CC BY
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THE ROLE OF SOFT POWER IN AFRICA: CASE STUDY OF CHINA'S HEALTH DIPLOMACY IN NIGERIA (2014-2020)
1USMAN ALIYU UBA, 2 FiLiZ KATMAN
1PhD Candidate, Istanbul Aydin University, Turkiye. usmanuba@stu.aydin.edu.tr ORCID: https://orcid.org/0009-0005-7561-6138 2Assist. Prof. Dr., Istanbul Aydin University, Turkiye. filizkatman@aydin.edu.tr ORCID: https://orcid.org/0000-0001-5029-173X
Abstract -Africa's relations with the rest of the world have not only been limited to ties with past colonial powers such as the United Kingdom, France, and Portugal amongst others. China has been challenging former colonial powers globally. China has also emerged to become one of the most influential on the continent, establishing footprints around many African countries. Chinese institutions have ramped up infrastructural development, loan support, and aid delivery to nearly all African states, presumably in a bid to improve China's global reputation. As a case study, this paper focuses on China's health diplomacy during the Ebola epidemic of 2014 and the coronavirus pandemic in 2020. The period has been a pivotal one for China-Nigeria's relationship with both opportunities and challenges. The study focuses on the notion of 'soft power' adopted by Joseph Nye to argue that China is using health diplomacy as a tool and strategy in strengthening its partnership with Nigeria. A quantitative research method has been applied to understand China's partnership with Nigeria using data obtained through a survey of the Nigerian population. The study concludes that Nigerians have somewhat unfavorable opinions over China's use of health diplomacy to boost its soft power in Nigeria.
Keywords: China-Nigeria relationship, Coronavirus pandemic, Ebola epidemic, Health Diplomacy, Soft power
INTRODUCTION
For nearly a century, notwithstanding the consequences caused by the Second World War and the subsequent global economic crisis, the universe has never come to a standstill, as humanity surrendered to an invisible enemy—the coronavirus disease; COVID-19. Having been contracted by many, killed millions, and ravaged the strongest global economies, the year 2020 will be remembered as one of the most tragic periods in the history of the modern world. Although, no scientific evidence, including research findings from the World Health Organization (WHO) has proved the origins of COVID-19.1 The pandemic has been politicized, with the US and several European countries pointing fingers and accusing China of covering up its mishandling of the virus. Nevertheless, China was one of the success stories in 2020 that put public health policies into practice in the most effective way during the COVID-19 pandemic. Chinese officials have frequently denied all allegations, and instead called for more global responses against the pandemic. Despite the criticisms against Beijing from the West, business continued as usual regarding China's relations with African countries. The pandemic has taught humanity the need to revisit and strengthen international responses to a global crisis. An important component of the intense transformation occurring in the global political space is the dynamic growth in the rapport between China and Africa. As one of the first amongst developing economies to formalize its affiliation with Africa, irrespective of several years of historical aptitude for skirmishes against humanistic aspirations and imperialism, China's involvement with African economies continue to grow as witnessed by its
1 "WHO media briefing from Wuhan on COVID-19 mission," World Health Organization, (2021), retrieved from https://www.who.int/multi-media/details/who-media-briefing-from-wuhan-on-covid-19-mission---9-february-2021#
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varying level of involvement in the energy, mining, cobalt, copper, and health care industry. For several decades, China has assisted Africa in various forms and capacities with records of remarkable contributions to the continents health care sector.2 Several academic works have emphasized China's soft power through investments, political interventions, cultural trainings, as well as the media and educational sectors, to influence African states. Other studies have emphasized more on China's human capital development, bilateral relations, and the generosity of Beijing to deliver aid to the most vulnerable countries in Africa, presumably in pursuit of expanding its political agenda on the continent. While some of the previous studies hinted on the medical aid delivered by China to Africa, less attention has been given to bilateral relations through health diplomacy used by China as a soft power tool.
Considering the dearth of academic literature on health diplomacy in general, as well as the role of soft power in Africa, this paper was aimed to fill in the gap, by providing answer to the research question; What is the role of China's health diplomacy in Nigeria from 2014 to 2020? The study attempts to explore the role of China's soft power on African states by selecting Nigeria as a case study. The country provides a crucial basis to understand Sino-African relations in several aspects including health diplomacy. Nigeria's long-standing relations with Beijing dates to the 1970s. For decades, Nigeria has been one of China's top strategic partners in Africa. Therefore, the study also aims to explore Sino-African partnership in terms of health diplomacy during the period of 20142020, as a significant period to fully understand the patterns and impact on soft power of China in Africa.
Definition and Types of Power in international relations
Power has been defined in several ways by "Realism" and "Liberalism" which are some of the fundamental fields of international relations. On one hand, Morgenthau, who represents neo-realism claims that power is the ability to control people's ideas and actions.3 On the other hand, liberals claim that power is the means of acquiring something which others cannot easily obtain.4 Nevertheless, both definitions are quite similar considering the main objective of the actors Scholars have argued that sources of power include concrete items like geographical locations, agricultural resources, population, and number of national security forces do not fulfil scale of power in a country.5
Another classification of power was proposed by Joseph Nye, who identified two types of power. First, is "hard power," which consists of the use of military against another country or the use of sanctions and tariffs to cripple the economy of a targeted entity or country.6 Second, Nye, identified "soft power," which includes the history, culture, economic, and social aspect of a country.7 Although, Nye originally limited soft power definition to a kind of foreign influence excluding investment, aid delivery and diplomacy.8 The concept presents "oxymoronic" characteristics that sparked debates among scholars concerning the precise meaning and
2 Yun Sun, "Africa in China's foreign policy", Brookings, (April 14, 2014), retrieved March 10, 2023, from https://www.brookings.edu/research/africa-in-chinas-foreign-policy/
3 Hans Joachim Morgenthau, "Politics Among Nations: The Struggle for Power and Peace, 7th ed., (New York: Knopf, 1978), p, 4-15.
4 Robert Keohane and Joseph S. Nye Jr, "Power and interdependence," Survival Global Politics and Strategy, Vol. 15, No. 4, (March 3, 2008), retrieved January 12, 2023, from
https://doi.org/10.1080/00396337308441409.
5 Carnes Lord, Losing hearts and minds?: Public diplomacy and strategic influence in the age of terror, 1st ed., (Michigan: Praeger Security International, 2006), p. 139.
6 Joseph Samuel Nye, "Soft Power." Foreign Policy, No. 80, (Autumn, 1990), retrieved July 12, 2022, from https://doi.org/10.2307/1148580
7 Soft power: The means to success in world politics by Joseph S. Nye, (New York: Public Affairs, 2004), 99-100, ISBN 9781586482251; 9781586483067. Donna A. Christo, American Economist.
8 Nye, "Soft power," Foreign Policy", pp. 153-71.
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understanding of the term.9 However, policy makers have tried to use the notion of soft power embedded with social values and public diplomacy to reshape the foreign policy of a state. While most scholars have in the past focused on the influence of the West including the U.S. and European countries, the influence of China's soft power has recently become the prime focus of many researchers attempting to understand the efforts made by Chinese officials to impose their global agenda through social values and public diplomacy.10 History of China-Africa health relations
The involvement of China in the health sector with African countries extends to the 1960s after the Chinese people began sending their health workers to Africa. These were made up of Chinese healthcare professionals who delivered effective treatment to Africans, established local capacity, trained medical staff, and constructed hospitals as a visible demonstration of collaboration amid developing nations against imperial and colonial powers.11 Until 1972, China was completely isolated from any global health governance since international institutions including the United Nations (UN) acknowledged Taiwan as the legal government in replacement of the Chinese government. Beijing has deployed medical care to attain political goals; namely control over the Soviet Union, Europe, and the U.S. in Africa, as well as worldwide acceptance of the People's Republic of China (PRC) over Taiwan. In 1971, about 26 countries in Africa agreed after the United Nations General Assembly (UNGA) acknowledges the PRC to become a member of WHO in the following year, and thus a member of the international multidimensional health service. Regardless of the obvious foreign goals, China's help to Africa occurred even when its resources and capabilities were not enough, making its attempts more respectable and harmony amid equal Sino-African countries.12
China has provided medical aid to Africa for several decades.13 The initial Chinese medical aid to Africa was officially dispatched by the China's government to Algeria in 1963. However, China's increasing aid has sparked a fierce global debate about the alleged negative consequences of its initiatives in developing nations. This seems to have startled the Chinese authorities, not least since it had previously embraced international aid as a mechanism for portraying the appearance of China as a "responsible stakeholder".14 China's major aim of providing relief to health sectors in Africa varies according to the context of history.15 Chinese government officials have insisted that medical assistance is provided to enhance the health of Africans and that the objectives were mainly altruistic. However, the choice of China to offer medical aid to Africa might be considered primarily motivated by political concerns. The medical aid provided by China to Africa has been intrinsically linked to the position of China in the international geopolitical environment and the foreign policy decisions of China.16
China's health relations with African countries during COVID-19 pandemic
9 Joseph Samuel Nye, "Soft power: the origins and political progress of a concept," Palgrave communications Vol. 3, No. 1, (2017), p. 1-3, retrieved July 10, 2022, from
https://doi.org/10.1057/palcomms.2017.8
10 Sami Ullah Chaudhry, "Chinas soft power: changing the world perception", published M.A thesis, Naval Postgraduate School Monterey California, (2015), p. 80.
11 Maddalena Procopio, "China's Health Diplomacy in Africa: Pitsfalls behind the leading role," Italian institute for international political studies, (2020), retrieved August 7, 2021, from https://www.ispionline.it/en/pubblicazione/chinas-health-diplomacy-africa-pitfalls-behind-leading-role-25694
12 See Procopio, "China's Health Diplomacy".
13 Zheng Chen, "China and the responsibility to protect," Journal of Contemporary China, Vol. 25, No. 101, (2016), pp. 686-700, retrieved January 3, 2023, from
https: //doi.org/10.1080/10670564.2016.1160500
14 See Cheng, "China and the responsibility to protect," pp. 685-700.
15 Anshan Li, Chinese medical cooperation in Africa: With special emphasis on the medical teams and anti-malaria campaign, (Uppsala: The Nordic Africa Institute, 2011), p. 27.
16 The dragon's gift: the real story of China in Africa, by Deborah Bratutigam, (Oxford: Oxford University Press, 2009), 300 pp. Reviewed by Nicolas Van de Walle, Foreign Affairs.
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During the peak of COVID-19 pandemic, China was the first country in the world to organize an anti-pandemic summit with Africa. Furthermore, it has called on other rich countries to do more to support African nations during the pandemic. It has shown an example by dispatching medical aid such as protective gears, masks, and ventilators to almost all the 53 African nations. From the beginning of the pandemic until November 2021, China has distributed over 1.7 billion doses of COVID-19 vaccines to over 110 countries and agencies around the world, including 50 African nations.17 At the beginning of 2021, China was one of the main producers of COVID-19 vaccines but 'vaccine diplomacy' gained momentum in July 2021 when Beijing first donated dosses of vaccines to some Latin American countries.18 Egypt was among the first countries to receive the donation of the Sinopharm Chinese vaccines in December 2020.19
In November 2021, following the 8th FOCAC Ministerial conference which was held in Dakar, China has renewed its pledge to combat COVID-19 by providing about one billion doses of vaccines to African countries. Until mid-2022, nearly 50 African countries continued to receive vaccines from China. While the pace of the delivery has gained momentum, the total number of delivered vaccines has constantly diminished due to financial restrictions of some of the African countries and over reliance on the UN initiated program for COVID-19 vaccines known as COVAX.20 Health diplomacy between China and Nigeria
Nigeria is a prominent country and the largest nation in Africa. It has extremely low human capital development despite having large natural resources and billions of dollars revenue generated from the oil sector. Less than 50 percent of the Nigeria's 220 million population have accessed to basic amenities such as portable drinking water, public health, and sanitation etc. There is chronic electricity blackout and poor state of medical facilities across the country.21 China is a significant country, the most populous in Asia and the globe. Nevertheless, the two countries have only lately embarked on a meaningful bilateral relation. The first significant bilateral interaction between Nigeria and China happened in 1960 when a Chinese delegation visited the country at the request of the Nigerian authority.22 The Chinese government sent a congratulatory message through the delegate on the success against colonialism. After gaining independence, a diplomatic relationship was established between China and Nigeria and embassies were subsequently established in both countries' capitals.23
In 2006, the Chinese government professed eight actions at the China-Africa Cooperation Forum (FOCAC) summit in Beijing, to support African countries, elevate the people's means of living and enhance the open relations among China and African countries. The construction of 30 hospitals among the top project commissioned in Africa with Nigeria being one of the African countries that
17 See Bratutigam, "The dragon's gift".
18 Kester Kenn Klomegah, China Strengthening Its Diplomacy in Africa's Health Sector, Eurasia review, (2021), retrieved June 25, 2022, from https://www.eurasiareview.com/28122021-china-strengthening-its-diplomacy-in-africas-health-sector-oped/
19 Dave Lawler, "Biden's Next Challenge Vaccine Diplomacy," Axios World, (2021), retrieved July 12, 2022 from https://www.axios.com/2021/03/22/us-coronavirus-vaccine-diplomacy-china-exports
20 Seow Ting Lee, "Vaccine diplomacy: nation branding and China's COVID-19 soft power play," Place Branding and Public Diplomacy, Vol. 19, (2021), pp. 64-78, retrieved 12 July 2022 from
https://doi.org/10.1057/s41254-021 -00224-4
21 "China COVID-19 Vaccine Tracker," Bridge consulting, (2022), retrieved January 20, 2023 from https://bridgebeijing.com/our-publications/our-publications-1 /china-covid-19-vaccines-tracker/
22 Abiodun Alao, "Nigeria and the BRICs: Diplomatic, trade, cultural and military relations", Africa Portal, (2011), retrieved March 12, 2023, from
https://www.africaportal.org/publications/nigeria-and-the-brics-diplomatic-trade-cultural-and-military-relations/
23 Alaba Ogunsanwo, China's Policy in Africa, (London: Cambridge University Press, 2008), pp. 1-28.
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benefited from the project.24 The former Chinese ambassador to Nigeria Deng Boqing, reported that the "China-Nigeria friendship hospital", which covered an area of about 5 hectares, was an impeccable gift to mark the 42nd anniversary of China and Nigeria diplomatic relations. With an aggregate investment of over 12 million U.S. dollars, the hospital was completed within 22 months and handed over to the Nigerian government. This was done at the hospital ceremony attended by senior Nigerian officials, including the then-vice president. He commended China's undying commitment to the West African country and Africa in general. He also stressed that the new China-Nigeria Friendship Hospital will be accessible to all Nigerians.25
Besides the construction of the China's sponsored hospital, also known as Nigeria's federal staff hospital, Chinese officials revealed that an additional donation of medical equipment and resources to the health care facility. The Chinese government also trained more medical professionals, as well as management, who would work at the new hospital in short-term courses, according to the ambassador. Nigeria's Minister of Health, Onyebuchi Chukwu, revealed at the handover ceremony that a coherent maternal and child health program, including the mitigation of mother-to-child HIV/AIDS transmission and immunization, had been enforced at the medical facility. According to the minister, China's contribution to Nigeria was highly beneficial since it coincided with the development objectives of the West African country, which are incorporated in the existing government's structural reforms.26 The Study's research findings
Primary data was collected by applying quantitative research methods through a survey, administered to one thousand respondents from Nigeria's tertiary institutions. SPSS software was used to analyze the collected data. While the secondary data was collected from textbooks, journal articles, dissertations, conferences, online news, opinions, and editorials. Publications from international organizations and research centers were also incorporated. For the quantitative data analysis, sampling techniques have been applied to the survey to understand Nigerians' perceptions and opinions regarding China's health diplomacy and soft power. Universe of the Study and sampling
The survey primarily targets Nigerian adults above 18 years, irrespective of gender, class, and religion. The survey was conducted between December 2022 and February 2023, in the city Abuja and Lagos. The selection of these cities was based on their cosmopolitan structures. Both cities have more educated individuals who presume to know about the general relationship between Nigeria and China. The cities also represent the seat of commercial and government power in Nigeria. They both serve as homes to the infectious disease centers, the Chinese embassy, notable tertiary institutions and other parastatals related to this study.
Measurement of variables
The variables used for the study include:
i. The personal characteristics of respondents.
ii. The perception of Nigerians about the Chinese soft power.
iii. The perception of Nigerians about China's health diplomacy.
iv. The challenges facing China's health diplomacy with Nigeria. Demographic features of the respondents
As part of general characteristics of the populations, the tables below provide detailed information about the age, gender, religion, and marital status of the respondents. Age distribution
24 "China-assisted hospital commissioned in Nigeria," Embassy of the People's Republic of China in the Republic of South Africa, (2013), retrieved December 15, 2022, from http://za.china-embassy.gov.cn/eng/zfgxss/ca00/201301/t20130129_7688639.htm
25 "China-assisted hospital commissioned in Nigeria," Embassy of the People's Republic of China in the Republic of South Africa, (2013), retrieved December 15, 2022, from http://za.china-embassy.gov.cn/eng/zfgxss/ca00/201301/t20130129_7688639.htm
26 See "China-assisted hospital commissioned in Nigeria," Embassy".
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Age distribution is important in this study as it can provide insight into the different stages of life in which the role of China's health diplomacy in Nigeria is likely to be most effective. Age groups can be used to identify target groups in health campaigns and to measure the success of health diplomacy initiatives. The age distribution indicates that more than half 525 (52.5%) of the respondents were within the age of 30-39 years, 313 (31.3%) of the respondents were within the age of 40-49, while about 15.1% and 1.1% were below 30 years and above 49 years, respectively. This implies that most of the respondents in the study are in the prime of their lives and are likely to be more engaged in the issues relating to China's health diplomacy in Nigeria, as they are more likely to be informed and aware of the implications of China's health diplomacy in Nigeria. This could be especially relevant in evaluating the impact of China's health diplomacy in Nigeria, as the opinions and experiences of those in their 30s and 40s may be more relevant to the discussion than those of younger or older age groups.
Table 1 - Age of the Respondents
Frequency Percent Valid Percent Cumulative Percent
18-19 61 6.1 6.1 6.1
20-29 90 9.0 9.0 15.1
30-39 525 52.5 52.5 67.6
Valid
40-49 313 31.3 31.3 98.9
50-59 11 1.1 1.1 100.0
Total 1000 100.0 100.0
Table 1 shows the age composition of the respondents who participated in the survey. About 52.5% were between the ages of 30-39, followed by 31.3% who were between the ages of 40-49, while 9.0% were between the ages of 20-29, and 6.1% were between the ages of 18-19. The least 1.1% of the respondents were between the ages of 50-59.
52.50%
31.30°°
6.10°% 9.00°
■ ■ _ 1.10°
<20 20-29 30-39 40-49 50-59
Figure 1 : Distribution of respondents' age
Gender of Respondents
Gender is a crucial variable to consider when studying China's health diplomacy in Nigeria. Gender roles and identities can influence how individuals and communities interact with and perceive China's health diplomacy initiatives. Additionally, gender can affect individuals' responses to health initiatives and programs. Understanding gender roles and identities can help to inform health
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policies, initiatives, and interventions tailored to the needs of both men and women in Nigeria. Table 2 and Figure 2 indicate that most (60.5%) of the respondents were females, while (39.5%) of the respondents were male. This indicates that more females were involved in the study than males. It also indicates females are more willing to publicly express their opinions on how the Nigerian and Chinese government could improve public health infrastructures.
Table 2 - Gender of the Respondents
Frequency Percent Valid Percent Cumulative Percent
male 395 39.5 39.5 39.5
Valid female 605 60.5 60.5 100.0
Total 1000 100.0 100.0
Table 2 and figure 2 show that 60.5% of the respondents were female, while the rest of 39.5% were male. The result indicates that majority of the targeted population in Lagos and Abuja were female.
Figure 2: Distribution of respondents' gender by percentage
Marital status
Marital status can be an indicator of access to healthcare, as married individuals may have partners who are able to access and pay for healthcare services, whereas single individuals may be more likely to rely on public services. It could also be an indicator of access to support and resources, as married individuals may have access to more financial, emotional, and social support. The result indicates that 59.3% of the respondents were single, 37.8% of the respondents were married, while 2.5% and 0.2% were widowed and divorced, respectively. This indicates a preponderance of unmarried people among the respondents. The low percentage of divorced and widowed respondents could indicate that the population surveyed is generally younger and healthier. This could have implications for China's health diplomacy success in Nigeria.
Educational Level
Education provides insight into individuals' ability to comprehend and evaluate the different aspects of the topic at hand. Additionally, it may reveal any potential biases or preconceived notions about the issue that could affect the results of the study. Result in Figure 3 indicates that 52.7% of the respondents had first degree, ranging from higher national diploma and bachelor's degrees, 27.6% had postgraduate degrees, while 4.8% and 2.7% had secondary and primary education, respectively. This suggests that most individuals surveyed had some form of higher
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education, such as a bachelor or higher national diploma degree. The fact that more than a quarter of the respondents had postgraduate degrees indicates that there is an emphasis on furthering education in the population. The low percentages of those with secondary and primary education is evidence that the population surveyed is highly educated. With this level of education, respondents are likely to be more informed and better able to understand the complex issues surrounding China's health diplomacy in Nigeria. It also suggests that respondents are likely to have a higher level of understanding of the roles and responsibilities of both countries in the context of health diplomacy.
Primary Secondary OND/NCE/BA HND/Bsc/BA Post graduate education education
Figure 3: Percentage distribution of respondents' educational level
Occupation
The occupation of participants in this study is a crucial variable to consider. This is because different occupations may affect people's attitudes and understanding of China's health diplomacy in Nigeria. For example, people in higher-level positions such as government officials or diplomats may be more familiar with China's health diplomacy efforts and the politics involved than people in lower-level positions such as nurses or administrative staff. Additionally, people in different occupations may have different motivations and interests in China's health diplomacy efforts. Therefore, understanding these differences can provide valuable insight into the study and help draw more accurate conclusions.
Table 3 reveals the occupation of respondents engaged in the survey. It further indicates that a large proportion (44.1%) were medical practitioners, 11.8% were Corp members, 10.0% were students, 8.3% of the respondents were artisans. Other occupation respondents engaged include ICT developer, journalist, Civil servants, business developer, police officer and entrepreneur. This suggests that most of the respondents were likely to be knowledgeable about health-related issues, given that 44.1% of them were medical practitioners. This could be an indication that the respondents would be more likely to provide insightful opinions and perspectives on the role of China's health diplomacy in Nigeria. Additionally, the presence of students and Corp members also suggests that the respondents may be aware of the impacts of health diplomacy in Nigeria, as students and Corp members are typically more engaged in their local communities.
Table 3 - Distribution of Respondents' Occupation
Occupation Frequency (N= 1000) Percentages
Artisans 83 8.3
Medical practitioner 441 44.1
ICT developer 21 2.1
Journalism 4 0.4
Self-employed 38 3.8
Business developer 45 4.5
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Corp members 118 11.8
Students 100 10.0
Police officer 3 0.3
Civil servants 43 4.3
Entrepreneur 60 6.0
Lawyer 12 1.2
Business developer 32 3.2
Perception of Nigerians about China's health diplomacy
In 2014, China has contributed financial resources, protection and treatment supplies to several African countries including Nigeria, to prevent the spread of Ebola virus to Nigeria.27 Notwithstanding strong criticism from the U.S. and its western allies against China's transparency towards COVID-19 pandemic, Nigeria neither issued an official condemnation nor embarked on "band wagoning" attitudes to heat up anti-Beijing sentiments. However, during the early days of the pandemic, some African countries including Nigeria summoned Chinese envoys in their respective countries and interrogated them over allegations of maltreatment and racist attitudes against their citizens, residing in China.28 Against the backdrop of the allegations, African government-level responses have quickly shifted from strong critique of China to a soft return to status quo. However, China's economy has shown a strong growth trajectory amidst a global recession especially during the pandemic.29 In April 2020, Nigerian doctors held demonstrations against the federal government's plan to invite Chinese doctors to Nigeria for the purpose of sharing their experience with the Nigeria center for disease control (NCDC). However, the plan was rejected by the Nigerian medical association (NMA) to support the country's fight against COVID-19.30
Table 4 presents the perception of Nigerians about China's health diplomacy. The result indicates that 65.0% of the respondents agreed that Nigeria appreciates China's Health assistance to fight COVID-19 and Ebola, 61.1% agreed that China medical intervention is in good faith, 54.8% of the respondents agreed that China is a good ally to Nigeria in terms of providing health assistance. Also, 27.8% of the respondents disagreed that Chinese government should not intervened in the Ebola crisis in in Nigeria, 39.6% of the respondents disagreed that Chinese government should not have intervene in the COVID-19 pandemic in Nigeria. This implies that respondents strongly believe the Chinese government should be more involved in global health crises, such as the Ebola crisis and the COVID-19 pandemic in Nigeria. This could indicate that respondents believe that the Chinese government has the resources and expertise to assist in a crisis like this. They also believe that they should be involved in helping to alleviate the Nigerian people's suffering. Additionally, it can be deduced from the results that most respondents view China's health assistance to Nigeria in a positive light. This suggest that China's efforts to help Nigeria fight COVID-19 and Ebola are strong. This is a sign of a positive relationship between the two countries and shows that China could be a reliable ally in health assistance.
27 "On China's Assistance to Africa in the Fight against Ebola," Embassy of China in Lesotho, (2014), retrieved July 7, 2021, from www.mofcom.gov.cn/article/ae/ai/201408/20140800689401.shtml
28 Aidoghie Paulinus, "COVID-19: FG summons Chinese ambassador over allegations of maltreatment of Nigerians in China", The Sun, (2020).
29 Finbarr Bermingham and Orange Wang. "China economy continues strong growth trajectory in October, but imbalances remain." South China Morning Post, (2020), retrieved April 1, 2023, from https://www.scmp.com/economy/china-economy/article/3109967/china-economy-continues-strong-growth-trajectory-october
30 Ebuka Onyeji. "Coronavirus: Nigerian doctors reject country's plan to invite Chinese medical team", Premium Times, (April 6, 2020), retrived July 8, 2022, from
https://www.premiumtimesng.com/health/health-news/386163-coronavirus-nigerian-doctors-reject-countrys-plan-to-invite-chinese-medical-team.html
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Table 4 - Perception of Nigerians about China's health diplomacy
Perception statements Agree Uncertain Disagree Mean
China medical intervention in Nigeria is in good faith 61.1 18.0 20.9 2.40±0.81
Chinese government should not intervene in the 27.8 9.6 62.8 2.35±0.88
Ebola crisis in Nigeria
Chinese government should not have intervened in 39.6 8.0 52.4 2.13±0.95
the COVID-19 pandemic in Nigeria
Nigeria appreciates China's Health assistance to fight 65.0 10.7 24.3 2.41±0.85
COVID-19 and Ebola
China is responsible for the public health issue the 59.4 13.7 26.9 1.68±0.17
world is facing during COVID
Nigeria does not need Chinese health diplomacy 41.2 10.4 48.4 2.07±0.94
China's Health infrastructure to Nigeria is of inferior 43.5 16.3 46.2 1.97±0.91
quality
China is a good ally to Nigeria in terms of providing 54.8 14.7 30.5 2.24±0.89
health assistance
Challenges facing China's health diplomacy in Nigeria
Notwithstanding China's rising role as a major and international health donor, the country has also been facing comparable challenges as other players in the international health funding space. Some of the major challenges are synchronization of health investments, resource prioritization, programmatic and financial accountability, health workforce shortage and problems of sustainability.31 Other challenges that could impede China's efforts in Nigeria are due to lack of coherent governmental policies, rampant corruption, insecurity, public misconduct, and mismanagement. Several reports suggested that Chinese people are often negligent of domestic laws and working standards in Nigeria that could hamper the ability of China's government to responsible in Nigeria.32 Furthermore, this study focused mainly on the following challenges: (i) Lack of sustainability, (ii) Challenges in communication between Chinese and Nigeria health officials (iii) political and business related agendas (iv) Challenges of implementation and aid delivery to the people in need and (v) Challenges due to cultural perspectives and historical context.
Table 5 shows that 70.3% of respondents identified the problem of lack of sustainability as a major barrier to health diplomacy in Nigeria, 68.5% of the respondents also identified the problem of divergence between political and business agendas, 64.0% of the respondents viewed cultural perspectives and historical as a barrier to China health diplomacy in Nigeria. Other challenges to China's health. This implies that there are multiple challenges to China's health diplomacy in Nigeria, including the lack of sustainability, divergence between political and business agendas, cultural and historical perspectives. These findings suggest that China's health diplomacy in Nigeria must be reworked for it to be successful.
Table 5 - Challenges facing China's Health Diplomacy in Nigeria
Challenges Agree Uncertain Disagree
Sustainability 70.3 14.2 15.5 2.55±0.75
challenges in communication 62.2 8.6 29.2 2.33±0.90
cultural perspectives and historical 64.0 14.0 22.0 2.42±0.83
context
31 Ernest Tambo, et al., "China's Belt and Road Initiative: Incorporating public health measures toward global economic growth and shared prosperity." Global Health Journal, Vol. 3, No. 2 (June 2019), retrieved April 5, 2023, from https://doi.org/10.1016/j.glohj.2019.06.003, pp. 46-49
32 Yanzhuo Xu, "China and its International Responsibility in Africa", Ph.D. thesis, Durham University, 2014, retrieved February 10, 2023, from http://etheses.dur.ac.uk/10914, pp. 250-300.
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divergence between political and business agendas 68.5 11.3 20.2 2.48±0.81
organization of aid implementation 58.8 13.6 27.6 2.31±0.88
Grand mean = 2.40
China's soft power perception in Nigeria
As highlighted in the beginning of this paper, soft power is used by China to attract or influence a targeted country. Both China and Nigeria have ramped up efforts to strengthen their diplomatic relations particularly in the last decades. On the one hand, China possesses the capability as a major global power to positively complement Nigeria's demands. In contrast, the Nigerian government has attempted to establish major domestic and political reforms to eliminate several obstacles that could impede Nigeria's bilateral relationships with global powers and Sino-Nigeria relationship.33 This part was aimed to understand the level of familiarity, reputation, and influence of China's soft power in Nigeria.
Familiarity of China's soft power perception in Nigeria
Relative to familiarity of China's soft power perception in Nigeria. From Table 6, the grand mean score of 2.11 was obtained and used as a cut-off point to decide respondents' perception of China's Soft power in Nigeria. Scores within and above the grand mean score were categorized as agreement to the statements, while scores lower than the grand mean score were categorized as disagreement to the statements. Table 6 shows that the statement; I am quite knowledgeable about China's health aid to my country has the highest mean score of 2.29, with 57.7% of the respondents agreeing to the statements. Closely followed, the respondents were aware of China's funding for HIV/AIDS prevention in my country (X = 2.12). However, most of the respondents were unaware of China's commitment to maternal and child health care in the country (X =1.97). This is evidence as 42.1% disagreed that they are aware of China's commitment to maternal and child health care in Nigeria, while 19.3% were uncertain in their response to the statement. Similarly, substantial number of the respondents were not aware of China's commitment to tuberculosis treatment in Nigeria (X = 2.05) as 36.0% of the respondents disagreed that they aware of China's commitment to tuberculosis treatment in Nigeria, while 22.6% were uncertain in their response to the statement.
Reputation of China's soft power perception in Nigeria
Most of the respondents believed they do not mind travelling to China for medical treatment if need be (X = 2.17). Most of the respondents also believed that China has highly trained and very experienced medical professionals and modern facilities, hence I can recommend this to people (X = 2.14). Conversely, most of the respondents opined that the established partnership between Nigeria's health system and China do not make them more confident of the health care services rendered in China (X = 2.06). This is further explained as 38.8% disagreed that the established partnership between Nigeria's health system and China make them more confident of the health care services rendered in China, while 16.7% were uncertain about the statement. This implies that though most Nigerians are aware of China's health aid to their country, they are still not well informed about the specific details pertaining to China's commitment to maternal and child health care, tuberculosis treatment and the established partnership between Nigeria's health system and China. This suggests that there is a need for more awareness and education on the specific details
33 Gregory Mthembu-Salter, "Chinese Investment in African Free Trade Zones: Lessons from Nigeria's Experience," Africa Portal, (2009), retrieved March 25, 2023, from https://www.africaportal.org/publications/chinese-investment-in-african-free-trade-zones-lessons-from-nigerias-experience
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of China's health aid in Nigeria to increase familiarity and trust in China's soft power perception in the country.
Influence of China's soft power perception in Nigeria
In terms of influence of China's soft power perception in Nigeria, most of the respondents commended China's health aid response to Africa on Ebola crisis (X =2.20). This is further expressed in the respondents' response as 50.9% of them agreed that China's health aid response to Africa on Ebola crisis is commendable. In the same vein, a substantial number of the respondents believed China's intervention in Nigeria during the COVID-19 pandemic significantly increase their perception positively (X = 2.10). This is clearly seen in Table 6 as 47.4% of the respondents agreed that China's intervention in Nigeria during the COVID-19 pandemic significantly increase its perception positively.
On the contrary, only few believed that China's health diplomacy to Nigeria has had much impact on the way Ebola was curtailed (X =2.05). This is further depicted in Table 6 as 36.7% disagreed with the statement, while 17.7% were uncertain in their response. Similarly, less than half of the respondents believed that China's intervention in Nigeria during Ebola crisis increase its perception positively. This is further explained in Table 6 as 37.4% of the respondents disagreed that China's intervention in Nigeria during Ebola crisis increase its perception positively, while 19.9% were uncertain in their response to the statement. The results imply that the influence of China's soft power perception in Nigeria is not as strong as it could be. While most of the respondents commended China's health aid response to Africa on Ebola crisis and its intervention in Nigeria during the COVID-19 pandemic, fewer people believe that China's health diplomacy to Nigeria has had much impact on the way Ebola was curtailed nor that its intervention in Nigeria during the Ebola crisis significantly increased its perception positively. This suggests that Nigeria is still hesitant towards China's soft power, and that more effort is needed to positively improve China's image in Nigeria
Table 6 - Distribution on China's soft power perception in Nigeria by respondents
China's soft power perception in Nigeria Agree Uncertain Disagree Mean/SD
Familiarity
I am quite knowledgeable about China's health aid to 57.7 13.4 28.9 2.29±0.89
my country
I am aware of China's funding for HIV/AIDS prevention 46.5 19.0 34.5 2.12±0.89
in my country
I am aware of China's commitment to tuberculosis 41.4 22.6 36.0 2.05±0.88
treatment in my nation
I am aware of China's commitment to maternal and 38.6 19.3 42.1 1.97±0.90
child health care in my country
Grand mean = 2.11
Reputation
I do not mind travelling to China for medical 53.4 10.0 36.6 2.17±0.93
treatment if need be
the established partnership between my country's 44.5 16.7 38.8 2.06±0.91
health system and China makes me more confident of
the health care services rendered in China
I believe China has highly trained and very 50.7 13.0 36.3 2.14±0.92
experienced medical professionals and modern
facilities, hence I can recommend this to people
Grand mean = 2.12
Influence
China's health diplomacy to Nigeria has had much 41.9 21.4 36.7 2.05±0.89
impact on the way Ebola was curtailed
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China's health aid response to Africa on Ebola crisis is commendable 50.9 17.7 31.4 2.20±0.89
China's intervention in Nigeria during the COVID-19 pandemic significantly increase its perception positively 47.4 15.0 37.6 2.10±0.92
China's intervention in Nigeria during Ebola crisis increases its perception positively 42.7 19.9 37.4 2.05±0.89
Grand mean = 2.10
CONCLUSION
The study examined Nigerian's opinions on China's health diplomacy in Nigeria. A quantitative research method was employed for the study. This was due to its potential and capability to measure different opinions of the Nigerian population about China's relations with Nigeria. The study established that respondents have negative opinions of China's health diplomacy in their country. The research also highlighted that there are various issues that impede China's success in this area, including a lack of sustainability, conflicting political and business agendas, cultural and historical differences. This implies that China must take steps to improve its health diplomacy in Nigeria by building trust and addressing the issues that impede its success. This could involve long-term commitments to health projects, addressing cultural differences, and working with local stakeholders to ensure that the projects are sustainable and mutually beneficial. Nevertheless, the data collected from one thousand respondents, shows there is a significant relationship between perception of Nigerians about China's health diplomacy and China's soft power perception in Nigeria (r= 0.192, p<0.05). It implies that the more favorable Nigerians perceive China's health diplomacy, the more likely they perceive China's soft power in Nigeria. This suggests that China's humanitarian efforts in the country, such as providing aid and medical assistance, have a positive influence on how Nigerians view China's soft power. It also suggests that if Nigerians view China as engaging in beneficial health diplomacy, they are more likely to view China as having a positive influence on the country.
Conclusively, the study found that Nigerians generally have an unfavorable opinion of China's health diplomacy and soft power in Nigeria, which suggests that China needs to take steps to improve its reputation and build better relationships with the people of Nigeria. Chinese governments and health agencies should develop sustainable health initiatives tailored to the specific needs of the Nigerian population. This will foster strong relationships between Chinese and Nigerian health organizations, as well as promote long-term cooperation and shared learning. To improve the perception of China's soft power in Nigeria, it is recommended that the Chinese government take proactive steps to engage with Nigerian citizens and communities. This includes engaging with local businesses, NGOs, and other civil society organizations. The Chinese government should also strive to create a more open dialogue with Nigerian citizens and listen to their concerns, about China's activities in the country. This could help to create a more positive perception of Chinese soft power in Nigeria and build trust between the two countries.
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