The Role of Chinese Medical Teams in Bridging Healthcare Gaps in Africa: A Scoping Review

The Role of Chinese Medical Teams in Bridging Healthcare Gaps in Africa: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of Chinese Medical Teams in Bridging Healthcare Gaps in Africa: A Scoping Review Emmanuel Kwasi Afriyie, Samuel Egyarko Ankomah, Duqiao Li, Yuqing Guo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5820869/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jun, 2025 Read the published version in Global Health Research and Policy → Version 1 posted 5 You are reading this latest preprint version Abstract Background Sub-Saharan Africa has faced profound healthcare challenges, including severe shortages of professionals and infrastructural deficits. Despite significant international aid, the full impact of Chinese Medical Teams (CMTs) in addressing these issues had remained underexplored. This scoping review aimed to synthesise existing literature on the role of CMTs in Africa, identifying key drivers, barriers, and gaps in research that could enhance the effectiveness of these programmes. Methods Utilising the Arksey and O'Malley framework and adhering to the PRISMA-ScR checklist, we conducted a comprehensive search across major English and Chinese databases up to February 2023. We included studies that provided both qualitative and quantitative insights into the effectiveness, modalities, and challenges of CMTs. Data were analysed using thematic analysis, supported by NVivo 11 software. Results Our review included 20 English articles and 27 Chinese articles from 2009 to 2022, highlighting CMTs’ significant role in improving healthcare through direct medical assistance, training of healthcare workers, and infrastructure development. Key drivers of CMT initiatives included diplomatic goals, economic cooperation, and humanitarian efforts. Conversely, operational challenges such as cultural differences, language barriers, and infrastructural inadequacies were prominent. Conclusions CMTs have effectively addressed healthcare disparities in Africa through a distinctive, government-led, and non-conditional programme. Their flexible, long-term engagement has strengthened healthcare systems across underserved regions, offering a programme for sustainable global health aid. However, challenges such as cultural barriers and logistical constraints suggest a need for improved cultural competency and flexible staffing. Further empirical research, particularly involving African researchers, is essential to fully understand CMTs' long-term impact and refine strategies for future international health initiatives that align with local needs. Chinese medical team Africa healthcare gaps modality effectiveness scoping review Figures Figure 1 Introduction Access to healthcare is a fundamental human right [1], yet ensuring this right remains a significant challenge in many sub-Saharan African countries [2–4]. Despite the ambitious target set by Sustainable Development Goal 3 to achieve universal health coverage by 2030, this objective continues to be elusive for sub-Saharan Africa [5], which accounts for nearly 24% of the global burden of disease [6]. Economic constraints are a major contributor to the challenge, as approximately 40% of the sub-Saharan African population still lives in extreme poverty (surviving on less than US $ 1.9 per day) [7]. Weak healthcare infrastructure exacerbates this situation, characterised by shortages of healthcare facilities, workers and medical equipment [8]. The World Health Organisation (WHO) reports that 36 out of the 47 countries in the African region face shortages of doctors, nurses and midwives, representing the highest rate of healthcare professional shortages among all WHO regions [9]. Despite multilateral and bilateral aid from various countries, substantial gaps in healthcare infrastructure and services persist in Africa [10]. As one of the key donors, China has been addressing these gaps by providing medical aid to Africa, especially through the deployment of medical teams [11]. These teams deliver on-the-ground medical support, share expertise, and train local healthcare workers [12]. From 1963 to 2019, Chinese medical teams (CMTs) have served more than 180 million patients across 51 African countries, offering over 400 million outpatient consultations, 20 million inpatient treatments, and 1.6 million surgeries [13, 14]. In total, over 20,000 medical professionals have been dispatched to African countries with the aim of bridging local healthcare gaps [14]. During the outbreaks of Ebola virus disease between April and October 2014, the substantial emergency aid provided by CMTs to West African countries totalled 750 million Chinese yuan (approximately US $ 123 million) [15]. Additionally, from 2020 to 2021, CMTs significantly contributed to combating COVID-19 in African countries through the dispatch of medical teams, and the provision of vaccines, medical supplies, and personal protective equipment [12]. Despite the long and extensive involvement of CMTs in Africa, a comprehensive understanding of their efforts in bridging local healthcare gaps remains unclear. This gap in knowledge may hinder the optimisation of CMT programmes, thereby limit their overall effectiveness. Herein, this scoping review aims to consolidate existing literature on the impact of CMTs in mitigating healthcare access disparities in African countries. It specifically seeks to identify the primary drivers and barriers to their activities. The anticipated findings are expected to provide valuable insights into the roles and effectiveness of CMTs, thereby supporting strategic planning and policy-making regarding China’s foreign medical aid. Additionally, the review aims to pinpoint any research gaps that require further exploration. Methods We employed the scoping review methodology as described by Arksey and O'Malley [16] to synthesise both qualitative and quantitative evidence related to the activities of CMTs in African countries. We developed a detailed protocol for this study (Supplementary Material: Appendix 1) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist [17] when reporting the methodology, analytical processes, and findings (Supplementary Material: Appendix 2). To better elucidate the impact of CMTs in addressing local healthcare needs in Africa, we framed our review on the following research questions: (1) What are the modality and effectiveness of CMT programmes in Africa? (2) What are the primary drivers and barriers for CMTs in their efforts to bridge local healthcare gaps? Search strategy We searched major English and Chinese peer-reviewed databases, including PubMed, Web of Science, ScienceDirect, Scopus, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure and Wanfang Data, in February 2023 to identify relevant publications from inception until the search date. To ensure inclusivity, we used broad search terms encompassing various aspects of CMT activities, allowing key themes to emerge naturally rather than being restricted by predefined outcomes. For searches in English databases, we used the free-text terms (("Medical assistance" OR "medical team" OR "medical program" OR "bilateral assistance" OR "bilateral support" OR "bilateral funding" OR "bilateral aid" OR "CMT" OR "CMA" OR "foreign aid" OR "foreign assistance" OR "medical mission" OR "medical group" OR "medical intervention" OR "medical service") AND (China OR Chinese)) AND (Africa OR "Low-and middle-income countries" OR "LMICs"). We first tested the search string in PubMed and adapted it to other databases. The full search strategies for all databases are detailed in Supplementary Material: Appendix 3. Additionally, we screened the reference lists of included publications for relevant articles not otherwise captured. Inclusion and exclusion criteria We included English and Chinese publications that provided qualitative and quantitative evidence on the impact of CMTs in Africa. We specifically targeted articles detailing the modality and effectiveness of CMT programmes and exploring the facilitators and barriers these programmes encounter in bridging local healthcare gaps. We excluded articles not directly related to medical aid, general discussions about China’s medical aid to Africa without a specific focus on CMTs, conference proceedings, commentaries, abstracts, book reviews, and publications for which full texts were inaccessible. Study selection We imported all retrieved records into Endnote X9 software (Clarivate, Philadelphia, U.S.) and removed duplicates. The inclusion and exclusion criteria were pilot-tested on 25% of the articles and refined for clarity and applicability. EKA and SEA independently screened the titles and abstracts of the English publications and then compared their results. DL and YG performed similar tasks for the Chinese publications. Both screening groups regularly consulted with DW, an experienced researcher in scoping review, to resolve discrepancies, ensuring that consensus was reached before continuing. This approach, which involved multiple screeners, was pivotal in reducing biases and errors [18]. Quality assessment of included publications We appraised the quality of included articles using the Joanna Briggs Institute Critical Appraisal Checklist [19]. Each criterion on the checklist was evaluated for every study, assigning ratings of "Yes", "No", "Unclear", or "Not applicable". Articles without any "No" or "Unclear" ratings were considered "Strong" in quality. Those with one to three such ratings were categorised as "Moderately strong", while those with more than three were deemed "Weak". Only articles rated as "Strong" or "Moderately strong" were included in our review. Detailed appraisals of each publication are available in Supplementary Material: Appendix 4. Data extraction A purposefully designed Microsoft Excel spreadsheet was used to extract data from included articles, including title, year of publication, first or corresponding author’s country, journal impact factor, article type and study design, data source, targeted country, targeted issue, and CMT intervention. EKA, SEA, DL, and YG first tested the data extraction form on 3 English/Chinese articles individually and consulted with DW to resolve discrepancies. Then EKA and SEA extracted data from English articles, and DL and YG charted Chinese articles. Evidence synthesis and analysis We employed thematic analysis to examine the data [20], using NVivo 11 qualitative data analysis software (QSR International, Burlington, U.S.) to organise the included articles [21]. Our analysis was guided by the research questions, with themes emerging inductively from the literature rather than being predefined. To ensure the trustworthiness and validity of the analytical processes, we used a debriefing technique, which involved regular discussions among the research team to resolve discrepancies, refine coding structures, and ensure consistency in theme identification [22]. EKA and SEA independently coded the included English articles, while DL and YG coded the Chinese articles. Throughout the process, findings were regularly discussed with DW and DX to refine interpretations and address any inconsistencies. Following this process, the final themes identified were: (a) Modality: programme location, programme duration, collaborative initiatives, resources and expertise; (b) Effectiveness: meeting local healthcare needs, improving the quality of care, capacity building; (c) Major drivers: political and diplomatic goals, economic cooperation, humanitarian aid; (d) Barriers: infrastructure and resource disparities, cultural differences, language barriers. Patient and public involvement This study did not involve patients or members of the public. Their input was not sought in the design of the scoping review, interpretation of the results, or the drafting and editing of this manuscript. Authors’ positionality This study was conducted by a multidisciplinary team comprising scholars and professionals with diverse backgrounds in health policy, global health, and clinical practice. The authors include two health professionals (EKA and SEA) from a teaching hospital hosting CMTs in Ghana, one of whom is currently pursuing a PhD at a Chinese medical university. Additionally, the team consists of three Chinese scholars specialising in health policy and global health (HL, DW and DX), as well as two Chinese medical students (DL and YG). The team’s diverse academic and professional backgrounds, along with the inclusion of both insiders and outsiders, provide a balanced perspective on CMTs’ role in African healthcare systems. Results Selection of sources of evidence The study selection process is illustrated in the PRISMA-ScR flow diagram in Fig. 1 . Initially, a total of 935 English and 1056 Chinese publications were identified. After duplicates were removed, the numbers decreased to 765 and 922, respectively. Subsequent title and abstract screening further narrowed the selection to 52 English and 46 Chinese articles for full-text review. Finally, 32 English articles (6 unrelated to medical aid, 25 unrelated to CMTs, and 1 unrelated to the study) and 19 Chinese articles (18 unrelated to CMTs and 1 news report) were excluded, leaving 20 English and 27 Chinese articles for the final synthesis. Characteristics of literature included Table 1 outlines the characteristics of the 20 English articles included in our analysis, published between 2009 and 2022. Most of these articles (n = 15) explored the impact of CMTs across multiple African countries. Three articles specifically focused on individual countries: Togo, Liberia, and Sierra Leone. Additionally, two articles conducted comparative analyses: one between Tanzania and Malawi and the other between Tanzania and Ghana. Notably, researchers from China and/or high-income countries (HICs) (U.S., Canada, Sweden) were the first or corresponding authors in 18 of the 20 articles. In comparison, only 2 articles were published collaboratively by researchers from China and other LMICs (Bangladesh and Cameroon). More than half of the articles (n = 11) were published in journals without an impact factor at the time of publication, whereas only 1 review appeared in The Lancet in 2014 (Impact factor: 44.002). Table 1 Characteristics of the 20 English articles included for evidence synthesis and analysis Title Year of publication First or corresponding author’s country Journal (IF in the year of publication) Article Type and Study Design Data source Targeted country Targeted issue CMT intervention China-Africa Cooperation Initiatives in Malaria Control and Elimination [28] 2014 China Advances in Parasitology (IF: 4.829) Review article Literature review Multiple countries Infrastructure development Malaria control Establishment of malaria control centres Supply of medicines and equipment Medical team assistance China's foreign aid for global poverty alleviation: artemisinin-based combination therapies against malaria in Togo [38] 2021 China Global Health Journal (IF: 0) Review article The malaria profile in Togo; literature review Togo Malaria control Training of local healthcare professionals Building of malaria cooperative laboratory Provision of anti-malaria drugs China's engagement with development assistance for health in Africa [33] 2017 Bangladesh & China Global Health Research and Policy (IF: 0) Original research: quantitative Features of 531 health-related projects undertaken between 2000 and 2013 Multiple countries Infrastructure development Malaria control Tuberculosis control Highly infectious diseases such as Influenza, Lasa Fever, sexual and Reproductive Health Financial aid Supply of medicines and equipment Training of local healthcare professionals Medical team assistance Health education and promotion Challenges and Opportunities in China's Health Aid to Africa: Findings from Qualitative Interviews in Tanzania and Malawi [32] 2020 U.S. Globalization and Health (IF: 2.525) Original research: Qualitative Interviews with 29 key stakeholders in Malawi (20 Malawian and 9 Chinese) and 29 key stakeholders in Tanzania (13 Tanzanians and 16 Chinese) Malawi and Tanzania Infrastructure development Health workforce Medical team assistance Training of local healthcare professionals Influencing Factors for Expatriation Willingness of Chinese Medical Aid Team Members in Africa: A Qualitative Descriptive Study [30] 2020 China International Journal of Environmental Research and Public Health (IF: 2.849) Original research: Qualitative Interviews with hospital directors, local Health and Family Planning Commission (HFPC) officers, and Chinese medical aid team members Multiple countries Highly infectious diseases such as HIV and dengue fever Ebola outbreak Malaria control Medical team assistance China's distinctive engagement in global health [24] 2014 China The Lancet (IF: 44.002) Review article Literature review; interviews with former officials, CMT members, and key provincial authorities Multiple countries Infrastructure development Malaria control Financial aid Supply of medicines and equipment Medical team assistance Training of local healthcare professionals Enhancing China-Africa Health Cooperation for a Healthier and Safer World: A Multilateral Perspective [12] 2022 China China Quarterly of International Strategic Studies (IF: 0) Original research: qualitative Structured literature review; semi-structured questionnaires and interviews with officials from African countries, multilateral organisations, as well as Chinese policymakers and researchers Multiple countries HIV/AIDS Tuberculosis control Ebola and COVID-19 outbreaks Medical team assistance Health education and promotion Immunisation Provision of vaccines and personal protective equipment Chinese medical teams in Africa: a flagship program facing formidable challenges [14] 2019 China & U.S. Journal of Global Health (IF: 3.079) Viewpoint Literature review; meetings/workshops on China’s health aid programmes; 17 interviews with international donors, Ministry of Health officials, and CMT members Tanzania and Ghana Infrastructure development Health workforce Medical team assistance Building medical facilities Supply of medicines and equipment China's engagement in global health governance: A critical analysis of China's assistance to the health sector of Africa [29] 2014 China Journal of Global Health (IF: 3.559) Viewpoint Literature review; books; government official documents and data; working papers from non-state organisations and think tanks Multiple countries Infrastructure development Healthcare services Medical team assistance Financial aid China's provincial diplomacy to Africa: Applications to health cooperation [27] 2014 U.S. Contemporary Politics (IF: 0) Review article Literature review Multiple countries HIV/AIDS Tuberculosis control Malaria control Infrastructure development Health workforce Healthcare services Financial aid Supply of medicines and equipment Medical team assistance Training of local healthcare professionals China's African policy in the post-Cold War era [11] 2009 China Journal of Contemporary Asia (IF: 0) Review article Policy documents; Literature review Multiple countries N/A N/A Domestic politics and China's health aid to Africa [25] 2014 China China: An International Journal (IF: 0) Review article Literature review Multiple countries Ebola outbreak Health workforce Infrastructure development Medical team assistance Financial aid Supply of medicines and equipment Training of local healthcare professionals China's health assistance to Africa: opportunism or altruism? [15] 2016 U.S. Globalization and Health (IF: 2.54) Review article Literature review Multiple countries Health workforce Healthcare services Medical team assistance Supply of medicines and equipment Training of local healthcare professionals The value of China-Africa health development initiatives in strengthening the “One Health” strategy [31] 2017 Cameroon & China Global Health Journal (IF: 0) Review article Literature review Multiple countries Malaria control Highly Infectious diseases such as measles, filariasis, and schistosomiasis SARS and Ebola outbreaks Medical team assistance Building medical facilities Supply of medicines and equipment Health education and promotion China's Aid Policies in Africa: Opportunities and Challenges [34] 2010 Canada The Round Table: The Commonwealth Journal of International Affairs (IF: 0) Review article Literature review Multiple countries N/A N/A Old bottle new wine? The evolution of China’s aid in Africa 1956–2014 [26] 2019 China Third World Quarterly (IF: 0) Review article Features of China’s aid projects in Africa from 1956 to 1999 Multiple countries Infrastructure development Financial aid Supply of medicines and equipment Medical team assistance Chinese military medical teams in the Ebola outbreak of Sierra Leone [35] 2016 China Journal of the Royal Army Medical Corps (IF: 0.662) Original article: Descriptive study Features of the Chinese Military Medical Teams (CMMTs) rescue mission in Sierra Leone 2014–2015 Sierra Leone Ebola outbreak Infrastructure development Medical team assistance Building Ebola cases holding area Training of local healthcare professionals China’s role as a global health donor in Africa: what can we learn from studying under-reported resource flows? [23] 2014 U.S., China Globalization and Health (IF: 2.54) Original research: Quantitative Features of 255 health, population, water, and sanitation (HPWS) projects undertaken from 2000–2012 Multiple countries Infrastructure development Malaria control N/A Experiences and challenges in the health protection of medical teams in the Chinese Ebola Treatment Centre, Liberia: A Qualitative study [36] 2018 China Infectious Diseases of Poverty (IF: 0) Original research: Qualitative Interviews with 15 informants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Centre from 2014 to 2015 Liberia Ebola outbreak Medical team assistance Training of local healthcare professionals Determinants of China’s development assistance for Health at the sub-national level of African countries (2006–2015) [37] 2018 Sweden & China Infectious Diseases of Poverty (IF: 0) Original research: Quantitative Features of China's Development Assistance for Health (DAH) Project 2006–2015 Multiple countries Infrastructure development Malaria control Medical team assistance Building hospitals and Anti-malaria centres Training of local healthcare professionals Supply of medicines and equipment IF: Impact factor, CMT: Chinese Medical Team Table 2 Summary of key findings from reviewed English articles Research questions Emerging theme(s) No. of articles Reference(s) Main findings Modality Programme location 20 [11, 12, 14, 15, 23–38] • The inaugural CMT was dispatched to Algeria in 1963. • By 2013, 1171 CMTs had operated in 42 African countries, providing aid under a "no strings attached" policy. • Primarily serve rural areas, focusing on bridging healthcare gaps and combating specific diseases like malaria. Programme duration 7 [14, 24, 26, 27, 30, 35, 36] • Ranged from a few months to over two years. • Short-term missions focused on immediate healthcare needs. • Long-term engagements aimed at sustainable healthcare improvements. Collaborative initiatives 15 [12, 14, 23–25, 27, 28, 30–33, 35–38] • Collaborated with local healthcare teams to deliver services ranging from primary care to specialised treatments. • Partnerships with African countries enhanced medical service delivery to remote areas, focusing on infectious diseases and pandemic responses. Resources and expertise 16 [12, 14, 15, 23, 24, 26–33, 35–37] • CMTs include medical professionals specialised in various fields, public health experts, and administrative staff. • Chinese provincial governments deploy teams, providing tailored resources and training of medical professionals. Effectiveness Meeting local healthcare needs 5 [12, 28, 31, 35, 38] • Reduced patient load for common illnesses and improved health outcomes, particularly in rural areas. • Initiatives such as "Brightness Action" and "Heart-to-Heart" significantly enhanced specific health outcomes. Improving the quality of care 8 [12, 14, 15, 28, 31, 33, 35, 38] • Raised healthcare standards in Africa by establishing medical facilities, training institutions, and targeted health initiatives. • Strengthened malaria control by providing free diagnosis and treatment, along with broader healthcare service enhancement. Capacity building 14 [12, 14, 15, 24, 25, 27, 31–38] • Provided substantial training opportunities for African health professionals, ensuring a “never-leaving” impact of the Chinese medical team. • Extended collaborations beyond patient treatment, fostering mutual respect, knowledge exchange, and improvements in healthcare delivery. Major drivers Political and diplomatic goals 14 [11, 12, 14, 15, 23–25, 27–29, 32, 34, 37, 38] • Driven by political and diplomatic goals, CMTs reflect China's strategic interests in Africa. • Used as a tool for enhancing diplomatic relations, helping to project China's influence in the region. Economic cooperation 13 [12, 15, 23, 24, 27–29, 31–35, 37] • Economic cooperation, extending beyond healthcare, characterises CMT programmes in Africa. • China's contributions to global health include a variety of economic support measures, going beyond just financial aid. Humanitarian aid 9 [12, 14, 24, 25, 27, 28, 31, 35, 38] • China's humanitarian efforts in Africa began in the 1960s, continuing to evolve with a focus on a human-centric approach. • Humanitarian aid was a pivotal component of CMT programmes, underscoring China’s commitment to enhancing healthcare across the continent. Barriers Infrastructure and resource disparities 10 [12, 14, 27, 28, 30–33, 35, 36] • Infrastructure and resource disparities impacted the timely delivery of supplies and personnel. • Inadequate transportation, funding, and resources limited access to medical assistance in remote African communities. Cultural differences 5 [12, 14, 32, 35, 36] • Adjusting to different cultures, environments, and communication styles posed challenges, affecting programme effectiveness. Language barriers 5 [12, 14, 25, 32, 35] • Language barriers posed challenges in communicating health information, treatment plans, and preventive measures. • Ineffective communication in local languages led to misinterpretations, hindering programme implementation. CMT: Chinese Medical Team The included English articles comprised 10 reviews, 2 viewpoints, and 8 original articles, of which 5 were qualitative and 3 were quantitative. These studies spanned a broad spectrum of health-related issues in African countries, demonstrating the multifaceted contributions of CMTs across the continent. Topics included essential healthcare infrastructure development (n = 12), malaria control (n = 9), the Ebola outbreak (n = 6), health workforce (n = 5), highly infectious diseases including HIV (n = 5), tuberculosis control (n = 3), healthcare service enhancement (n = 3), the COVID-19 pandemic (n = 1), and SARS (n = 1). The interventions undertaken by CMTs, as reported in the articles, included medical team assistance (n = 16), supply of medicines and equipment (n = 11), training of local healthcare professionals (n = 10), provision of financial aid (n = 6), construction of medical facilities (n = 5), health education and promotion (n = 3), and immunisation (n = 1). The 27 included Chinese articles largely paralleled with the English articles in terms of publications period (from 2010 to 2022). A significant number of these articles (n = 18) focused on CMTs’ impact in multiple African countries. Six articles examined individual countries: Malawi, Sudan, Mauritania, Cameroon, and the Democratic Republic of Congo, while three articles conducted comparisons: one between Malta and Zanzibar (Tanzania), one between Sierra Leone and Zimbabwe, and the other between São Tomé and Príncipe and Mozambique. All but one article, co-authored by researchers from Sudan and China, were published solely by Chinese researchers. About half of the articles (n = 13) were published in Chinese core journals, indicating a high quality of research. The included Chinese articles comprised 15 reviews, 11 case articles, and one ethnographic study. They explored CMTs' contributions to addressing issues including essential healthcare infrastructure development (n = 17), healthcare service enhancement (n = 13), health workforce (n = 7), public health (n = 7), control of infectious diseases such as HIV, tuberculosis, malaria, and schistosomiasis (n = 9), as well as Ebola (n = 3), COVID-19 (n = 4), and rehabilitation medicine (n = 1). Reported CMT programmes included medical team assistance (n = 20), supply of medicines and equipment (n = 18), training of local healthcare professionals (n = 16), technical cooperation and exchange (n = 16), construction of medical facilities (n = 17), public health assistance (n = 9), Chinese medicine (n = 9), short-term programmes such as the “Brightness Action” (n = 6), health education and promotion (n = 4), and immunisation (n = 1). We synthesised evidence from both English and Chinese articles included in this review, organising key findings under thematic categories. While only English-language studies are cited in the text, an overview of the 27 Chinese studies included and a summary of their key findings are provided in Supplementary Material: Appendix 5 for reference. Modality of CMT programmes Programme location It was widely recognised in the included articles that the first CMT was deployed to Algeria in 1963, marking the beginning of CMT medical aid in Africa [11, 12, 14, 15, 23–32]. This dispatch was characterised by a “no strings attached” approach, denoting the provision of aid without any political, economic, or ideological conditions [15, 32]. By the end of 2013, 1171 CMTs had operated in 113 medical centres across 49 recipient countries, with 42 of these countries located in Africa [24, 33–38]. A significant portion of the teams served in rural areas [12, 14, 15, 31], filling healthcare gaps where local medical coverage was insufficient [12]. Meanwhile, the establishment of 30 anti-malaria centres by 2013 exemplified the targeted efforts of CMTs to combat specific health challenges [28]. Programme duration The literature has reported significant variations in the duration of CMT programmes, ranging from a few months to over two years [14, 24, 26, 27, 30, 35, 36]. Short-term missions addressed immediate healthcare needs, such as during the 2014–2015 Ebola outbreak when CMTs provided treatment, infection control, and medical supplies, significantly mitigating the virus’s impact in African communities [35, 36]. Conversely, the long-term engagements of CMTs in African countries aimed to foster sustainable healthcare improvements [24]. These missions, which included training local health professionals and establishing essential healthcare infrastructure such as hospitals, clinics, and malaria control centres [27], were designed to lay a lasting foundation for the ongoing enhancement of healthcare systems in recipient countries [24, 26, 27]. Collaborative initiatives Numerous articles have documented the collaborations between CMTs and local healthcare teams in Africa [12, 14, 23–25, 27, 28, 30–33, 35–38], which comprised doctors, nurses, project directors, health facility administrators, Ministry of Health officials [14, 25, 32], and representatives from non-governmental organisations [33]. The multisectoral partnerships delivered a broad range of services, from primary care to specialised treatments [14, 24, 33]. Notably, a large focus of these initiatives was on controlling and eradicating malaria [23, 24, 27, 28, 30, 31, 33, 37, 38], as well as managing other infectious diseases like measles, filariasis, schistosomiasis, HIV, and tuberculosis [12, 27, 30, 31, 33], alongside responses to pandemics such as SARS, Ebola, and COVID-19 [12, 25, 30, 31, 35, 36]. These efforts included comprehensive strategies like vaccination campaigns and mass drug administration [12]. CMTs actively tackled non-communicable diseases through initiatives like the “Brightness Action” and “Heart-to-Heart” programmes between 2015 and 2019 [12, 24, 25, 33]. For instance, under the “Heart-to-Heart” programme, 170 heart surgeries were carried out in Ghana and Tanzania, while the “Brightness Action” programme facilitated 9,752 cataract surgeries in 25 countries, including Botswana, Eritrea, and Morocco [12]. Furthermore, to enhance healthcare delivery, Chinese partnerships have built hospitals, expanded local pharmaceutical production, and established over 10 clinics that integrate traditional Chinese and African medicines in remote African areas [24, 28, 31]. Resources and expertise The reviewed literature highlighted the composition of CMTs, which included seasoned professionals such as doctors and nurses specialised in infectious diseases, surgery, gynaecology, ophthalmology, and obstetrics [12, 14, 15, 23, 24, 26–33, 35–37], as well as public health experts [12, 35]. The teams also included translators [24, 26] and administrative support staff [30], who played critical roles in ensuring the smooth execution of initiatives. Provincial governments in China, such as Ningxia, Guangxi, and Tianjin, were responsible for deploying medical teams to specific African countries like Benin, Comoros, Cameroon, and Gabon [15, 23, 27, 30]. These teams were strategically positioned in local hospitals and clinics [37], allowing the direct allocation of resources, including medical supplies and training courses tailored to meet the recipient countries’ specific needs [14, 24, 29, 31, 33, 36]. Effectiveness of CMT programmes Meeting local healthcare needs Local clinics and hospitals that benefited from CMT programmes reported a reduction in patient load related to common illnesses, evidencing the effectiveness of these initiatives [12, 28, 31, 35, 38]. Campaigns like “Brightness Action” and “Heart-to-Heart” were highly praised for significantly improving specific health outcomes, particularly in rural areas [12]. Moreover, many articles demonstrated the effectiveness of CMTs in controlling infectious diseases. For example, a malaria control initiative in the Plateaux Region of Togo in 2017 reduced the infection rate from 79–37% [38]. In Sierra Leone, CMTs were instrumental in containing the 2014 Ebola outbreak, with no new cases two days before their departure [35]. In Zanzibar, Tanzania, CMTs provided critical assistance in schistosomiasis management, helping to reduce local infection rates [31]. Similarly, in Comoros, CMTs’ support for the malaria eradication effort through an artemisinin-based combination therapy resulted in zero deaths and a 98% reduction in the morbidity rate [12, 28, 38]. Improving the quality of care The quality of care is a key focus of CMT programmes, as underscored by many articles [12, 14, 15, 28, 31, 33, 35, 38]. China's commitment to enhancing healthcare standards across Africa is evident through the establishment of medical facilities and training institutions throughout the continent [14, 31]. Specifically, CMTs’ efforts to control malaria included not only the provision of free diagnosis and treatment but also the distribution of long-lasting insecticide-treated nets, particularly for vulnerable groups such as children and pregnant women [28, 38]. Furthermore, many CMT programmes were designed to address the most outstanding health challenges in Africa, such as conducting cataract and heart surgeries, malaria elimination, and containment of infectious diseases like Ebola and COVID-19 [12, 28, 33, 35]. These efforts, supported by the deployment of highly skilled, reliable and dedicated professionals [14, 15], have resulted in notable improvements in both the quantity and quality of care in multiple African countries [38]. Capacity building Both the English and Chinese literature highlighted the substantial training opportunities provided by CMTs to African health professionals, which significantly enhanced local capacity-building efforts. This enduring contribution has ensured a “never-leaving” impact of CMTs, thereby reinforcing Africa’s public health systems [12, 14, 15, 24, 25, 27, 31–38]. Moreover, collaborations with CMTs often extend beyond patient treatment, fostering a mutual exchange of medical knowledge and best practices. These interactions have not only facilitated the sharing of expertise but also nurtured professional respect between CMT members and local healthcare workers, thereby improving overall healthcare delivery [32, 34]. Major drivers of CMT Political and diplomatic goals As demonstrated in a significant proportion of the articles reviewed, CMT programmes are crucial to China's foreign policy in Africa, often driven by political and diplomatic goals [11, 12, 14, 15, 23–25, 27–29, 32, 34, 37, 38]. The Chinese government prioritises non-interference, mutual economic development benefits, and self-determination in its engagements with African partners [11, 15, 23–25, 29, 34]. These bilateral agreements, initiated at the national level, are frequently implemented by provincial or prefectural governments [15, 27]. The Fifth International Roundtable on China-Africa Health Collaboration in March 2015 resulted in policy recommendations for Universal Health Coverage and proposed monitoring efforts [12]. Furthermore, a memorandum signed at the 2015 Forum on China-Africa Cooperation meeting in Johannesburg supported the establishment of the Africa Centres for Disease Control and Prevention, marking a significant milestone in China-Africa health cooperation [12]. According to Shen & Fan, CMTs represent not just a component of China’s foreign medical aid but also a strategic element in fostering partnerships and contributing to Africa's development goals [27]. Economic cooperation CMT programmes were also motivated by economic cooperation [12, 15, 23, 24, 27–29, 31–35, 37]. China's economic ties with Africa, as manifested through medical aid, illustrated how health initiatives are integrated with broader economic and trade engagements [15, 24]. A prominent example is the 2012 Forum on China–Africa Cooperation Beijing Action Plan for 2013–2015, which aimed to scale up the China–Africa Development Fund to US $ 5 billion. This plan focused on enhancing technological support, sharing experiences, and boosting the capacity for independent development across African countries [27]. These efforts not only solidified the economic ties but also showed China’s commitment to addressing the health challenges in Africa [23]. Furthermore, the economic relationships helped to bolster local and national public health laboratory systems [28, 31]. For example, between 2014 and 2015, China invested in health infrastructure in Sierra Leone, including advanced laboratory facilities that enabled real-time disease surveillance and enhanced diagnostic capabilities during the Ebola outbreak [35]. As noted by Grepin et al., China's economic contributions to global health encompass more than just financial aid; they extend to providing technical support, training healthcare professionals, and developing health infrastructure [23]. Humanitarian aid Our review revealed the pivotal role of humanitarian aid in CMT programmes in Africa, emphasising the human-centric approach that underpins China's commitment to raising healthcare standards [12, 14, 24, 25, 27, 28, 31, 35, 38]. Tracking back to the 1960s, this commitment began during a period marked by China’s solidarity with newly independent African nations, advocating non-alignment and South-South cooperation [24, 25]. The deployment of medical teams, characterised by a policy of non-interference in domestic affairs, highlighted this humanitarian intent [25]. In 2015, for example, China provided substantial aid by sending five tranches of humanitarian assistance valued at $ 120 million to 13 African countries, along with nearly 1,200 medical staff and public health experts [12]. Moreover, China’s collaboration with international organisations like the WHO and the United Nations reinforced its dedication to global health security and its commitment to international solidarity with Africa [12, 28, 31]. Barriers to CMT programmes Infrastructure and resource disparities Infrastructure and resource disparities posed significant challenges to the effectiveness of CMT programmes in Africa, as evidenced by over half of the articles reviewed [12, 14, 27, 28, 30–33, 35, 36]. In many remote African communities, access to medical assistance was hindered by inadequate transportation, funding, and resources, which affected the timely delivery of essential supplies, personnel, and equipment [14, 27, 28, 30, 33, 36]. Additionally, the vast scope of health challenges - from infectious diseases to high mortality rates and poor sanitation – placed overwhelming demands on the limited resources [12, 27, 31, 35]. Daly et al., emphasised the issue of mismatched priorities in resource allocation, which impedes the sustainability of CMT programmes [32]. Notably, in Tanzania and Ghana, CMT management has faced considerable challenges in recruiting qualified doctors from their respective provinces [14]. Cultural differences Five articles highlighted the significant impact of cultural differences on CMT programmes in Africa [12, 14, 32, 35, 36]. For instance, Daly et al. highlighted the professional respect between African and Chinese healthcare workers that fosters mutual learning [32]. However, challenges were also noted, with some local healthcare workers experiencing difficulties in engaging with their Chinese counterparts [12, 32]. These challenges, primarily related to cultural adjustments, communication styles, and environmental adaptations, could have affected the effectiveness of the programmes [14, 35, 36]. Language barriers Language barriers constituted a significant challenge in CMT programmes across Africa, as noted in five articles [12, 14, 25, 32, 35]. While English, French, and Portuguese are widely spoken in many African countries, a substantial proportion of the population, particular in rural areas, primarily communicates in local languages. This linguistic diversity complicates the communication of health information, treatment plans, and preventive measures [14, 32, 35]. For instance, a study conducted in Tanzania and Malawi found that African residents and Chinese healthcare workers reported strained relationships due to communication difficulties, including misunderstandings of culturally specific mannerisms, gestures, and etiquettes[32]. Ineffective communication can hinder the successful implementation of healthcare initiatives and reduce patient trust in medical interventions. Therefore, overcoming these language obstacles is crucial for the effectiveness of health programmes in Africa's multilingual contexts [12, 25]. Discussion Effectiveness of CMT programmes This scoping review is one of the few studies to systematically examine CMTs across Africa, highlighting their unique modality, effectiveness, and primary drivers in bridging healthcare gaps in underserved areas. By synthesising both English and Chinese literature, our findings reveal that CMTs have had a substantial and diverse impact on infrastructure development, healthcare service enhancement, infectious disease control, and capacity building across the continent [24]. Deployed as early as 1963, CMTs have fostered collaborative ties with African countries and expanded their scope to include a range of essential medical services and public health initiatives [24]. The effectiveness of CMTs is evident through their provision of critical services such as malaria treatment, surgeries, and ophthalmology, which have collectively improved healthcare access and outcomes in communities that face considerable barriers to healthcare [12, 38]. Modality of CMT programmes CMTs stand out within international health aid due to its structured, government-led deployment and a "no strings attached" approach [15, 32]. In contrast to Western aid models, which often include conditionalities tied to political or economic reforms—as seen in the U.S. President’s Emergency Plan for AIDS Relief [39, 40], the "no strings attached" approach enables greater operational flexibility in diverse African contexts, allowing the focus to remain on local health needs without the complexities associated with conditional aid [15, 32]. This structure fosters trust and simplifies collaboration with local governments, which may otherwise be wary of aid that mandates political or economic reforms. CMTs are often directed through provincial authorities in China, establishing a stable, long-term "twinning" approach in which Chinese provinces develop enduring partnerships with African countries [24]. This strategy, derived from China’s domestic inter-provincial support system, allows CMTs to provide consistent, well-coordinated aid over time, reinforcing relationships across both the governmental and community levels [27]. Evidence suggests that this approach has enabled greater acceptance of CMTs within local communities, particularly in rural areas where long-term engagement is essential for sustainable health improvements [15, 32]. Additionally, CMTs include a tailored mix of specialists and general practitioners deployed to address specific healthcare needs, particularly in infectious disease control, maternal and child health, and surgery [28]. Mission durations vary from short-term emergency responses to long-term engagements that can last up to two years, balancing rapid crisis response with sustained health system support [30, 32]. Importantly, CMTs integrate directly into local healthcare institutions rather than functioning as independent units, working closely with local providers to facilitate skill transfer, knowledge exchange, and capacity building [24, 35]. For instance, CMT doctors work alongside local healthcare workers during surgeries, transferring techniques that continue to benefit patients after their departure [12]. This collaboration not only fosters mutual respect but also ensures that the healthcare improvements are sustainable within the local systems [32, 35]. Policy and implementation implications CMTs offer significant implications for global health policy. Integrated within China’s broader diplomatic objectives, such as the Forum on China-Africa Cooperation [11, 12], they serve as a model of "South-South cooperation," emphasising mutual respect, non-interference, and shared goals [23, 34]. Unlike many Western health aid programmes that impose political or economic conditions [39], the non-conditionality of CMT assistance gains the respect and cooperation of local governments [32], showcasing that non-conditional aid can effectively bridge healthcare gaps in resource-limited settings while respecting local governance structures. Moreover, the flexibility and adaptability of CMTs - particularly during the Ebola and COVID-19 outbreaks - demonstrate the advantages of a government-coordinated, rapid response mechanism [12, 35]. This adaptability positions CMT programmes as a potential model for other nations seeking to enhance their global health influence. Integrating policy recommendations into CMT practices, such as continuous training and knowledge transfer for local healthcare workers, could further inform global health strategies aimed at strengthening sustainable local capacities in regions facing healthcare challenges. Challenges for CMTs Despite their accomplishments, CMTs face substantial challenges that impact their effectiveness. Cultural and language barriers remain among the most significant challenges [30, 32], as CMT personnel must adapt to local customs and communicate effectively with patients and local health providers [32]. Although translators are often included [24, 26], a lack of in-depth cultural and language fluency hinders patient care and limits the effectiveness of health education campaigns [32]. Enhancing cultural competency training and expanding the role of local staff in communication roles could alleviate some of these challenges. Logistical and resource disparities also restrict CMT operations [36]. Many missions are deployed to areas with insufficient infrastructure, limited medical supplies, and inadequate transportation, complicating the delivery of consistent, high-quality care [32, 36]. Additionally, the government-mandated nature of CMT staffing means that some specialised health needs may go unmet if appropriate expertise is not available [27]. Introducing a more flexible staffing strategy that allows healthcare providers to volunteer could increase both the adaptability and impact of CMT initiatives. Existing literature and future research directions The English literature on CMTs is predominantly authored by researchers from HICs, often in collaboration with Chinese scholars [14, 27, 32]. While this reflects strong international interest, the limited participation of African researchers may introduce bias in interpreting CMTs’ effectiveness. A similar patten is observed in the Chinese literature, where only one article was co-authored by Chinese and African scholars. The current body of research is largely composed of review articles, opinion pieces, and case studies, with a notable lack of empirical studies—particularly longitudinal research—that could shed light on CMTs’ long-term impacts and operational dynamics. This scarcity restricts a comprehensive understanding of measurable outcomes and limits the research’s visibility, especially given that many studies appear in low-impact journals. Furthermore, while diplomatic goals, economic cooperation, and humanitarian aid were consistently cited as drivers of CMTs, none of the included studies systematically evaluated these as outcomes. Articles referenced CMTs’ role in fostering bilateral ties or facilitating broader economic engagement [23, 24], but no studies measured their direct impact on trade, diplomatic agreements, or geopolitical influence. Future research should prioritise empirical studies, particularly those involving African scholars, to provide deeper, context-specific insights into CMTs’ contributions and limitations. Such work would help refine the design and implementation of CMT programmes, ensuring they align more effectively with local needs and contribute to more sustainable and inclusive international health cooperation. Additionally, studies should explore geopolitical and economic dimensions of CMTs, including their role in fostering diplomatic ties and economic cooperation, to provide a holistic evaluation of their impact in Africa. Strengths and limitations of this review This scoping review was strengthened by adherence to established methodological frameworks, including the Arksey and O’Malley guidelines [16] and the PRISMA-ScR checklist [17], ensuring a systematic and rigorous synthesis. The Joanna Briggs Institute Critical Appraisal Checklist further enhanced the credibility and transparency of our findings. Additionally, by incorporating both English and Chinese sources, we minimised selection bias and ensured a more comprehensive representation of diverse cultural perspectives. However, certain limitations should be noted. The reliance on peer-reviewed articles may have introduced publication bias, potentially overrepresenting studies with favourable outcomes [41]. Additionally, studies published after February 2023 were not included, meaning recent developments in CMT programmes may not be reflected. Furthermore, this review focused on programme modalities and effectiveness, it did not examine broader financial trends in China’s health-related aid. This gap limits a fuller understanding of CMTs' financial sustainability, resource allocation, and integration within China's global health strategy. While the inclusion of authors with direct experience in institutions collaborating with CMTs provides valuable insights, we acknowledge that our perspectives are shaped by our affiliations and academic backgrounds. This underscores the importance of continued dialogue and collaboration across diverse disciplines and regions to ensure a more comprehensive evaluation of CMTs' role in African healthcare systems. Conclusion This review underscores the vital role of CMTs in addressing healthcare disparities in Africa through a distinctive, non-conditional, and government-led approach. Their contributions to healthcare system strengthening, emergency response, and capacity-building demonstrate their importance in global health initiatives. CMTs’ adaptability, particularly in crises like Ebola and COVID-19, and their integration within local systems, further highlight their potential for fostering sustainable international health collaborations. However, their effectiveness is moderated by structural and operational challenges, including resource limitations, cultural and language barriers, and sustainability concerns. These factors may constrain the long-term impact of CMTs, underscoring the need for more flexible staffing models, enhanced cultural training, and stronger integration with local healthcare systems. Abbreviations AIDS Acquired Immunodeficiency Syndrome CMT Chinese Medical Team COVID-19 Coronavirus Disease DAH Development Assistance for Health FOCAC The Forum on China-Africa Cooperation HICs High-Income Countries HIV Human Immunodeficiency Virus IF LMICs Impact Factor Low-and Middle-Income Countries PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews SARS Severe Acute Respiratory Syndrome WHO World Health Organization Declarations Acknowledgements The authors sincerely appreciate Dr. Barbara Profeta from the Swiss Agency for Development and Cooperation for her valuable comments and insights, which have significantly enhanced the quality of this work. We also thank Ms. Sara Sulieman and Mr. Dhirendra Paudel for their insightful suggestions on the discussion section of this study. Lastly, we are grateful to the School of International Education at Southern Medical University, China, for granting the first author the opportunity to pursue a PhD degree. Author contributions DX and EKA conceptualised the study. DW designed the methodology, supervised the scoping review process, and oversaw the manuscript writing. EKA and SEA developed the search strategy, identified, and selected relevant English articles, and analysed the articles included in the review. DL and YG searched, selected, and charted the Chinese articles. EKA and SEA drafted the manuscript. DW and EKA revised the manuscript. HL and DX commented on the manuscript. All authors have reviewed and given approval for the final version of the article. Funding This study received support from the Swiss Agency for Development and Cooperation (Grant#81067392, recipient: DX), Key Project of the National Social Science Fund of China (Grant#20&ZD122, recipient: DX), and the Chinese Government Scholarship (recipient: EKA). Availability of data and materials The case information sources are listed in Supplementary Material: Appendix, and all data and materials used can be accessed from the corresponding author upon reasonable request. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Ranabhat CL and Jakovljevic M. Sustainable Health Care Provision Worldwide: Is There a Necessary Trade-Off between Cost and Quality? Sustainability, 2023. 15(2): p. 1372. Deaton AS and Tortora R. People in sub-Saharan Africa rate their health and health care among the lowest in the world . 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China: An International Journal, 2014. 12(3): p. 176-198. Morgan P and Zheng Y. Old bottle new wine? The evolution of China’s aid in Africa 1956–2014 . Third World Quarterly, 2019. 40(7): p. 1283-1303. Shen GC and Fan VY. China's provincial diplomacy to Africa: applications to health cooperation . Contemporary Politics, 2014. 20(2): p. 182-208. Xia ZG, Wang RB, Wang DQ, Feng J, Zheng Q, Deng CS, et al. China-Africa cooperation initiatives in malaria control and elimination . Adv Parasit, 2014. 86: p. 319-37. Wang X and Sun T. China's engagement in global health governance: A critical analysis of China's assistance to the health sector of Africa . J Glob Health, 2014. 4(1): p. 010301. Chen X, Liu X, and Mao Z. Influencing Factors for Expatriation Willingness of Chinese Medical Aid Team Members (CMATMs) in Africa: A Qualitative Descriptive Study . Int J Env Res Pub He, 2020. 17(2). Tambo E, Tang S, Ai L, and Zhou XN. The value of China-Africa health development initiatives in strengthening "One Health" strategy . Glob Health J, 2017. 1(1): p. 33-46. Daly G, Kaufman J, Lin S, Gao L, Reyes M, Matemu S, et al. Challenges and Opportunities in China's Health Aid to Africa: Findings from Qualitative Interviews in Tanzania and Malawi . Global Health, 2020. 16(1): p. 71. Shajalal M, Xu J, Jing J, King M, Zhang J, Wang P, et al. China's engagement with development assistance for health in Africa . Glob Health Res Policy, 2017. 2: p. 24. Samy Y. China's Aid Policies in Africa: Opportunities and Challenges . The Round Table, 2010. 99(406): p. 75-90. Lu Y, Rong G, Yu SP, Sun Z, Duan X, Dong Z, et al. Chinese military medical teams in the Ebola outbreak of Sierra Leone . J R Army Med Corps, 2016. 162(3): p. 198-202. Li Y, Wang H, Jin XR, Li X, Pender M, Song CP, et al. Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study . 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10:32:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":82560,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"20250321SupplementaryMaterialAppendix15R1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5820869/v1/ce328e1edd58231e5e0878f5.docx"}],"financialInterests":"","formattedTitle":"The Role of Chinese Medical Teams in Bridging Healthcare Gaps in Africa: A Scoping Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccess to healthcare is a fundamental human right [1], yet ensuring this right remains a significant challenge in many sub-Saharan African countries [2\u0026ndash;4]. Despite the ambitious target set by Sustainable Development Goal 3 to achieve universal health coverage by 2030, this objective continues to be elusive for sub-Saharan Africa [5], which accounts for nearly 24% of the global burden of disease [6]. Economic constraints are a major contributor to the challenge, as approximately 40% of the sub-Saharan African population still lives in extreme poverty (surviving on less than US\u003cspan\u003e$\u003c/span\u003e1.9 per day) [7]. Weak healthcare infrastructure exacerbates this situation, characterised by shortages of healthcare facilities, workers and medical equipment [8]. The World Health Organisation (WHO) reports that 36 out of the 47 countries in the African region face shortages of doctors, nurses and midwives, representing the highest rate of healthcare professional shortages among all WHO regions [9].\u003c/p\u003e \u003cp\u003e Despite multilateral and bilateral aid from various countries, substantial gaps in healthcare infrastructure and services persist in Africa [10]. As one of the key donors, China has been addressing these gaps by providing medical aid to Africa, especially through the deployment of medical teams [11]. These teams deliver on-the-ground medical support, share expertise, and train local healthcare workers [12]. From 1963 to 2019, Chinese medical teams (CMTs) have served more than 180\u0026nbsp;million patients across 51 African countries, offering over 400\u0026nbsp;million outpatient consultations, 20\u0026nbsp;million inpatient treatments, and 1.6\u0026nbsp;million surgeries [13, 14]. In total, over 20,000 medical professionals have been dispatched to African countries with the aim of bridging local healthcare gaps [14]. During the outbreaks of Ebola virus disease between April and October 2014, the substantial emergency aid provided by CMTs to West African countries totalled 750\u0026nbsp;million Chinese yuan (approximately US\u003cspan\u003e$\u003c/span\u003e 123\u0026nbsp;million) [15]. Additionally, from 2020 to 2021, CMTs significantly contributed to combating COVID-19 in African countries through the dispatch of medical teams, and the provision of vaccines, medical supplies, and personal protective equipment [12].\u003c/p\u003e \u003cp\u003eDespite the long and extensive involvement of CMTs in Africa, a comprehensive understanding of their efforts in bridging local healthcare gaps remains unclear. This gap in knowledge may hinder the optimisation of CMT programmes, thereby limit their overall effectiveness. Herein, this scoping review aims to consolidate existing literature on the impact of CMTs in mitigating healthcare access disparities in African countries. It specifically seeks to identify the primary drivers and barriers to their activities. The anticipated findings are expected to provide valuable insights into the roles and effectiveness of CMTs, thereby supporting strategic planning and policy-making regarding China\u0026rsquo;s foreign medical aid. Additionally, the review aims to pinpoint any research gaps that require further exploration.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We employed the scoping review methodology as described by Arksey and O'Malley [16] to synthesise both qualitative and quantitative evidence related to the activities of CMTs in African countries. We developed a detailed protocol for this study (Supplementary Material: Appendix 1) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist [17] when reporting the methodology, analytical processes, and findings (Supplementary Material: Appendix 2).\u003c/p\u003e \u003cp\u003eTo better elucidate the impact of CMTs in addressing local healthcare needs in Africa, we framed our review on the following research questions: (1) What are the modality and effectiveness of CMT programmes in Africa? (2) What are the primary drivers and barriers for CMTs in their efforts to bridge local healthcare gaps?\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eWe searched major English and Chinese peer-reviewed databases, including PubMed, Web of Science, ScienceDirect, Scopus, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure and Wanfang Data, in February 2023 to identify relevant publications from inception until the search date. To ensure inclusivity, we used broad search terms encompassing various aspects of CMT activities, allowing key themes to emerge naturally rather than being restricted by predefined outcomes. For searches in English databases, we used the free-text terms ((\"Medical assistance\" OR \"medical team\" OR \"medical program\" OR \"bilateral assistance\" OR \"bilateral support\" OR \"bilateral funding\" OR \"bilateral aid\" OR \"CMT\" OR \"CMA\" OR \"foreign aid\" OR \"foreign assistance\" OR \"medical mission\" OR \"medical group\" OR \"medical intervention\" OR \"medical service\") AND (China OR Chinese)) AND (Africa OR \"Low-and middle-income countries\" OR \"LMICs\"). We first tested the search string in PubMed and adapted it to other databases. The full search strategies for all databases are detailed in Supplementary Material: Appendix 3. Additionally, we screened the reference lists of included publications for relevant articles not otherwise captured.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eWe included English and Chinese publications that provided qualitative and quantitative evidence on the impact of CMTs in Africa. We specifically targeted articles detailing the modality and effectiveness of CMT programmes and exploring the facilitators and barriers these programmes encounter in bridging local healthcare gaps. We excluded articles not directly related to medical aid, general discussions about China\u0026rsquo;s medical aid to Africa without a specific focus on CMTs, conference proceedings, commentaries, abstracts, book reviews, and publications for which full texts were inaccessible.\u003c/p\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eWe imported all retrieved records into Endnote X9 software (Clarivate, Philadelphia, U.S.) and removed duplicates. The inclusion and exclusion criteria were pilot-tested on 25% of the articles and refined for clarity and applicability. EKA and SEA independently screened the titles and abstracts of the English publications and then compared their results. DL and YG performed similar tasks for the Chinese publications. Both screening groups regularly consulted with DW, an experienced researcher in scoping review, to resolve discrepancies, ensuring that consensus was reached before continuing. This approach, which involved multiple screeners, was pivotal in reducing biases and errors [18].\u003c/p\u003e\n\u003ch3\u003eQuality assessment of included publications\u003c/h3\u003e\n\u003cp\u003eWe appraised the quality of included articles using the Joanna Briggs Institute Critical Appraisal Checklist [19]. Each criterion on the checklist was evaluated for every study, assigning ratings of \"Yes\", \"No\", \"Unclear\", or \"Not applicable\". Articles without any \"No\" or \"Unclear\" ratings were considered \"Strong\" in quality. Those with one to three such ratings were categorised as \"Moderately strong\", while those with more than three were deemed \"Weak\". Only articles rated as \"Strong\" or \"Moderately strong\" were included in our review. Detailed appraisals of each publication are available in Supplementary Material: Appendix 4.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eA purposefully designed Microsoft Excel spreadsheet was used to extract data from included articles, including title, year of publication, first or corresponding author\u0026rsquo;s country, journal impact factor, article type and study design, data source, targeted country, targeted issue, and CMT intervention. EKA, SEA, DL, and YG first tested the data extraction form on 3 English/Chinese articles individually and consulted with DW to resolve discrepancies. Then EKA and SEA extracted data from English articles, and DL and YG charted Chinese articles.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEvidence synthesis and analysis\u003c/h2\u003e \u003cp\u003eWe employed thematic analysis to examine the data [20], using NVivo 11 qualitative data analysis software (QSR International, Burlington, U.S.) to organise the included articles [21]. Our analysis was guided by the research questions, with themes emerging inductively from the literature rather than being predefined. To ensure the trustworthiness and validity of the analytical processes, we used a debriefing technique, which involved regular discussions among the research team to resolve discrepancies, refine coding structures, and ensure consistency in theme identification [22]. EKA and SEA independently coded the included English articles, while DL and YG coded the Chinese articles. Throughout the process, findings were regularly discussed with DW and DX to refine interpretations and address any inconsistencies. Following this process, the final themes identified were: (a) Modality: programme location, programme duration, collaborative initiatives, resources and expertise; (b) Effectiveness: meeting local healthcare needs, improving the quality of care, capacity building; (c) Major drivers: political and diplomatic goals, economic cooperation, humanitarian aid; (d) Barriers: infrastructure and resource disparities, cultural differences, language barriers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient and public involvement\u003c/h3\u003e\n\u003cp\u003eThis study did not involve patients or members of the public. Their input was not sought in the design of the scoping review, interpretation of the results, or the drafting and editing of this manuscript.\u003c/p\u003e\n\u003ch3\u003eAuthors’ positionality\u003c/h3\u003e\n\u003cp\u003eThis study was conducted by a multidisciplinary team comprising scholars and professionals with diverse backgrounds in health policy, global health, and clinical practice. The authors include two health professionals (EKA and SEA) from a teaching hospital hosting CMTs in Ghana, one of whom is currently pursuing a PhD at a Chinese medical university. Additionally, the team consists of three Chinese scholars specialising in health policy and global health (HL, DW and DX), as well as two Chinese medical students (DL and YG). The team\u0026rsquo;s diverse academic and professional backgrounds, along with the inclusion of both insiders and outsiders, provide a balanced perspective on CMTs\u0026rsquo; role in African healthcare systems.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSelection of sources of evidence\u003c/h2\u003e \u003cp\u003eThe study selection process is illustrated in the PRISMA-ScR flow diagram in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Initially, a total of 935 English and 1056 Chinese publications were identified. After duplicates were removed, the numbers decreased to 765 and 922, respectively. Subsequent title and abstract screening further narrowed the selection to 52 English and 46 Chinese articles for full-text review. Finally, 32 English articles (6 unrelated to medical aid, 25 unrelated to CMTs, and 1 unrelated to the study) and 19 Chinese articles (18 unrelated to CMTs and 1 news report) were excluded, leaving 20 English and 27 Chinese articles for the final synthesis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of literature included\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the characteristics of the 20 English articles included in our analysis, published between 2009 and 2022. Most of these articles (n\u0026thinsp;=\u0026thinsp;15) explored the impact of CMTs across multiple African countries. Three articles specifically focused on individual countries: Togo, Liberia, and Sierra Leone. Additionally, two articles conducted comparative analyses: one between Tanzania and Malawi and the other between Tanzania and Ghana. Notably, researchers from China and/or high-income countries (HICs) (U.S., Canada, Sweden) were the first or corresponding authors in 18 of the 20 articles. In comparison, only 2 articles were published collaboratively by researchers from China and other LMICs (Bangladesh and Cameroon). More than half of the articles (n\u0026thinsp;=\u0026thinsp;11) were published in journals without an impact factor at the time of publication, whereas only 1 review appeared in The Lancet in 2014 (Impact factor: 44.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the 20 English articles included for evidence synthesis and analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear of publication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst or corresponding author\u0026rsquo;s country\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal (IF in the year of publication)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eArticle Type and Study Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eData source\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTargeted country\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTargeted issue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCMT intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina-Africa Cooperation Initiatives in Malaria Control and Elimination [28]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdvances in Parasitology (IF: 4.829)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEstablishment of malaria control centres\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's foreign aid for global poverty alleviation: artemisinin-based combination therapies against malaria in Togo [38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobal Health Journal (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe malaria profile in Togo; literature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003cp\u003eBuilding of malaria cooperative laboratory\u003c/p\u003e \u003cp\u003eProvision of anti-malaria drugs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's engagement with development assistance for health in Africa [33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBangladesh \u0026amp; China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobal Health Research and Policy (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures of 531 health-related projects undertaken between 2000 and 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003cp\u003eTuberculosis control\u003c/p\u003e \u003cp\u003eHighly infectious diseases such as Influenza, Lasa Fever, sexual and Reproductive Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eHealth education and promotion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenges and Opportunities in China's Health Aid to Africa: Findings from Qualitative Interviews in Tanzania and Malawi [32]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobalization and Health (IF: 2.525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: Qualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterviews with 29 key stakeholders in Malawi (20 Malawian and 9 Chinese) and 29 key stakeholders in Tanzania (13 Tanzanians and 16 Chinese)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMalawi and Tanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eHealth workforce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluencing Factors for Expatriation Willingness of Chinese Medical Aid Team Members in Africa: A Qualitative Descriptive Study [30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternational Journal of Environmental Research and Public Health (IF: 2.849)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: Qualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterviews with hospital directors, local Health and Family Planning Commission (HFPC) officers, and Chinese medical aid team members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHighly infectious diseases such as HIV and dengue fever\u003c/p\u003e \u003cp\u003eEbola outbreak\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's distinctive engagement in global health [24]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Lancet (IF: 44.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review; interviews with former officials, CMT members, and key provincial authorities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhancing China-Africa Health Cooperation for a Healthier and Safer World: A Multilateral Perspective [12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina Quarterly of International Strategic Studies (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: qualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStructured literature review; semi-structured questionnaires and interviews with officials from African countries, multilateral organisations, as well as Chinese policymakers and researchers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHIV/AIDS\u003c/p\u003e \u003cp\u003eTuberculosis control\u003c/p\u003e \u003cp\u003eEbola and COVID-19 outbreaks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eHealth education and promotion\u003c/p\u003e \u003cp\u003eImmunisation\u003c/p\u003e \u003cp\u003eProvision of vaccines and personal protective equipment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese medical teams in Africa: a flagship program facing formidable challenges [14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina \u0026amp; U.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Global Health (IF: 3.079)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eViewpoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review; meetings/workshops on China\u0026rsquo;s health aid programmes; 17 interviews with international donors, Ministry of Health officials, and CMT members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTanzania and Ghana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eHealth workforce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eBuilding medical facilities\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's engagement in global health governance: A critical analysis of China's assistance to the health sector of Africa [29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Global Health (IF: 3.559)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eViewpoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review; books; government official documents and data; working papers from non-state organisations and think tanks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eHealthcare services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's provincial diplomacy to Africa: Applications to health cooperation [27]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContemporary Politics (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHIV/AIDS\u003c/p\u003e \u003cp\u003eTuberculosis control\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eHealth workforce\u003c/p\u003e \u003cp\u003eHealthcare services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's African policy in the post-Cold War era [11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of Contemporary Asia (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePolicy documents; Literature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomestic politics and China's health aid to Africa [25]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina: An International Journal (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEbola outbreak\u003c/p\u003e \u003cp\u003eHealth workforce\u003c/p\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's health assistance to Africa: opportunism or altruism? [15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobalization and Health (IF: 2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealth workforce\u003c/p\u003e \u003cp\u003eHealthcare services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe value of China-Africa health development initiatives in strengthening the \u0026ldquo;One Health\u0026rdquo; strategy [31]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCameroon \u0026amp; China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobal Health Journal (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003cp\u003eHighly Infectious diseases such as measles, filariasis, and schistosomiasis\u003c/p\u003e \u003cp\u003eSARS and Ebola outbreaks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eBuilding medical facilities\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eHealth education and promotion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina's Aid Policies in Africa: Opportunities and Challenges [34]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Round Table: The Commonwealth Journal of International Affairs (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLiterature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOld bottle new wine? The evolution of China\u0026rsquo;s aid in Africa 1956\u0026ndash;2014 [26]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird World Quarterly (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReview article\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures of China\u0026rsquo;s aid projects in Africa from 1956 to 1999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFinancial aid\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese military medical teams in the Ebola outbreak of Sierra Leone [35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal of the Royal Army Medical Corps (IF: 0.662)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal article: Descriptive study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures of the Chinese Military Medical Teams (CMMTs) rescue mission in Sierra Leone 2014\u0026ndash;2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSierra Leone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEbola outbreak\u003c/p\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eBuilding Ebola cases holding area\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina\u0026rsquo;s role as a global health donor in Africa: what can we learn from studying under-reported resource flows? [23]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S., China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobalization and Health (IF: 2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: Quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures of 255 health, population, water, and sanitation (HPWS) projects undertaken from 2000\u0026ndash;2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiences and challenges in the health protection of medical teams in the Chinese Ebola Treatment Centre, Liberia: A Qualitative study [36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInfectious Diseases of Poverty (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: Qualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterviews with 15 informants from the People\u0026rsquo;s Liberation Army of China medical team which operated the Chinese Ebola Treatment Centre from 2014 to 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLiberia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEbola outbreak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeterminants of China\u0026rsquo;s development assistance for Health at the sub-national level of African countries (2006\u0026ndash;2015) [37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSweden \u0026amp; China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInfectious Diseases of Poverty (IF: 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOriginal research: Quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeatures of China's Development Assistance for Health (DAH) Project 2006\u0026ndash;2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultiple countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInfrastructure development\u003c/p\u003e \u003cp\u003eMalaria control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical team assistance\u003c/p\u003e \u003cp\u003eBuilding hospitals and Anti-malaria centres\u003c/p\u003e \u003cp\u003eTraining of local healthcare professionals\u003c/p\u003e \u003cp\u003eSupply of medicines and equipment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eIF: Impact factor, CMT: Chinese Medical Team\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of key findings from reviewed English articles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch questions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmerging theme(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. of articles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMain findings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eModality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgramme location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[11, 12, 14, 15, 23\u0026ndash;38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; The inaugural CMT was dispatched to Algeria in 1963.\u003c/p\u003e \u003cp\u003e\u0026bull; By 2013, 1171 CMTs had operated in 42 African countries, providing aid under a \"no strings attached\" policy.\u003c/p\u003e \u003cp\u003e\u0026bull; Primarily serve rural areas, focusing on bridging healthcare gaps and combating specific diseases like malaria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgramme duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[14, 24, 26, 27, 30, 35, 36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Ranged from a few months to over two years.\u003c/p\u003e \u003cp\u003e\u0026bull; Short-term missions focused on immediate healthcare needs.\u003c/p\u003e \u003cp\u003e\u0026bull; Long-term engagements aimed at sustainable healthcare improvements.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborative\u003c/p\u003e \u003cp\u003einitiatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 23\u0026ndash;25, 27, 28, 30\u0026ndash;33, 35\u0026ndash;38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Collaborated with local healthcare teams to deliver services ranging from primary care to specialised treatments.\u003c/p\u003e \u003cp\u003e\u0026bull; Partnerships with African countries enhanced medical service delivery to remote areas, focusing on infectious diseases and pandemic responses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResources and expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 15, 23, 24, 26\u0026ndash;33, 35\u0026ndash;37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; CMTs include medical professionals specialised in various fields, public health experts, and administrative staff.\u003c/p\u003e \u003cp\u003e\u0026bull; Chinese provincial governments deploy teams, providing tailored resources and training of medical professionals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEffectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeeting local healthcare needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 28, 31, 35, 38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Reduced patient load for common illnesses and improved health outcomes, particularly in rural areas.\u003c/p\u003e \u003cp\u003e\u0026bull; Initiatives such as \"Brightness Action\" and \"Heart-to-Heart\" significantly enhanced specific health outcomes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving the quality of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 15, 28, 31, 33, 35, 38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Raised healthcare standards in Africa by establishing medical facilities, training institutions, and targeted health initiatives.\u003c/p\u003e \u003cp\u003e\u0026bull; Strengthened malaria control by providing free diagnosis and treatment, along with broader healthcare service enhancement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapacity building\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 15, 24, 25, 27, 31\u0026ndash;38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Provided substantial training opportunities for African health professionals, ensuring a \u0026ldquo;never-leaving\u0026rdquo; impact of the Chinese medical team.\u003c/p\u003e \u003cp\u003e\u0026bull; Extended collaborations beyond patient treatment, fostering mutual respect, knowledge exchange, and improvements in healthcare delivery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMajor drivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolitical and diplomatic goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[11, 12, 14, 15, 23\u0026ndash;25, 27\u0026ndash;29, 32, 34, 37, 38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Driven by political and diplomatic goals, CMTs reflect China's strategic interests in Africa.\u003c/p\u003e \u003cp\u003e\u0026bull; Used as a tool for enhancing diplomatic relations, helping to project China's influence in the region.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEconomic cooperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 15, 23, 24, 27\u0026ndash;29, 31\u0026ndash;35, 37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Economic cooperation, extending beyond healthcare, characterises CMT programmes in Africa.\u003c/p\u003e \u003cp\u003e\u0026bull; China's contributions to global health include a variety of economic support measures, going beyond just financial aid.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHumanitarian aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 24, 25, 27, 28, 31, 35, 38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; China's humanitarian efforts in Africa began in the 1960s, continuing to evolve with a focus on a human-centric approach.\u003c/p\u003e \u003cp\u003e\u0026bull; Humanitarian aid was a pivotal component of CMT programmes, underscoring China\u0026rsquo;s commitment to enhancing healthcare across the continent.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBarriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfrastructure and resource disparities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 27, 28, 30\u0026ndash;33, 35, 36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Infrastructure and resource disparities impacted the timely delivery of supplies and personnel.\u003c/p\u003e \u003cp\u003e\u0026bull; Inadequate transportation, funding, and resources limited access to medical assistance in remote African communities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural differences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 32, 35, 36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Adjusting to different cultures, environments, and communication styles posed challenges, affecting programme effectiveness.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLanguage barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e[12, 14, 25, 32, 35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Language barriers posed challenges in communicating health information, treatment plans, and preventive measures.\u003c/p\u003e \u003cp\u003e\u0026bull; Ineffective communication in local languages led to misinterpretations, hindering programme implementation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCMT: Chinese Medical Team\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe included English articles comprised 10 reviews, 2 viewpoints, and 8 original articles, of which 5 were qualitative and 3 were quantitative. These studies spanned a broad spectrum of health-related issues in African countries, demonstrating the multifaceted contributions of CMTs across the continent. Topics included essential healthcare infrastructure development (n\u0026thinsp;=\u0026thinsp;12), malaria control (n\u0026thinsp;=\u0026thinsp;9), the Ebola outbreak (n\u0026thinsp;=\u0026thinsp;6), health workforce (n\u0026thinsp;=\u0026thinsp;5), highly infectious diseases including HIV (n\u0026thinsp;=\u0026thinsp;5), tuberculosis control (n\u0026thinsp;=\u0026thinsp;3), healthcare service enhancement (n\u0026thinsp;=\u0026thinsp;3), the COVID-19 pandemic (n\u0026thinsp;=\u0026thinsp;1), and SARS (n\u0026thinsp;=\u0026thinsp;1). The interventions undertaken by CMTs, as reported in the articles, included medical team assistance (n\u0026thinsp;=\u0026thinsp;16), supply of medicines and equipment (n\u0026thinsp;=\u0026thinsp;11), training of local healthcare professionals (n\u0026thinsp;=\u0026thinsp;10), provision of financial aid (n\u0026thinsp;=\u0026thinsp;6), construction of medical facilities (n\u0026thinsp;=\u0026thinsp;5), health education and promotion (n\u0026thinsp;=\u0026thinsp;3), and immunisation (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003eThe 27 included Chinese articles largely paralleled with the English articles in terms of publications period (from 2010 to 2022). A significant number of these articles (n\u0026thinsp;=\u0026thinsp;18) focused on CMTs\u0026rsquo; impact in multiple African countries. Six articles examined individual countries: Malawi, Sudan, Mauritania, Cameroon, and the Democratic Republic of Congo, while three articles conducted comparisons: one between Malta and Zanzibar (Tanzania), one between Sierra Leone and Zimbabwe, and the other between S\u0026atilde;o Tom\u0026eacute; and Pr\u0026iacute;ncipe and Mozambique. All but one article, co-authored by researchers from Sudan and China, were published solely by Chinese researchers. About half of the articles (n\u0026thinsp;=\u0026thinsp;13) were published in Chinese core journals, indicating a high quality of research.\u003c/p\u003e \u003cp\u003eThe included Chinese articles comprised 15 reviews, 11 case articles, and one ethnographic study. They explored CMTs' contributions to addressing issues including essential healthcare infrastructure development (n\u0026thinsp;=\u0026thinsp;17), healthcare service enhancement (n\u0026thinsp;=\u0026thinsp;13), health workforce (n\u0026thinsp;=\u0026thinsp;7), public health (n\u0026thinsp;=\u0026thinsp;7), control of infectious diseases such as HIV, tuberculosis, malaria, and schistosomiasis (n\u0026thinsp;=\u0026thinsp;9), as well as Ebola (n\u0026thinsp;=\u0026thinsp;3), COVID-19 (n\u0026thinsp;=\u0026thinsp;4), and rehabilitation medicine (n\u0026thinsp;=\u0026thinsp;1). Reported CMT programmes included medical team assistance (n\u0026thinsp;=\u0026thinsp;20), supply of medicines and equipment (n\u0026thinsp;=\u0026thinsp;18), training of local healthcare professionals (n\u0026thinsp;=\u0026thinsp;16), technical cooperation and exchange (n\u0026thinsp;=\u0026thinsp;16), construction of medical facilities (n\u0026thinsp;=\u0026thinsp;17), public health assistance (n\u0026thinsp;=\u0026thinsp;9), Chinese medicine (n\u0026thinsp;=\u0026thinsp;9), short-term programmes such as the \u0026ldquo;Brightness Action\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;6), health education and promotion (n\u0026thinsp;=\u0026thinsp;4), and immunisation (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003eWe synthesised evidence from both English and Chinese articles included in this review, organising key findings under thematic categories. While only English-language studies are cited in the text, an overview of the 27 Chinese studies included and a summary of their key findings are provided in Supplementary Material: Appendix 5 for reference.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eModality of CMT programmes\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eProgramme location\u003c/h2\u003e \u003cp\u003eIt was widely recognised in the included articles that the first CMT was deployed to Algeria in 1963, marking the beginning of CMT medical aid in Africa [11, 12, 14, 15, 23\u0026ndash;32]. This dispatch was characterised by a \u0026ldquo;no strings attached\u0026rdquo; approach, denoting the provision of aid without any political, economic, or ideological conditions [15, 32]. By the end of 2013, 1171 CMTs had operated in 113 medical centres across 49 recipient countries, with 42 of these countries located in Africa [24, 33\u0026ndash;38]. A significant portion of the teams served in rural areas [12, 14, 15, 31], filling healthcare gaps where local medical coverage was insufficient [12]. Meanwhile, the establishment of 30 anti-malaria centres by 2013 exemplified the targeted efforts of CMTs to combat specific health challenges [28].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eProgramme duration\u003c/h2\u003e \u003cp\u003eThe literature has reported significant variations in the duration of CMT programmes, ranging from a few months to over two years [14, 24, 26, 27, 30, 35, 36]. Short-term missions addressed immediate healthcare needs, such as during the 2014\u0026ndash;2015 Ebola outbreak when CMTs provided treatment, infection control, and medical supplies, significantly mitigating the virus\u0026rsquo;s impact in African communities [35, 36]. Conversely, the long-term engagements of CMTs in African countries aimed to foster sustainable healthcare improvements [24]. These missions, which included training local health professionals and establishing essential healthcare infrastructure such as hospitals, clinics, and malaria control centres [27], were designed to lay a lasting foundation for the ongoing enhancement of healthcare systems in recipient countries [24, 26, 27].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCollaborative initiatives\u003c/h2\u003e \u003cp\u003e Numerous articles have documented the collaborations between CMTs and local healthcare teams in Africa [12, 14, 23\u0026ndash;25, 27, 28, 30\u0026ndash;33, 35\u0026ndash;38], which comprised doctors, nurses, project directors, health facility administrators, Ministry of Health officials [14, 25, 32], and representatives from non-governmental organisations [33]. The multisectoral partnerships delivered a broad range of services, from primary care to specialised treatments [14, 24, 33]. Notably, a large focus of these initiatives was on controlling and eradicating malaria [23, 24, 27, 28, 30, 31, 33, 37, 38], as well as managing other infectious diseases like measles, filariasis, schistosomiasis, HIV, and tuberculosis [12, 27, 30, 31, 33], alongside responses to pandemics such as SARS, Ebola, and COVID-19 [12, 25, 30, 31, 35, 36]. These efforts included comprehensive strategies like vaccination campaigns and mass drug administration [12]. CMTs actively tackled non-communicable diseases through initiatives like the \u0026ldquo;Brightness Action\u0026rdquo; and \u0026ldquo;Heart-to-Heart\u0026rdquo; programmes between 2015 and 2019 [12, 24, 25, 33]. For instance, under the \u0026ldquo;Heart-to-Heart\u0026rdquo; programme, 170 heart surgeries were carried out in Ghana and Tanzania, while the \u0026ldquo;Brightness Action\u0026rdquo; programme facilitated 9,752 cataract surgeries in 25 countries, including Botswana, Eritrea, and Morocco [12]. Furthermore, to enhance healthcare delivery, Chinese partnerships have built hospitals, expanded local pharmaceutical production, and established over 10 clinics that integrate traditional Chinese and African medicines in remote African areas [24, 28, 31].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eResources and expertise\u003c/h2\u003e \u003cp\u003eThe reviewed literature highlighted the composition of CMTs, which included seasoned professionals such as doctors and nurses specialised in infectious diseases, surgery, gynaecology, ophthalmology, and obstetrics [12, 14, 15, 23, 24, 26\u0026ndash;33, 35\u0026ndash;37], as well as public health experts [12, 35]. The teams also included translators [24, 26] and administrative support staff [30], who played critical roles in ensuring the smooth execution of initiatives. Provincial governments in China, such as Ningxia, Guangxi, and Tianjin, were responsible for deploying medical teams to specific African countries like Benin, Comoros, Cameroon, and Gabon [15, 23, 27, 30]. These teams were strategically positioned in local hospitals and clinics [37], allowing the direct allocation of resources, including medical supplies and training courses tailored to meet the recipient countries\u0026rsquo; specific needs [14, 24, 29, 31, 33, 36].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of CMT programmes\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003eMeeting local healthcare needs\u003c/h2\u003e \u003cp\u003eLocal clinics and hospitals that benefited from CMT programmes reported a reduction in patient load related to common illnesses, evidencing the effectiveness of these initiatives [12, 28, 31, 35, 38]. Campaigns like \u0026ldquo;Brightness Action\u0026rdquo; and \u0026ldquo;Heart-to-Heart\u0026rdquo; were highly praised for significantly improving specific health outcomes, particularly in rural areas [12]. Moreover, many articles demonstrated the effectiveness of CMTs in controlling infectious diseases. For example, a malaria control initiative in the Plateaux Region of Togo in 2017 reduced the infection rate from 79\u0026ndash;37% [38]. In Sierra Leone, CMTs were instrumental in containing the 2014 Ebola outbreak, with no new cases two days before their departure [35]. In Zanzibar, Tanzania, CMTs provided critical assistance in schistosomiasis management, helping to reduce local infection rates [31]. Similarly, in Comoros, CMTs\u0026rsquo; support for the malaria eradication effort through an artemisinin-based combination therapy resulted in zero deaths and a 98% reduction in the morbidity rate [12, 28, 38].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImproving the quality of care\u003c/h2\u003e \u003cp\u003eThe quality of care is a key focus of CMT programmes, as underscored by many articles [12, 14, 15, 28, 31, 33, 35, 38]. China's commitment to enhancing healthcare standards across Africa is evident through the establishment of medical facilities and training institutions throughout the continent [14, 31]. Specifically, CMTs\u0026rsquo; efforts to control malaria included not only the provision of free diagnosis and treatment but also the distribution of long-lasting insecticide-treated nets, particularly for vulnerable groups such as children and pregnant women [28, 38]. Furthermore, many CMT programmes were designed to address the most outstanding health challenges in Africa, such as conducting cataract and heart surgeries, malaria elimination, and containment of infectious diseases like Ebola and COVID-19 [12, 28, 33, 35]. These efforts, supported by the deployment of highly skilled, reliable and dedicated professionals [14, 15], have resulted in notable improvements in both the quantity and quality of care in multiple African countries [38].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCapacity building\u003c/h2\u003e \u003cp\u003eBoth the English and Chinese literature highlighted the substantial training opportunities provided by CMTs to African health professionals, which significantly enhanced local capacity-building efforts. This enduring contribution has ensured a \u0026ldquo;never-leaving\u0026rdquo; impact of CMTs, thereby reinforcing Africa\u0026rsquo;s public health systems [12, 14, 15, 24, 25, 27, 31\u0026ndash;38]. Moreover, collaborations with CMTs often extend beyond patient treatment, fostering a mutual exchange of medical knowledge and best practices. These interactions have not only facilitated the sharing of expertise but also nurtured professional respect between CMT members and local healthcare workers, thereby improving overall healthcare delivery [32, 34].\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eMajor drivers of CMT\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003ePolitical and diplomatic goals\u003c/h2\u003e \u003cp\u003eAs demonstrated in a significant proportion of the articles reviewed, CMT programmes are crucial to China's foreign policy in Africa, often driven by political and diplomatic goals [11, 12, 14, 15, 23\u0026ndash;25, 27\u0026ndash;29, 32, 34, 37, 38]. The Chinese government prioritises non-interference, mutual economic development benefits, and self-determination in its engagements with African partners [11, 15, 23\u0026ndash;25, 29, 34]. These bilateral agreements, initiated at the national level, are frequently implemented by provincial or prefectural governments [15, 27]. The Fifth International Roundtable on China-Africa Health Collaboration in March 2015 resulted in policy recommendations for Universal Health Coverage and proposed monitoring efforts [12]. Furthermore, a memorandum signed at the 2015 Forum on China-Africa Cooperation meeting in Johannesburg supported the establishment of the Africa Centres for Disease Control and Prevention, marking a significant milestone in China-Africa health cooperation [12]. According to Shen \u0026amp; Fan, CMTs represent not just a component of China\u0026rsquo;s foreign medical aid but also a strategic element in fostering partnerships and contributing to Africa's development goals [27].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eEconomic cooperation\u003c/h2\u003e \u003cp\u003eCMT programmes were also motivated by economic cooperation [12, 15, 23, 24, 27\u0026ndash;29, 31\u0026ndash;35, 37]. China's economic ties with Africa, as manifested through medical aid, illustrated how health initiatives are integrated with broader economic and trade engagements [15, 24]. A prominent example is the 2012 Forum on China\u0026ndash;Africa Cooperation Beijing Action Plan for 2013\u0026ndash;2015, which aimed to scale up the China\u0026ndash;Africa Development Fund to US\u003cspan\u003e$\u003c/span\u003e5\u0026nbsp;billion. This plan focused on enhancing technological support, sharing experiences, and boosting the capacity for independent development across African countries [27]. These efforts not only solidified the economic ties but also showed China\u0026rsquo;s commitment to addressing the health challenges in Africa [23]. Furthermore, the economic relationships helped to bolster local and national public health laboratory systems [28, 31]. For example, between 2014 and 2015, China invested in health infrastructure in Sierra Leone, including advanced laboratory facilities that enabled real-time disease surveillance and enhanced diagnostic capabilities during the Ebola outbreak [35]. As noted by Grepin et al., China's economic contributions to global health encompass more than just financial aid; they extend to providing technical support, training healthcare professionals, and developing health infrastructure [23].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eHumanitarian aid\u003c/h2\u003e \u003cp\u003e Our review revealed the pivotal role of humanitarian aid in CMT programmes in Africa, emphasising the human-centric approach that underpins China's commitment to raising healthcare standards [12, 14, 24, 25, 27, 28, 31, 35, 38]. Tracking back to the 1960s, this commitment began during a period marked by China\u0026rsquo;s solidarity with newly independent African nations, advocating non-alignment and South-South cooperation [24, 25]. The deployment of medical teams, characterised by a policy of non-interference in domestic affairs, highlighted this humanitarian intent [25]. In 2015, for example, China provided substantial aid by sending five tranches of humanitarian assistance valued at \u003cspan\u003e$\u003c/span\u003e120\u0026nbsp;million to 13 African countries, along with nearly 1,200 medical staff and public health experts [12]. Moreover, China\u0026rsquo;s collaboration with international organisations like the WHO and the United Nations reinforced its dedication to global health security and its commitment to international solidarity with Africa [12, 28, 31].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eBarriers to CMT programmes\u003c/h2\u003e \u003cdiv id=\"Sec28\" class=\"Section4\"\u003e \u003ch2\u003eInfrastructure and resource disparities\u003c/h2\u003e \u003cp\u003eInfrastructure and resource disparities posed significant challenges to the effectiveness of CMT programmes in Africa, as evidenced by over half of the articles reviewed [12, 14, 27, 28, 30\u0026ndash;33, 35, 36]. In many remote African communities, access to medical assistance was hindered by inadequate transportation, funding, and resources, which affected the timely delivery of essential supplies, personnel, and equipment [14, 27, 28, 30, 33, 36]. Additionally, the vast scope of health challenges - from infectious diseases to high mortality rates and poor sanitation \u0026ndash; placed overwhelming demands on the limited resources [12, 27, 31, 35]. Daly et al., emphasised the issue of mismatched priorities in resource allocation, which impedes the sustainability of CMT programmes [32]. Notably, in Tanzania and Ghana, CMT management has faced considerable challenges in recruiting qualified doctors from their respective provinces [14].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eCultural differences\u003c/h2\u003e \u003cp\u003eFive articles highlighted the significant impact of cultural differences on CMT programmes in Africa [12, 14, 32, 35, 36]. For instance, Daly et al. highlighted the professional respect between African and Chinese healthcare workers that fosters mutual learning [32]. However, challenges were also noted, with some local healthcare workers experiencing difficulties in engaging with their Chinese counterparts [12, 32]. These challenges, primarily related to cultural adjustments, communication styles, and environmental adaptations, could have affected the effectiveness of the programmes [14, 35, 36].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLanguage barriers\u003c/h3\u003e\n\u003cp\u003eLanguage barriers constituted a significant challenge in CMT programmes across Africa, as noted in five articles [12, 14, 25, 32, 35]. While English, French, and Portuguese are widely spoken in many African countries, a substantial proportion of the population, particular in rural areas, primarily communicates in local languages. This linguistic diversity complicates the communication of health information, treatment plans, and preventive measures [14, 32, 35]. For instance, a study conducted in Tanzania and Malawi found that African residents and Chinese healthcare workers reported strained relationships due to communication difficulties, including misunderstandings of culturally specific mannerisms, gestures, and etiquettes[32]. Ineffective communication can hinder the successful implementation of healthcare initiatives and reduce patient trust in medical interventions. Therefore, overcoming these language obstacles is crucial for the effectiveness of health programmes in Africa's multilingual contexts [12, 25].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of CMT programmes\u003c/h2\u003e \u003cp\u003e This scoping review is one of the few studies to systematically examine CMTs across Africa, highlighting their unique modality, effectiveness, and primary drivers in bridging healthcare gaps in underserved areas. By synthesising both English and Chinese literature, our findings reveal that CMTs have had a substantial and diverse impact on infrastructure development, healthcare service enhancement, infectious disease control, and capacity building across the continent [24]. Deployed as early as 1963, CMTs have fostered collaborative ties with African countries and expanded their scope to include a range of essential medical services and public health initiatives [24]. The effectiveness of CMTs is evident through their provision of critical services such as malaria treatment, surgeries, and ophthalmology, which have collectively improved healthcare access and outcomes in communities that face considerable barriers to healthcare [12, 38].\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eModality of CMT programmes\u003c/h2\u003e \u003cp\u003eCMTs stand out within international health aid due to its structured, government-led deployment and a \"no strings attached\" approach [15, 32]. In contrast to Western aid models, which often include conditionalities tied to political or economic reforms\u0026mdash;as seen in the U.S. President\u0026rsquo;s Emergency Plan for AIDS Relief [39, 40], the \"no strings attached\" approach enables greater operational flexibility in diverse African contexts, allowing the focus to remain on local health needs without the complexities associated with conditional aid [15, 32]. This structure fosters trust and simplifies collaboration with local governments, which may otherwise be wary of aid that mandates political or economic reforms.\u003c/p\u003e \u003cp\u003eCMTs are often directed through provincial authorities in China, establishing a stable, long-term \"twinning\" approach in which Chinese provinces develop enduring partnerships with African countries [24]. This strategy, derived from China\u0026rsquo;s domestic inter-provincial support system, allows CMTs to provide consistent, well-coordinated aid over time, reinforcing relationships across both the governmental and community levels [27]. Evidence suggests that this approach has enabled greater acceptance of CMTs within local communities, particularly in rural areas where long-term engagement is essential for sustainable health improvements [15, 32].\u003c/p\u003e \u003cp\u003eAdditionally, CMTs include a tailored mix of specialists and general practitioners deployed to address specific healthcare needs, particularly in infectious disease control, maternal and child health, and surgery [28]. Mission durations vary from short-term emergency responses to long-term engagements that can last up to two years, balancing rapid crisis response with sustained health system support [30, 32]. Importantly, CMTs integrate directly into local healthcare institutions rather than functioning as independent units, working closely with local providers to facilitate skill transfer, knowledge exchange, and capacity building [24, 35]. For instance, CMT doctors work alongside local healthcare workers during surgeries, transferring techniques that continue to benefit patients after their departure [12]. This collaboration not only fosters mutual respect but also ensures that the healthcare improvements are sustainable within the local systems [32, 35].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003ePolicy and implementation implications\u003c/h2\u003e \u003cp\u003eCMTs offer significant implications for global health policy. Integrated within China\u0026rsquo;s broader diplomatic objectives, such as the Forum on China-Africa Cooperation [11, 12], they serve as a model of \"South-South cooperation,\" emphasising mutual respect, non-interference, and shared goals [23, 34]. Unlike many Western health aid programmes that impose political or economic conditions [39], the non-conditionality of CMT assistance gains the respect and cooperation of local governments [32], showcasing that non-conditional aid can effectively bridge healthcare gaps in resource-limited settings while respecting local governance structures.\u003c/p\u003e \u003cp\u003eMoreover, the flexibility and adaptability of CMTs - particularly during the Ebola and COVID-19 outbreaks - demonstrate the advantages of a government-coordinated, rapid response mechanism [12, 35]. This adaptability positions CMT programmes as a potential model for other nations seeking to enhance their global health influence. Integrating policy recommendations into CMT practices, such as continuous training and knowledge transfer for local healthcare workers, could further inform global health strategies aimed at strengthening sustainable local capacities in regions facing healthcare challenges.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eChallenges for CMTs\u003c/h3\u003e\n\u003cp\u003eDespite their accomplishments, CMTs face substantial challenges that impact their effectiveness. Cultural and language barriers remain among the most significant challenges [30, 32], as CMT personnel must adapt to local customs and communicate effectively with patients and local health providers [32]. Although translators are often included [24, 26], a lack of in-depth cultural and language fluency hinders patient care and limits the effectiveness of health education campaigns [32]. Enhancing cultural competency training and expanding the role of local staff in communication roles could alleviate some of these challenges. Logistical and resource disparities also restrict CMT operations [36]. Many missions are deployed to areas with insufficient infrastructure, limited medical supplies, and inadequate transportation, complicating the delivery of consistent, high-quality care [32, 36]. Additionally, the government-mandated nature of CMT staffing means that some specialised health needs may go unmet if appropriate expertise is not available [27]. Introducing a more flexible staffing strategy that allows healthcare providers to volunteer could increase both the adaptability and impact of CMT initiatives.\u003c/p\u003e\n\u003ch3\u003eExisting literature and future research directions\u003c/h3\u003e\n\u003cp\u003eThe English literature on CMTs is predominantly authored by researchers from HICs, often in collaboration with Chinese scholars [14, 27, 32]. While this reflects strong international interest, the limited participation of African researchers may introduce bias in interpreting CMTs\u0026rsquo; effectiveness. A similar patten is observed in the Chinese literature, where only one article was co-authored by Chinese and African scholars. The current body of research is largely composed of review articles, opinion pieces, and case studies, with a notable lack of empirical studies\u0026mdash;particularly longitudinal research\u0026mdash;that could shed light on CMTs\u0026rsquo; long-term impacts and operational dynamics. This scarcity restricts a comprehensive understanding of measurable outcomes and limits the research\u0026rsquo;s visibility, especially given that many studies appear in low-impact journals.\u003c/p\u003e \u003cp\u003eFurthermore, while diplomatic goals, economic cooperation, and humanitarian aid were consistently cited as drivers of CMTs, none of the included studies systematically evaluated these as outcomes. Articles referenced CMTs\u0026rsquo; role in fostering bilateral ties or facilitating broader economic engagement [23, 24], but no studies measured their direct impact on trade, diplomatic agreements, or geopolitical influence.\u003c/p\u003e \u003cp\u003eFuture research should prioritise empirical studies, particularly those involving African scholars, to provide deeper, context-specific insights into CMTs\u0026rsquo; contributions and limitations. Such work would help refine the design and implementation of CMT programmes, ensuring they align more effectively with local needs and contribute to more sustainable and inclusive international health cooperation. Additionally, studies should explore geopolitical and economic dimensions of CMTs, including their role in fostering diplomatic ties and economic cooperation, to provide a holistic evaluation of their impact in Africa.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of this review\u003c/h2\u003e \u003cp\u003e This scoping review was strengthened by adherence to established methodological frameworks, including the Arksey and O\u0026rsquo;Malley guidelines [16] and the PRISMA-ScR checklist [17], ensuring a systematic and rigorous synthesis. The Joanna Briggs Institute Critical Appraisal Checklist further enhanced the credibility and transparency of our findings. Additionally, by incorporating both English and Chinese sources, we minimised selection bias and ensured a more comprehensive representation of diverse cultural perspectives.\u003c/p\u003e \u003cp\u003eHowever, certain limitations should be noted. The reliance on peer-reviewed articles may have introduced publication bias, potentially overrepresenting studies with favourable outcomes [41]. Additionally, studies published after February 2023 were not included, meaning recent developments in CMT programmes may not be reflected. Furthermore, this review focused on programme modalities and effectiveness, it did not examine broader financial trends in China\u0026rsquo;s health-related aid. This gap limits a fuller understanding of CMTs' financial sustainability, resource allocation, and integration within China's global health strategy. While the inclusion of authors with direct experience in institutions collaborating with CMTs provides valuable insights, we acknowledge that our perspectives are shaped by our affiliations and academic backgrounds. This underscores the importance of continued dialogue and collaboration across diverse disciplines and regions to ensure a more comprehensive evaluation of CMTs' role in African healthcare systems.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This review underscores the vital role of CMTs in addressing healthcare disparities in Africa through a distinctive, non-conditional, and government-led approach. Their contributions to healthcare system strengthening, emergency response, and capacity-building demonstrate their importance in global health initiatives. CMTs\u0026rsquo; adaptability, particularly in crises like Ebola and COVID-19, and their integration within local systems, further highlight their potential for fostering sustainable international health collaborations. However, their effectiveness is moderated by structural and operational challenges, including resource limitations, cultural and language barriers, and sustainability concerns. These factors may constrain the long-term impact of CMTs, underscoring the need for more flexible staffing models, enhanced cultural training, and stronger integration with local healthcare systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCMT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eChinese Medical Team\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCOVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eCoronavirus Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eDAH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eDevelopment Assistance for Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eFOCAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eThe Forum on China-Africa Cooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eHigh-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eIF\u003c/p\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eImpact Factor\u003c/p\u003e\n \u003cp\u003eLow-and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePRISMA-ScR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSARS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eSevere Acute Respiratory Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors sincerely appreciate Dr. Barbara Profeta from the Swiss Agency for Development and Cooperation for her valuable comments and insights, which have significantly enhanced the quality of this work. We also thank Ms. Sara Sulieman and Mr. Dhirendra Paudel for their insightful suggestions on the discussion section of this study. Lastly, we are grateful to the School of International Education at Southern Medical University, China, for granting the first author the opportunity to pursue a PhD degree.\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eDX and EKA conceptualised the study. DW designed the methodology, supervised the scoping review process, and oversaw the manuscript writing. EKA and SEA developed the search strategy, identified, and selected relevant English articles, and analysed the articles included in the review. DL and YG searched, selected, and charted the Chinese articles. EKA and SEA drafted the manuscript. DW and EKA revised the manuscript. HL and DX commented on the manuscript. All authors have reviewed and given approval for the final version of the article.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study received support from the Swiss Agency for Development and Cooperation (Grant#81067392, recipient: DX), Key Project of the National Social Science Fund of China (Grant#20\u0026amp;ZD122, recipient: DX), and the Chinese Government Scholarship (recipient: EKA).\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe case information sources are listed in Supplementary Material: Appendix, and all data and materials used can be accessed from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRanabhat CL and Jakovljevic M. 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Integrating global HIV services with primary health care: a key step in sustainable HIV epidemic control\u003cem\u003e.\u003c/em\u003e The Lancet Global Health, 2023. 11(7): p. e1120-e1124.\u003c/li\u003e\n\u003cli\u003eUnited States Agency for International Development. USAID\u0026rsquo;s Unique Role in PEPFAR. 2024 [cited 2024; Available from: https://www.usaid.gov/global-health/health-areas/hiv-and-aids/usaids-unique-role-pepfar. Accessed 24 May 2024.\u003c/li\u003e\n\u003cli\u003eSong F, Hooper L, and Loke YK. Publication bias: what is it? How do we measure it? How do we avoid it? Open Access Journal of Clinical Trials, 2013: p. 71-81.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"global-health-research-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ghrp","sideBox":"Learn more about [Global Health Research and Policy](http://ghrp.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/GHRP/default.aspx","title":"Global Health Research and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chinese medical team, Africa, healthcare gaps, modality, effectiveness, scoping review","lastPublishedDoi":"10.21203/rs.3.rs-5820869/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5820869/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSub-Saharan Africa has faced profound healthcare challenges, including severe shortages of professionals and infrastructural deficits. Despite significant international aid, the full impact of Chinese Medical Teams (CMTs) in addressing these issues had remained underexplored. This scoping review aimed to synthesise existing literature on the role of CMTs in Africa, identifying key drivers, barriers, and gaps in research that could enhance the effectiveness of these programmes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUtilising the Arksey and O'Malley framework and adhering to the PRISMA-ScR checklist, we conducted a comprehensive search across major English and Chinese databases up to February 2023. We included studies that provided both qualitative and quantitative insights into the effectiveness, modalities, and challenges of CMTs. Data were analysed using thematic analysis, supported by NVivo 11 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur review included 20 English articles and 27 Chinese articles from 2009 to 2022, highlighting CMTs\u0026rsquo; significant role in improving healthcare through direct medical assistance, training of healthcare workers, and infrastructure development. Key drivers of CMT initiatives included diplomatic goals, economic cooperation, and humanitarian efforts. Conversely, operational challenges such as cultural differences, language barriers, and infrastructural inadequacies were prominent.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCMTs have effectively addressed healthcare disparities in Africa through a distinctive, government-led, and non-conditional programme. Their flexible, long-term engagement has strengthened healthcare systems across underserved regions, offering a programme for sustainable global health aid. However, challenges such as cultural barriers and logistical constraints suggest a need for improved cultural competency and flexible staffing. Further empirical research, particularly involving African researchers, is essential to fully understand CMTs' long-term impact and refine strategies for future international health initiatives that align with local needs.\u003c/p\u003e","manuscriptTitle":"The Role of Chinese Medical Teams in Bridging Healthcare Gaps in Africa: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 10:24:11","doi":"10.21203/rs.3.rs-5820869/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-03-31T21:28:44+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-28T06:19:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-27T12:20:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Global Health Research and Policy","date":"2025-03-21T10:35:31+00:00","index":"","fulltext":""},{"type":"decision","content":"Minor revision","date":"2025-03-04T01:23:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"global-health-research-and-policy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ghrp","sideBox":"Learn more about [Global Health Research and Policy](http://ghrp.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/GHRP/default.aspx","title":"Global Health Research and Policy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"435a2645-75ce-44d2-b0a5-c682927df8fc","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-23T15:59:50+00:00","versionOfRecord":{"articleIdentity":"rs-5820869","link":"https://doi.org/10.1186/s41256-025-00420-2","journal":{"identity":"global-health-research-and-policy","isVorOnly":false,"title":"Global Health Research and Policy"},"publishedOn":"2025-06-16 15:57:15","publishedOnDateReadable":"June 16th, 2025"},"versionCreatedAt":"2025-03-31 10:24:11","video":"","vorDoi":"10.1186/s41256-025-00420-2","vorDoiUrl":"https://doi.org/10.1186/s41256-025-00420-2","workflowStages":[]},"version":"v1","identity":"rs-5820869","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5820869","identity":"rs-5820869","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}