By: Ho Hui Yan and Alan H. Yang

In a bid to maintain and expand its links with the global community Taiwan is promoting regional links in Southeast and South Asia as a way to communicate through institutional projects generated by its formidable domestic health programs, some of the best in the region.

As countries seek to harness their soft power through foreign policy, medical diplomacy has come to the forefront of foreign policy in the recent decades. Health is an important indicator of development, and its importance is highlighted through the list of 50 health-related indicators under the UN Sustainable Development Goals.

In the fast-growing Southeast Asia region, increasing healthcare demand and an epidemiological shift from infectious to chronic diseases is placing increasing strain on health care systems.

More than 60 million of the region’s people are impoverished as a result of health-care spending, and the World Health Organization has made it a regional priority to achieve universal health coverage. According to the Association of South East Asian Nations (ASEAN) Economic Community Blueprint 2025, average healthcare expenditure in ASEAN was only US$643 compared with US$4,471 in OECD countries in 2014, suggesting considerable potential for growth.

This potential has attracted the attention of other major stakeholders. Through the US Agency for International Development (USAID), Washington has invested more than US$6 billion in 2017 on healthcare-related issues in over 60 countries, including many in Southeast Asia. The funds from USAID focus on maternal and child health, communicable diseases management such as tuberculosis and malaria, and HIV/AIDS.

China is also an emerging force. Although the bulk of China’s medical diplomacy efforts are concentrated in Africa, Southeast Asia has emerged as a new regional priority. After the SARS pandemic in 2003, China stepped up its efforts in regional health cooperation through ASEAN. Cooperation frameworks such as the China-ASEAN (10+1) and ASEAN-China, Japan and Korea (10+3) focus on nontraditional security issues such as infectious diseases and public health.

Taiwan’s New Southbound Policy

Medical cooperation is one of the five flagship projects under Taiwan’s people-centered New Southbound Policy (NSP). The NSP involves building comprehensive ties through mutual collaboration with 18 countries – the 10 ASEAN members, six South Asian countries as well as Australia and New Zealand. Besides medical cooperation, Taiwan aims to promote bilateral and multicultural connectivity in cultures, tourism, technology and agriculture.

Taiwan’s healthcare system is well-known around the world and lauded for its universal coverage, high quality and accessibility and low cost. Many countries in Southeast Asia already look towards Taiwan as a benchmark for their own healthcare systems, and many hospitals in Taiwan have been carrying out their own medical diplomacy efforts.

For example, the National Taiwan University Hospital has been training Vietnamese health professionals since 2005 before the NSP was implemented, and Mackay Memorial Hospital has been sending medical teams to underserved communities in Myanmar, Cambodia and Thailand since 2008.

Emerging Global Health Diplomacy

Prominent examples of successful medical diplomacy strategies include the US, Brazil, China and particularly Cuba, which has one of the most successful and comprehensive medical diplomacy strategies in the world.  In 2009, more than 37,000 Cuban medical professionals were working in 98 countries across the world, and Cuban medical schools have provided free education and training for over 12,000 medical personnel from developing countries.

In addition to receiving sizeable earnings for provision of direct medical services and benefiting from favorable rates for oil from Venezuela, Havana has garnered much support from beneficiary countries in the WHO and other UN bodies, who have voted overwhelmingly in support of lifting the US’s embargo of Cuba.

The Caribbean nation demonstrates the extent of goodwill and influence that health diplomacy can harness to improve foreign relations and achieve non-health related goals in the global arena in the face of traditional US hostility towards it.

Taiwan’s Soft Power  

The New Southbound Policy is not Taiwan’s first foray into medical diplomacy. It sent its first team of medical personnel to Libya in 1961, and since then has continued supporting countries in Africa, Latin America and the Pacific. Many of the recipient countries have diplomatic ties with Taiwan, which makes government-led cooperation possible, although the number of countries on this list has been decreasing due to China’s efforts to undermine Taiwan’s international recognition.

Through the International Co-operation Development Fund (ICDF) and other efforts by Taiwanese hospitals, Taiwan has contributed to humanitarian assistance efforts by sending medical teams to countries post-disaster, helped to build up health infrastructure and information systems, as well as tackle specific health issues such as kidney failure, diabetes and maternal health.

Moreover, the Fund offers scholarships to students to study medicine, public health and health administration degrees in Taiwan, as well as short-term courses for medical professionals to expand their range of expertise and skills.

Through these initiatives, Taiwan aims to go beyond the traditional diplomatic exchanges between governments and extend its goodwill and influence. These contributions to the health and medical sectors have been frequently highlighted as an epitome of Taiwan’s relationship and friendship with its diplomatic allies.

Different Medical Diplomacy

Medical diplomacy is one of Taiwan’s five flagship NSP programs. The government anticipates developing public-private partnerships instead of providing aid, and departs from previous economics-focused strategies. The medical cooperation projects thus have the potential to strengthen not only Taiwan’s soft power but to boost awareness in partner countries and improve its regional contribution.

The current medical cooperation initiative is quite unlike Taiwan’s previous examples of medical diplomacy. For starters, most of the NSP partner countries have their own existing health infrastructure. They share no diplomatic ties with the island country. However, instead of providing direct medical care or basic public health programs, the NSP focuses on high-level professional skill transfer such as organ transplant surgeries, as well as the development of potential markets for Taiwanese medical supply and pharmaceutical companies.

Other areas of collaboration include medical regulation harmonization, laboratory verification collaboration, and the strengthening regional infectious disease networks.

To facilitate entry into the different countries, which differ greatly in terms of medical resources and capabilities, the “One Country One Center” (OCOC) initiative was introduced in June 2018 with India, Indonesia, the Philippines, Malaysia, Thailand and Vietnam as its primary partners.

Under this initiative, selected medical centers coordinate with these countries to improve medical cooperation and assist other health-related industries in entering these markets.

Taiwan is also taking the opportunity to market itself as a destination for international medical tourism, offering high quality services including spinal surgeries, reconstructive microsurgeries, aesthetic medicine and comprehensive health examination packages.

Achievements So Far

Since its inception in 2016, medical cooperation and development of industrial chains between Taiwan and Southeast Asia has grown significantly. In July 2016, the Taiwan External Trade Development Council (TAITRA) organized a medical trade team and held talks with 248 companies from Myanmar, Thailand and Singapore. The group, comprised of representatives from 17 Taiwanese companies, signed deals worth US$8.39 million.

The six medical centers under the OCOC project trained a total of 336 medical professionals from South and Southeast Asian countries, and introduced 69 Taiwanese companies into the region in 2018. Hospitals like the Changhua Christian Hospital is partnering up with contemporaries in Thailand to develop smart IT hospital management systems.

Advancements have been made in the area of regulation, with Taiwanese laboratories achieving recognition by Indonesia, and the removal of barriers for Taiwanese pharmaceuticals to enter the Malaysia market, and likewise for traditional herbal medicines into Singapore and Malaysia.

There has also been steady growth in patients from South and Southeast Asia, with a cumulative total of 112,00 patients receiving services from Taiwan by September 2018. Trade shows have been organized both within Taiwan and in NSP partner countries to promote pharmaceutical, health information technology and medical device capabilities.

In the area of public health, collaboration has begun with a select number of countries such as Indonesia and Vietnam on diseases like dengue fever and tuberculosis.

What’s Next?

The achievements are a first step towards greater coordination and integration of a public health network in Asia and beyond. Through the OCOC initiative, Taiwan has made advances in developing “soft” infrastructure in the region by building on the people-to-people connection between institutions and communities.

Despite some successes in lowering the barrier for Taiwanese companies to enter the Southeast Asian market, there is still untapped potential for development of further cooperation in the medical and pharmaceutical industries. Taiwan’s successful public healthcare system can serve as a reference for the NSP partner countries in developing their own universal healthcare system, in accordance to the WHO regional priority to achieve universal health coverage (UHC) in Southeast Asia.

Given geographical proximity and increasing bilateral exchanges, greater regional cooperation and integration is needed for greater public health security. With its emphasis on a people-centered approach, Taiwan is poised to capitalize on its healthcare expertise and realizing its goal of utilizing the NSP to strengthen Taiwan’s importance in Asia and beyond.

Ho Hui Yan is a research associate with the Taiwan-Asia Exchange Foundation, School of Health Care Administration, College of Management, Taipei Medical University. Alan H. Yang is executive director of the Taiwan-Asia Exchange Foundation. He is also a Professor at the Graduate Institute of East Asian Studies at National Chengchi University in Taiwan.