinary people to access basic medical needs. The values reflected by this medical ecology are at odds with the positioning of Chinese medical aid teams in Africa, often leaving team members in awkward predicaments.
Despite the generally underdeveloped state of healthcare in Africa, the continent has managed to align its standards for medical professionals and pharmaceutical quality with the benchmarks set by the WHO and developed nations in Europe and North America. However, this alignment has led to a situation where even basic medical supplies, such as fluids for intravenous drips, must be imported from Europe and the United States. Consequently, impoverished African countries are burdened with the high costs of medicines from developed countries, leaving ordinary people unable to have their basic medical needs met and resulting in a serious waste of resources.
In this context, the author points out that the awakening of Africa's autonomy in the medical and health field has become a potential leverage point for the development of Chinese medical aid in Africa. By "teaching people to fish" and assisting in the formulation of feasible health development strategies, Chinese medical aid teams can benefit African people in a more meaningful and sustainable way.
Original Article:
Chinese Medical Teams in Africa: Navigating Forward in the Quagmire of Neoliberal Healthcare
author: Tengfei Qi & Liangmin Gao
This year marks the 60th anniversary since China dispatched its first medical team to Algeria in 1963. Over the past 60 years, Chinese medical teams have traveled thousands of miles to save lives and heal the wounded in distant lands, not only practicing the spirit of international humanitarianism but also injecting vitality into China-Africa friendship. For a long time, when it comes to Chinese medical teams in Africa, the media and academia have focused more on macro issues such as humanitarian assistance, aid motivation, international health cooperation, health diplomacy, and the community of a shared future for human health, with little attention paid to the micro practices of the medical teams. There is even less in-depth research and discussion on the real situation of Chinese medical teams in Africa's local medical ecology.
From 2015 to 2019, the author conducted anthropological fieldwork in East Africa, during which he met many members of Chinese medical teams in Africa and went to their camps to interview them. After returning to China, he also interviewed staff from the former National Health and Family Planning Commission (now the National Health Commission) which is responsible for dispatching medical teams to Africa, as well as relevant personnel from the Ministry of Foreign Affairs and the Chinese Center for Disease Control and Prevention (China CDC). This has given him a comprehensive understanding of the current state of Chinese medical teams in Africa. Based on our fieldwork data from Uganda, Malawi, Tanganyika (mainland Tanzania), and Zanzibar (the islands of Tanzania), this article reveals the real problems and challenges faced by Chinese medical teams embedded in Africa's local medical ecology.
▍The Stages of Africa's Medical Ecology and the Disparity with Chinese Medical Teams
Under the national narrative of China's foreign aid, from 1963 to 2023, China has dispatched 24,000 medical team members to Africa. Currently, there are 45 medical teams working at 100 sites in 44 African countries. In the process, through clinical instruction, surgical demonstrations, academic exchanges, health lectures, epidemic prevention education, remote guidance, and mobile medical services, medical team members have established sister relationships with African hospitals, supported the establishment of specialized centers, trained medical personnel, enhanced the health and well-being of the people in recipient countries, and improved the level of medical technology in recipient countries. With their humanitarian spirit and superb medical skills, Chinese medical teams have gained the trust of recipient governments and people. They are both angels who save lives and messengers of friendship.
These praises are not unfounded and are well-deserved by the medical team members. However, compared to today's medical teams, previous teams may have more confidence in this regard. During the author's research in multiple East African countries, he found that these countries require doctors to obtain professional medical qualifications issued by their national medical associations in order to practice medicine. Due to language barriers, many medical team members have difficulty obtaining these certifications and can only hold volunteer certificates, limiting them to some marginal auxiliary work. One doctor complained, "Previous medical team members, such as Dr. Liu Fangyi, could often enter the presidential palace and enjoy state guest treatment, while we are just volunteers without work permits, prescription rights, or medicines - doctors without substance." The "previous medical team members" this doctor referred to specifically meant those during the Nyerere era. At that time, Tanzania had just gained independence and embarked on the path of African socialism, trying to develop primary healthcare and rural medical services. China sent medical teams to train Tanzanian medical personnel and help establish a primary healthcare system, "leaving a medical team that will never leave for the local people." At that time, Tanzania did not require Chinese medical teams to have local practice qualifications, and the teams opened up the situation with their medical skills and experience, becoming "honored guests" in Tanzania. Today, due to mandatory professional qualification regulations, apart from a few medical team members who can quickly participate in clinical diagnosis and treatment as doctors, most doctors generally need about a year and a half to obtain work permits, residence permits, and professional medical qualifications. For medical team members who only have two-year or, in recent years, mostly one-year aid terms, the space for implementing their professional activities has been greatly compressed.
The disparate treatment faced by Chinese medical teams in Africa in the two different periods is not because the previous medical teams had higher medical skills than the current ones, nor because changes in government have led to a shift in relations with China, but because they are embedded in different stages of Africa's medical ecology.
Since Western colonizers entered Africa, the medical ecology of Africa has roughly gone through four stages of development.
The first stage is the missionary medicine stage. Missionary medicine regarded the treatment of African patients as religious redemption and used it to carry out "civilizing" and "gospel spreading." With the help of medicines and scalpels, missionary medicine opened up the situation for missionary work through health interventions, becoming a forerunner of colonialism.
The second stage is the colonial medicine stage that began in the late 18th century, also known as the imperial medicine stage. At this stage, Western medicine operated in the conquered and occupied colonies, serving the establishment and maintenance of colonial regimes. Military doctors serving the troops, physicians serving the colonial governments, missionaries serving the missions, and medical scientists studying tropical diseases all appeared on the scene. Although they cultivated the first generation of indigenous medical elites in Africa, they mainly served Europeans and local dignitaries.
The third stage is the post-colonial medicine stage that accompanied national independence. After World War II, African countries gained independence one after another. However, post-independence medicine still had countless ties with colonial medicine, mainly manifested in the enthusiasm of indigenous medical elites for elite medicine, the continuation of missionary medical practices, medical assistance from former suzerain states or other Western countries, and the many branch institutions established by Western medical schools or medical research institutions. Although still subject to others in the medical field, political independence allowed African governments to hold the power to formulate health systems and make decisions on health development paths in their own hands. At this stage, most African countries made attempts at medical and health development, either through socialist medical experiments to develop primary healthcare and rural health work, or moving towards capitalist medicine by vigorously introducing private capital and developing private medicine.
The fourth stage is called the democratic political medicine stage. In the late 1980s and early 1990s, African countries generally faced financial difficulties triggered by economic crises and had to structurally adjust their countries according to the requirements of the World Bank and Western aid countries. Most countries entered a stage of democratic politics. At this stage, the medical ecology of Africa is manifested in the checks and balances of democratic politics on the medical and health system, specifically the interplay of three health values. These three values are utilitarian values, human rights values, and neoliberal values. Utilitarian values center on "guaranteeing the basics," using limited resources to serve the majority of people, and taking primary healthcare as the main strategy. Human rights values center on everyone's right to enjoy healthcare, advocate for the public welfare nature of the medical and health system, resist market-oriented tendencies, and thus lead to people's demands for free medical services. Neoliberal values regard medical services as a commodity, advocate transforming the medical and health system through privatization and marketization, implement strict physician practice standards, set high standards for drug and medical device access, and pursue high-end medical technology and talent. The interplay of the three values has led to uncertainty in Africa's medical ecology, but with the privatization process in the medical and health field, most African countries have formed medical and health systems guided by neoliberal principles.
The older generation of Chinese medical teams in Africa faced a medical ecology in the third stage. At that time, Africa was in the climax of the national independence movement. Due to long-term colonial rule, newly independent countries had tight finances and seriously lagging medical and health levels, urgently needing external support. In the spirit of humanitarianism, the Chinese government, in accordance with the principle of "Africa's needs, Africa's requests," dispatched clinical medical experts to Africa in a province-to-country model to guide and train local medical staff, participate in local medical practices, and provide aid in the form of medicines, equipment, and medical infrastructure construction. This timely assistance did not have many structural restrictions, and Chinese doctors could immediately carry out their professional activities locally. Today, however, medical teams face a medical ecology in Africa dominated by neoliberalism. African countries have introduced Western physician practice standards one after another. To practice medicine locally, one must train for several years to obtain a medical license and legally practice. Although medical team members have long obtained practice licenses in China and are all experts with rich medical experience, they are unable to practice as "normal doctors" for a considerable period of time and even face the embarrassment of being checked by local immigration officials.
▍The Prevalence of Neoliberalism and the Awkward Situation of Chinese Medical Teams
The physician practice license mentioned above is just the tip of the iceberg of the neoliberal medical ecology. Neoliberalism believes that the medical field should follow market logic, after all, any monopoly without market competition will lead to inefficiency. Under neoliberal reforms, the medical and health industry in Africa has been highly privatized in recent decades. Due to the lack of pharmaceutical production capacity and sufficient market competition, modern medicine relies almost entirely on imports and is expensive. Many African countries allow public hospital doctors to practice at multiple locations, open pharmacies, clinics, and even hospitals to help solve the shortage of national health resources. However, under the influence of neoliberalism, some medical personnel bring hospital medicines back to their own pharmacies for sale at a considerable profit through false prescriptions. Within public hospitals, the wind of doctors' self-interest and the pursuit of welfare benefits that do not match social development is prevalent, not only leading to frequent medical strikes demanding salary increases but also causing medical personnel and public health personnel to flock to high-paying social organizations.
The pursuit of high-end technology and talent is an inherent part of neoliberalism. Although Africa's overall medical level is lagging, its physician professional standards and drug quality standards are on par with the World Health Organization and Western countries. Staff from the former National Health and Family Planning Commission who are responsible for dispatching medical teams to Africa expressed concern about this development strategy that goes beyond the economic development level of African countries:
Many African health officials have been trained in Western countries and have very good backgrounds, but they lack a clear development strategy. Perhaps there is a development strategy, which is to set a medical standard according to American standards and then let the market drive it. In our aid to Africa, the most important thing is to share our experience in health development with Africa. Sixty years ago, many of our health indicators were similar to Africa's. Why have China's health indicators improved significantly now, while African countries have regressed? To a large extent, it is because they have not yet found a development path suitable for themselves. If China follows the current requirements of African countries that one must train for several years to obtain a medical license and legally practice medicine, then we would not have the barefoot doctor route. Without the barefoot doctor route, it would mean that in the past, China could not have short-term trained rural health personnel to help farmers solve their basic health needs. Barefoot doctors were a feasible path that China explored. Starting from barefoot doctors, we gradually transitioned to the path of so-called standardized doctors and professional doctors. African countries have not done this. From the beginning, they require their professional doctors to meet Western professional standards. Who can achieve this goal? Even if it is achieved, who will work here? They will have already run off to the United States, Britain, and France to be doctors. Therefore, we must consider the actual situation and not think that by setting a so-called low-standard practice standard, African people will receive substandard professional levels. It's not that concept. On the contrary, following high-standard practice standards will prevent most Africans from enjoying basic medical security. Many people used to criticize China's drug standards for being lower than those of Western countries and the World Health Organization. But if we all set such high drug standards, then many people would either have no medicine to take or have to spend more money to buy imported Western medicines. Although it may sound like a painful choice, it is a very realistic choice. We continuously considered our national conditions and gradually improved drug standards and practice standards to reach where we are today. African countries started by following Western standards, demanding high drug standards and strict physician practice standards. It may look good, but what can they ultimately achieve? In the end, it is just a beautiful blueprint. (Staff member from the former National Health and Family Planning Commission, 20150326)
African society lacks pharmaceutical factories and medicines, yet its own drug standards are on par with those of the West and the World Health Organization. This means that even saline for intravenous infusions must be imported from the West. Poor Africa enjoys the high-priced medicines of developed countries, not only failing to meet the basic medical needs of ordinary people but also causing serious resource waste. Staff from the Ministry of Foreign Affairs felt very helpless about this:
The shortage of doctors and medicines should not be nurtured, but should be helped to generate its own blood. The medical threshold set by Westerners is very high, and many of our medicines cannot enter. Our domestic medicines can solve the health problems of the Chinese people, so why can't they meet the needs of the African people? We should develop medicines that people can afford. We welcome Europe and America to produce in Africa. If you don't produce, you can't stop me from producing. We can't spend so much money on medicines every year that ultimately support a large group of people in developed countries. Westerners like to give fish, while we in the East don't even say "teach you how to fish," but rather "empower you how to fish by yourself," strengthening pharmaceutical capacity building. We have an open attitude and can cooperate with Europe and America. We should establish a community to make the African cake bigger, not fight for the cake, which is not conducive to each other and even less conducive to meeting Africa's medical needs. (Staff member from the Ministry of Foreign Affairs, 20150327)
With the development of Africa's economy, its medical and health undertakings have also achieved some development. Faced with Chinese medical teams, the health attitudes of some African countries have also changed, requiring medical teams to provide high-end equipment and technology or assist in building more specialized centers, rather than sending "Chinese experts" to work alone. The Ebola epidemic made African countries realize the importance of establishing disease control laboratories and put forward corresponding requirements. In the past, China mainly sent people to aid Africa, but this time it sent out high-end technology, setting up mobile P3 laboratories and fixed P3 laboratories within three months. Of course, establishing a disease control laboratory is not as simple as just building a laboratory. It also requires consideration of personnel training and biosafety issues, as well as regulatory construction. Once improperly handled, it can lead to virus leakage problems and become a biological bomb. Although the direction of learning, training, and improving disease prevention and control capabilities is worthy of affirmation, this requires coordination between countries, and coordination between African Union countries itself faces some challenges.
Given that national hospitals, private hospitals, and specialized medical centers in major African cities can generally meet the medical needs of big cities, some African countries require that medical teams should not practice in big city medical sites, but should go to remote areas with scarce resources and few doctors. Medical aid itself is not an enjoyable journey, and team members have already mentally prepared for the harsh working environment. Fortunately, compared to before, the overall living environment of medical teams has improved. Among the four locations in three countries that the author visited - Uganda, Malawi, Tanganyika, and Zanzibar - only one location had no fixed residence for the medical team, with members living scattered and without dedicated cooks and drivers, needing to handle their own food, clothing, housing, and transportation. With the maturity of medical aid, the other two countries and three locations have fixed residences that are relatively safe and comfortable, equipped with cooks, drivers, and translators. After a two-week handover with the previous medical team, they can quickly adapt to the living environment. Major cities have abundant health resources, and it is not inappropriate for medical teams to go to remote areas to fulfill their duties of saving lives. However, under the prevalence of neoliberalism and the overall lag in primary healthcare and public health systems, dispatching limited medical team members to practice in remote areas is just a drop in the bucket for local African people.
Ensuring people's freedom to choose medical services is a value adherence of neoliberalism. However, a significant proportion of the world's population lacks sufficient choice due to poverty. When Westerners and local African elites tout the freedom to choose healthcare, they may only be placing their foothold in developed countries, accustomed to seeing civilization as ready-made wealth before us. In ensuring the freedom to choose healthcare, African countries have been particularly outstanding in two aspects: developing private medical institutions and medical tourism.
Unlike the "unstable morale" of public hospitals, private medical institutions not only have first-class medical equipment and services but can also attract Africa's top doctors with salaries higher than public hospitals. Looking around Africa, the best medical institutions in various places are often private medical institutions. However, these private medical institutions are often controlled by foreign capital, such as the Aga Khan Hospital and its hospital network throughout East Africa, and the Indian Apollo Medical Group in many African countries. Private medical institutions naturally view medical services as a commodity, with high pricing, mainly targeting local wealthy people and foreigners, ensuring their autonomy in medical choice, becoming a concrete manifestation of neoliberal medicine.
What continues to exacerbate neoliberal medicine in Africa is the phenomenon of medical tourism. There is a proverb in African society, "If the husband does not come home for dinner, the wife cannot improve her cooking skills." Medical tourism has become a true reflection of this proverb. In Africa, health inequality is structural. When African social elites face disease problems, they either choose to go to the best local private hospitals or directly go abroad for treatment, especially to places with abundant medical resources and high technical levels such as Europe, America, India, and South Africa. To this end, African governments have to spend a large amount of foreign exchange and resources every year on public-funded overseas medical treatment for social and political elites. One consequence of this is that domestic public hospitals are not trusted and find it difficult to obtain large government investments and improve medical standards. Since ordinary African people mainly rely on public hospitals, overseas medical tourism exacerbates the lag in public hospital construction.
The neoliberal-led medical system favors private hospitals and medical tourism, ensuring the autonomy of African social elites and improving their health, but it also leads to the lagging development of public hospitals with "unstable morale," insufficient primary healthcare and public health system construction that can benefit ordinary people, and puts Chinese medical teams in an awkward situation. This awkwardness stems from the imbalance between the cognition and the reality of Chinese medical teams. Chinese medical teams position themselves as "helpers" and "assistants," working together with African medical personnel to improve the health and well-being of the people. However, what they encounter is the African medical and health situation dominated by neoliberalism: doctors seeking profits through multiple jobs, medicines relying on imports and hardly benefiting all people, and officials seeking medical treatment in other countries. This departure from cognition and reality often puts Chinese medical team members in an awkward position of value crisis and value reconstruction.
▍The Awakening of African Medical Autonomy Consciousness and Opportunities for Medical Teams
Medical and health autonomy has always been part of Africa's quest for an independent development path. In the early days of independence, during the Cold War, although constrained by external aid due to economic backwardness, most African countries were exploring medical and health development paths suitable for themselves, such as Tanzania's attempts to implement free medical policies and primary healthcare measures in the Ujamaa socialist villagization movement; Kenya's introduction of external capital to promote medical privatization reforms; and the revival of traditional medicine in most African countries such as South Africa, Ethiopia, Tanzania, and Uganda. In recent years, relying on advantages such as abundant natural resources, abundant labor, and large market potential, Africa's economic development speed has exceeded the world average. Benefiting from economic development, Africa has built hospitals, introduced pharmaceutical factories, trained local medical and health talent, prevented and controlled infectious diseases, improved child malnutrition and maternal and child health, and has certain medical and health resources and service capabilities. Its autonomy consciousness in medical and health is even stronger. This autonomy consciousness is mainly reflected in seeking development strategies, disease control, multilateral cooperation, and the development of traditional medicine. However, its medical and health development strategy is not clear. A staff member of the China Center for Disease Control and Prevention was once invited to discuss with the Africa Centers for Disease Control and Prevention and encountered something that made him laugh and cry:
We went to the Africa CDC for exchanges and received a project book. It was thick, dozens of pages of text, exuding a very beautiful macro plan. After reading it and then looking at the reality in Africa, the gap was too big, and it was unclear how to implement it. Only after inquiring did we learn that this project book was actually written with the help of the US CDC. (Staff member from China CDC, 20170326)
A vague medical and health development strategy, lacking a feasible goal, will not only stagnate its own development but also make various aid efforts face the challenge of not knowing where to start. Western aid has exacerbated the ambiguity of Africa's development strategy to a certain extent. In the health field, Europe and America often provide assistance in medicines, vaccines, disease treatment, and epidemic control, but rarely involve the health system. This leads to Africa falling into the strange circle of dependency theory - excessive reliance on Western medical resources, resulting in insufficient endogenous development momentum and inability to build a self-sufficient health system.
Despite this, the awakening of Africa's autonomy consciousness in the medical and health field has pointed out the development direction for the intervention of Chinese medical teams. The main responsibility of Chinese medical teams is to "teach people to fish" and assist in formulating feasible health development strategies that can benefit the people in a general sense. Due to climate, mosquitoes, zoonotic diseases, poor sanitation, and dangerous exposure behaviors, infectious diseases such as AIDS, Rift Valley fever, Ebola, avian influenza, malaria, and cholera are rampant on the African continent. Especially after the Ebola epidemic, many African countries realized the importance of establishing centers for disease control, sharing epidemic information, and carrying out disease prevention and control. In 2017, the Africa Centers for Disease Control and Prevention, the leading institution of the public health system on the African continent, was established and set up 5 regional cooperation centers on the African continent. Throughout the process, whether it was large-scale assistance, controlling the Ebola epidemic, or constructing the headquarters of the Africa CDC, China was deeply involved. Staff from the former National Health and Family Planning Commission believe that China's assistance to the three West African countries in fighting the Ebola epidemic is a watershed in medical aid to Africa. Previously, medical teams were more inclined to clinical treatment and rarely intervened in public health. This time, disease prevention and control training teams were dispatched, training 12,000 person-times, opening up new prospects for the internationalization of the China Center for Disease Control and Prevention. This new prospect also indicates the potential of medical teams in public health governance.
In 2014, China's medical teams fighting the Ebola epidemic also opened up new prospects for health cooperation with Africa. In the past, medical aid to Africa was basically bilateral cooperation between China and the recipient country, with little collaboration with other countries. But this action was the first time we formed multilateral cooperation. We participated in United Nations actions, sent experts to join several WHO groups, and worked with American and British experts to do experiments and discuss how to respond to the Ebola virus, whereas in the past, everyone did their own thing. In addition, non-governmental organizations and many Chinese-funded enterprises also intervened. This multilateral cooperation mechanism is also welcomed by African countries, as it can maximize the effect of aid. Previously, we were familiar with bilateral cooperation and had little experience with multilateral cooperation, and even felt it was very inefficient. But multilateral cooperation has a benefit. Although coordination is slow, it can form certain rules, that is, global rules. For example, once WHO drug qualification certification is disclosed, basically all African countries adopt it unconditionally, making it easy to register, without having to register drugs in each country one by one. (Staff member from the former National Health and Family Planning Commission, 20150326)
As Chinese medical aid to Africa enters a new stage, the possibility of medical teams transitioning from bilateral cooperation to multilateral cooperation is also increasing. In the future, medical teams will not only deal with medical institutions and people in recipient countries but may also cooperate with international organizations, local NGOs, and medical organizations from other aid countries.
Africa's autonomy in medicine and health is also reflected in the field of traditional medicine. As part of African social culture, traditional medicine is rooted in Africa's cultural consciousness. Traditional medicine emphasizes comprehensive treatment characteristics and strong accessibility. It has played a positive social role in responding to diseases such as AIDS, the novel coronavirus, and chronic diseases, becoming an important option for Africans to seek medical treatment independently. China is also a country that attaches importance to traditional medicine, and traditional medicine has always been a part of medical aid to Africa. For example, acupuncture is known as "Chinese magic needles" in Africa. In the hospitals that the author visited in Zanzibar and Uganda, acupuncture departments appeared. In addition, the emphasis on traditional medicine has also spawned cooperation between African countries and the Chinese government. Malawi, Tanzania, Comoros, Ghana, Ethiopia, Morocco, and 6 other countries have signed memorandums of understanding with China in the field of traditional medicine to carry out cooperation in legislation, healthcare, education and training, scientific research and development, and industrial cooperation. This means that upholding medical pluralism and promoting exchanges in traditional medicine will continue to be part of the work of medical teams in Africa.
▍Conclusion
Sending medical teams to African countries is currently China's longest-running, most effective, and closest-to-the-people foreign aid project. If the initial dispatch of medical teams was more to declare international humanitarianism and diplomatic friendship, then with the deepening of China-Africa exchanges, sending medical teams has become part of the China-Africa community with a shared future. It is only right to precisely serve the China-Africa community with a shared future and analyze the African medical ecology, after all, the African medical ecology is the structural constraint on the professional behavior of Chinese medical teams in Africa, as well as the platform for them to practice medicine and participate in public health governance.
As time changes, with African countries transitioning from the post-independence decolonization movement to political democratization reforms, the African medical ecology has also shifted from free exploration to neoliberalism. The African medical ecology dominated by neoliberalism is unique in terms of physician practice methods, drug and equipment standards, and primary healthcare, on the one hand ensuring the development of physician practice freedom, private hospitals, and medical tourism, while on the other hand weakening the possibility of ordinary people obtaining basic medical needs. This medical ecology reflects values that are contrary to the positioning of Chinese medical teams, often putting team members in awkward situations. At the same time, the awakening of Africa's autonomy consciousness in medicine and health has provided new opportunities for Chinese medical teams to embed themselves in the development of Africa's medical and health undertakings. Faced with the prevalence of neoliberalism and the awakening of autonomy consciousness in Africa's medical and health field, the positioning of Chinese medical teams is also facing challenges. How to transition from a demand-response type to a deep cooperation type embedded in Africa's medical ecology and how to adhere to the original intention of being "guiding experts representing China's standards" have become issues that China's foreign medical aid and participation in international public health governance urgently need to address.