China is an emerging economic powerhouse that can pay for its own health initiatives. However, the country receives more health aid from the Global Fund to Fight AIDS, Tuberculosis and Malaria than poor African countries that need it more, a health expert says.

China has been awarded nearly $1 billion in grants, becoming the fourth-largest recipient of funds behind Ethiopia, India, and Tanzania, since the Global Fund’s launch in 2002.

Jack C. Chow, former U.S. ambassador on global HIV/AIDS, knows why China has become eligible for these funds in the first place. It’s because of a loophole, he says.

“The Global Fund decides eligibility for grants based on the World Bank’s classification system, which divides countries by income,” Chow writes in post for the Foreign Policy website. “High-income countries such as the United States, the European industrial countries, and Japan are ineligible. Low-income countries, including many in sub-Saharan Africa, are grant-eligible. In between, so-called lower-middle-income countries like China are eligible if the grants are part of a cost-sharing program through which the fund pays up to 65 percent and the country pays the rest. (China stays in this lower-middle-income category because its huge population keeps per capita figures down.)”

China is in the lower-middle-income category with the likes of Bolivia, Cameroon, and India, Chow adds. “But because the fund’s pot of money isn’t allocated by income group, any grants that China wins reduce the remaining money available for all eligible countries,” he says.   

Chow notes that health ministers of poor countries have not voiced their concern over the issue nor has there been a public challenge or debate on the aid allotment.

He says that one reason could be that the Fund’s 26-member board operates on a consensus and that its meetings are time-constrained and meant to tackle issues that need immediate resolution.

“[T]here is likely more behind the silence than just procedure,” Chow, however, adds. “Opposing China in international forums would taint diplomatic ties, and poor countries do not want to face the repercussions.”

Chow also says another reason governments fail to take a stand is “perhaps for similar reasons of not wishing to provoke a reaction that impacts other diplomatic or political equities elsewhere.” He adds that opposition to China in international forums “would risk incurring Beijing’s diplomatic wrath.”

Chow ends by saying that China can spend billions of dollars on health as it did in hosting the Beijing Summer Olympics and the Shanghai World Expo.

“And why not take it one step further? By becoming a Global Fund donor, China could win acclaim with the West and the world’s poorest – earning exactly the kind of respect that a rising power deserves,” he says.