From local practices to national narratives: the micro-construction of Ningxia’s medical cooperation with Benin and China’s health diplomacy in Africa

Background China’s health diplomacy with Africa is a core part of China-Africa cooperation. Existing studies mostly focus on macro-level strategies and policies, lacking micro-level analysis of local actors and a bidirectional examination of mechanisms linking local practices and national narratives.Objective This study takes Ningxia’s over 40-year medical aid to Benin as a case, explores the interaction between local actions and national narratives, and reveals the micro-construction path of province-country linkage.Methods A single-case embedded research design was employed, drawing on in-depth interviews, policy documents, and official reports, and qualitative coding was conducted in NVivo 14.Results Ningxia implements national health and South–South cooperation strategies through institutionalised dispatch, distinctive technologies, and cultural interactions. Local practices appear to verify and enrich national narratives, and preliminary evidence suggests they can contribute to national policy discussions. Nevertheless, the structure and operation of the associated feedback mechanism remain to be further explored. This interactive process proceeds through four pathways: institutionalised organisation, embodied engagement, emotional communication, and technological innovation.Conclusions The Ningxia-Benin case reveals the provincial level as a crucial intermediary in health diplomacy, where local actions co-construct national narratives. This micro-level foundation enhances the resilience and popular legitimacy of China-Africa health cooperation, extending multi-level diplomacy theory beyond top-down implementation to a co-constitutive framework.