Development assistance is a significant mechanism by which major countries exercise influence in the global health arena. Of the major Asian powers, Japan has long provided significant funding, while China and India have primarily been recipients but are beginning to increase their funding roles. This article examines the amounts, channels, modes, disease allocations and the geographic focuses of their foreign health aid, and delineates the institutional structures that govern the formulation and implementation of foreign health aid policy in each of these countries, to explore what influence China, India, and Japan have and may develop in the global health arena. The article looks in particular at two focal lenses, sovereignty and institutional diversity, to understand what if anything is different from existing approaches to global health governance and what might be expected from these three key Asian nations vis-à-vis global health.
Japan’s global health leadership transcends its bilateral initiatives. The critical question that emerges now is whether Japan can sustain its will and capacity without clear policy direction from the current government amid domestic turmoil. What is to be done by Japan, and who will do it?
China and India have not engaged extensively with the global processes as donors. Yet, as recipients they have been open to a wide range of types of actors and relatively relaxed about sovereignty concerns, possibly providing a basis for a similar direction in development assistance for health (DAH) as their programs mature.
The domestic institutions responsible for external development assistance for health in both China and India would need to be substantially reformed and strengthened for these countries to have the capacity to play leading roles in global health governance in the future.
China and India increasingly have the capacity to invest greater resources in their own public health systems, which would redress some of the existing imbalances in allocations of global health finance.
Such domestic investment in domestic health care delivery would enhance India and China’s capacity to assume leadership roles and contribute towards innovations within global health and global health governance and augment their status as responsible and responsive global health stakeholders.