China and US change their approach to foreign aidExBulletin

The first batch of emergency humanitarian aid provided by China to Myanmar was loaded onto a plane in Beijing in March 2025. In response to a request from the Myanmar government, China provided emergency humanitarian aid to support earthquake relief efforts. Qin Yihua/Xinhua via Getty Images .

. Chen Yihua/Xinhua via Getty Images

Foreign aid has long been a way for the United States and China to gain soft power and influence, by providing public services in low-income countries that help them address poverty and disease, and engaging with people to build long-term cooperation.

For decades, the two countries have adopted separate international aid strategies. But the Trump administration has dismantled much of the United States’ traditional foreign aid systems and is charting a new course, while China is also adjusting its approach — increasing visible contributions to global institutions while scaling back some of the massive infrastructure projects that once defined its strategy.

The result is a moment of convergence and competition: as the United States moves toward a more transactional model long associated with Beijing, and China positions itself to become a greater presence in global health and development.

The three stages of Chinese aid

China’s post-World War II foreign aid strategy dates back to the 1950s when it supported the emerging communist states of North Korea and Vietnam. In those days, China itself was receiving aid from the Soviet Union, says Carrie Dolan, an expert on Chinese health aid at the College of William and Mary.

“The first phase was this anti-imperialist solidarity,” says Dolan. Then, in the 1990s, China changed.

“In the second phase, we saw aid supporting Chinese development,” Dolan says. China has framed its foreign aid as mutually beneficial to countries in the Global South, enhancing economic cooperation and increasing trade.

In the 2000s, as Xi Jinping rose to power, China sought global leadership and competition with the United States, Dolan says.

“Then the third phase, we actually see them moving into this soft power, great power competition.”

The way China has provided aid in this third phase has been largely through bilateral agreements such as the Belt and Road Initiative, according to Yanzhong Huang, a global health expert at the Council on Foreign Relations. This means making deals between government and government, often with large loans from China.

“[The initiative] “The focus was more on large-scale infrastructure such as ports, railways and power plants, and these were primarily financed through bilateral loans to build physical connectivity and secure economic returns for China,” says Huang.

Until recently, China’s methods contrasted with those of the United States at various levels, according to Samuel Brazzes, professor of international development at University College Dublin.

China has preferred to work directly with governments, while the United States has spent tens of billions of dollars to fund relief groups and international organizations such as the United Nations to address issues such as poverty and disease.

US foreign aid grants also tend to focus on long-term solutions and come with conditions for governments, such as improving human rights, democracy and corruption, Brazzes says. China has generally not imposed restrictions on its aid.

China has modified its strategy recently

Huang said Chinese foreign aid has been subject to much criticism, including from the United States and recipient countries.

Research conducted by Dolan in Kenya and Sierra Leone on the effectiveness of Chinese aid showed mixed reactions from local medical officials as well as relief and health workers. While her studies showed that people appreciated Chinese aid, they were also concerned that China did not always take into account domestic needs, and that it did not put in resources to sustain the longevity of its projects.

“We would see China buying MRI machines, and then they would come in, and then they would install the MRI machines, but once the machines broke down over time, there was no system in place to fix them,” Dolan says.

For example, Dolan says she was in what was once a state-of-the-art hospital funded by China in Kenya. Now she says weeds were growing on the ground.

Dolan says many people also felt that the large loans from China were plundering and made countries economically weak. There were also doubts that China’s economic interest was the real motivation behind the aid. Ultimately, Dolan and Huang say, this approach undermined China’s goal of building positive influence.

“The subjugation of aid to commercial interests has already eroded trust and soft power,” says Dolan. “And we had bilateral negotiations that were really opaque, enabled corruption, and really marginalized public health.”

That’s why, Huang says, over the past five years, China has slowly moved away from large bilateral deals and is now financing small projects in low-income countries and engaging more with the United Nations.

In 2021, President Xi Jinping announced a new initiative — called the Global Development Initiative — similar to what the United States has been doing, according to Huang. China has begun implementing what it calls “small and beautiful” projects to address poverty and health issues.

In the past few years, it has renovated a maternity ward in Zimbabwe, sent medical equipment to Panama, and hired locals to build a bridge on the island of Kiribati.

Will China take over US global health leadership?

Since the Trump administration’s overhaul of US foreign aid, experts and lawmakers alike have expressed a common concern: A US withdrawal would give rival China an opportunity to consolidate its influence.

Looking at China’s moves in 2025, experts say the picture is more complex. Jennifer Buie, chair of the Department of Global Health at Georgetown University and co-author of the research project with Dolan, looked at official documents and policy papers coming out of China and said there was a sense of opportunity after the reduction in US aid.

“China is now thinking: OK, now the United States is withdrawing from the United Nations, from the World Health Organization,” Bui says. “This is the time for China to build its global influence, control international organizations, and at the same time have a platform to expand its economic footprint.”

In February 2025, as the Trump administration was dismantling USAID, the Chinese aid agency said it would implement more “small and beautiful” projects. In March, when a major earthquake struck Myanmar, China pledged $137 million in aid, compared with about $9 million from the United States. In May, China announced a donation of $500 million to the World Health Organization, in addition to its annual dues.

These moves allow China to appear as the adult in the room, according to Nadji Rolland, a fellow at the National Bureau of Asian Research.

“You are showing the face of a benevolent force that is fundamentally responsible for humanity,” says Rowland. “Which aligns very well with Xi Jinping’s vision of a world order with China at its ”

However, China overall spent about the same amount on foreign aid in 2025 as it did in previous years, says Brian Burgess, who tracks Chinese aid spending at the College of William and Mary.

“They take short-term measures to win hearts and minds, but they don’t invest in the kind of infrastructure and sustainability that big diseases need to eradicate,” Burgess says.

He and Roland say China will not rush to fill the gap left by the United States

“I don’t think she’s quite ready to take on this role as a global health provider, and she may be starting to feel the difficulties,” says Rowland. “It’s a Chinese expression that says, ‘We’re moving very cautiously in this direction.’”

However, it is clear that China will try to increase its influence through foreign aid, as the US presence appears to be diminishing, it says.

The United States is also changing its model, which rings alarm bells for some

Last fall, US Secretary of State Marco Rubio announced a new America First global health strategy, claiming that the old foreign aid model wasted taxpayer money and did not advance US political and economic interests.

Instead, the State Department says it has concluded more than a dozen bilateral agreements with low-income countries. The administration says it hopes to provide access to resources such as minerals in Africa and create opportunities for American companies.

“[The U.S.] “China appears to be converging toward a pre-existing Chinese model, while China appears to be moving away from its own pre-existing approach,” Huang says.

By commercializing aid, the United States may face the same risks that China did, Huang and Dolan say.

“I think the United States should focus on actual health and resist trying to over-commercialize it,” Dolan says. “Because this is a commercial-first approach, it can only harm health outcomes.”

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