Abstract:Background: Access to long-lasting insecticidal nets (LLINs) remains a critical challenge for malaria-endemic regions in Africa. China, home to a growing number of WHO-prequalified LLIN manufacturers, has become a key supplier in international procurement systems, while also promoting South-South health and Triangular cooperation under the Health Silk Road initiative. Objectives: This study investigates China’s dual role in LLIN provision: (1) its function as a global manufacturing hub, and (2) how WHO-prequalified Chinese LLIN manufacturers contribute to innovation, affordability, equitable access, and South-South cooperation. Methods: The study draws on semi-structured interviews with procurement officers from international agencies, representatives of Chinese and foreign LLIN manufacturers based in China, and national malaria control program (NMCP) officials in Africa. Data were thematically analyzed using a qualitative approach. Results: Findings show that China supplies the majority of global LLINs through vertically integrated, cost-efficient production, supported by a large skilled labor force and stable supply chains. Yorkool, a leading example among WHO-prequalified Chinese LLIN manufacturers, leveraged the PQ process to strengthen R&D, develop dual-AI products, tailor materials to user preferences, and support LLIN production in Uganda through knowledge and material transfer. Conclusions: This study contributes to literature on the global supply of medical goods and South-South and triangular cooperation (SSTC) by showing how an emerging economy China has evolved from a manufacturing base into a standards-compliant innovator and institutional partner in global health. These practices expand access to preventive technologies and enrich the operational meaning of SSTC and the Health Silk Road. The findings suggest that emerging economies can shape more equitable global health systems not only as suppliers but also as contributors to innovation, quality assurance, and South-South learning advancing universal coverage of LLIN and broader progress toward universal health coverage (UHC).
Keywords: Health Systems and Universal Health Coverage (UHC), Universal health coverage (UHC), Long-lasting insecticidal nets (LLINs), WHO prequalification (PQ), South South, Global health supply chains and triangular cooperation (SSTC), Health Silk Road,
