Chinese Medical Imaging Firms Turn to Belt and Road Markets Amid Domestic Revenue Pressure

Affected by the industry-wide rectification campaign that began last year, multiple medical imaging companies anticipate a short-term slowdown in the domestic market.

From the data, in 2024, GE Healthcare’s second-quarter sales in the Chinese market declined by approximately 18%, Siemens Healthineers’ first-quarter performance in China dropped by 14%, United Imaging’s domestic revenue in the first half of the year decreased by 3.2% year-on-year, and Mindray Medical also indicated that the activity level of tendering and procurement in the domestic ultrasound market during the first half remained less than optimistic...

On the other hand, the significant surge in overseas revenue for multiple medical imaging enterprises has paved the way for domestic companies. In the first half of the year, United Imaging’s international revenue increased by approximately 30% year-on-year, while WDM’s sales revenue from overseas markets grew by more than 100% compared to the same period last year.

It is worth noting that an increasing number of enterprises are beginning to look beyond traditional markets in Europe, the United States, and Japan, designating countries along the “Belt and Road” as key export destinations.

Taking Contec Medical Systems as an example, its sales in the United States, Europe, Japan, and other regions were somewhat affected in 2023. However, by leveraging the Belt and Road Initiative (BRI) and related policies, the company achieved breakthroughs in BRI-participating countries such as Indonesia, the United Arab Emirates, and Algeria, thereby realizing steady growth in performance.

It is not just Contec Medical Systems; increasingly, companies affected in the European, American, and Japanese markets are shifting their focus toward countries along the “Belt and Road” routes. According to customs data, in the first half of 2024, China’s medical device exports to Poland increased by 18.52% year-on-year; exports to Vietnam rose by 14.21% year-on-year; and exports to Indonesia grew by 9.13% year-on-year.

As of now, the markets of “Belt and Road” countries have become a major export destination for China’s medical devices, accounting for 37.5% of the total value of medical device exports.

Since the proposal of the Belt and Road Initiative in 2013, China has engaged in cooperation with health ministries, medical academies, and other institutions in Central and Eastern Europe, ASEAN, the Arab League, and other countries and regions in areas such as healthcare talent development, public health services, and traditional medicine. To date, China has signed health cooperation agreements with more than 160 countries and international organizations.

During this period, domestic medical imaging companies leveraged policy dividends to rapidly promote Chinese-made medical imaging equipment to “Belt and Road” countries, successfully achieving international expansion or tapping into new markets.

For example, United Imaging has successfully entered the market of the Republic of Mozambique, providing it with the second MRI device in the country and the first in the northern region; it has also smoothly entered the Uzbekistan market, supplying two CT and MR devices equipped with the Digital Intelligent Tianyan System...

To date, United Imaging’s high-end medical equipment, including PET-CT, MRI, and CT systems, has been deployed in approximately 30% of the countries along the Belt and Road Initiative, such as Poland, Kazakhstan, Uzbekistan, Vietnam, the Philippines, Egypt, Iraq, and the United Arab Emirates.Among them, United Imaging has deployed over 200 units of its high-end imaging equipment in Poland.。

Furthermore, Neusoft Medical has actively responded to the Belt and Road Initiative with significant achievements. In 2000, Neusoft Medical exported CT equipment to Europe for the first time, embarking on its path to globalization. In 2013, following the launch of the Belt and Road Initiative, Neusoft Medical promptly adjusted its overseas expansion strategy, designating countries along the Belt and Road routes as key target markets.

Benefiting from the policy dividends of the Belt and Road Initiative, Neusoft Medical successfully signed a contract with the Kenyan government to provide one-stop solutions—including high-end medical imaging equipment, imaging cloud services, imaging services, and clinical training—to all 37 counties nationwide. Meanwhile, Neusoft Medical also achieved breakthroughs in Central and Eastern Europe along the Belt and Road routes, securing a tender project awarded by the Romanian Ministry of Health.

To date, Neusoft has signed hundreds of cooperation agreements with more than 90 countries along the “Belt and Road,” and its products have been widely deployed in many of these nations.Among them, hundreds of large-scale medical devices were deployed in the Middle East and North Africa alone.。

In addition, domestic imaging companies such as Synovate, Mingfeng Medical, Sonoscape, Mindray, WDM, Perlove Medical, Guangmai Medical, and Xiangsheng Medical have all prioritized countries along the “Belt and Road” as key regions for their overseas expansion, achieving significant breakthroughs.

For instance, Sinovision’s CT products have been installed in Kazakhstan, Uzbekistan, Russia, Egypt, Lebanon, Algeria, Ghana, and other countries; Mingfeng Medical’s CT equipment has been deployed in Vietnam, Romania, Egypt, Kenya, Argentina, Brazil, and other nations; Perlove Medical has supplied 31 high-end DR systems to Kyrgyzstan, delivered 40 C-arm units to Uzbekistan, and seen multiple imaging devices installed in hospitals across Pakistan.

Overall, Chinese medical imaging companies are breaking into the “Belt and Road” markets, finding new opportunities beyond traditional major export destinations such as Europe, the United States, and Japan.

To date, China has signed cooperation agreements on jointly building the Belt and Road Initiative with 154 countries, including 41 in Asia, 52 in Africa, 27 in Europe, 13 in North America, 9 in South America, and 12 in Oceania. AndEach country has its unique medical device market environment and development needs.。

In Central Asia,Influenced by geographical environment, economic development levels, and historical factors, local medical resources are relatively scarce, and the overall standard of healthcare is low. For example, in Kazakhstan, which ranks among the top economies in Central Asia, there are only approximately 600 CT and MRI radiologists nationwide and merely 40 nuclear medicine specialists. In terms of equipment, the country has only 96 MRI scanners and 174 CT scanners.

Nevertheless, the five Central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, and Turkmenistan) are vigorously promoting the development of their local healthcare industries. On one hand, these nations are accelerating the construction of new hospitals and clinics; on the other, they are upgrading and modernizing medical facilities inherited from the Soviet era, resulting in strong demand for medical equipment. For instance, Uzbekistan is gradually introducing advanced medical equipment and technologies, such as high-end CT scanners and magnetic resonance imaging (MRI) systems, while the Kazakh government has reviewed and approved the “Concept for the Development of Healthcare Infrastructure for 2024–2030.”

In Africa,Developing countries are highly concentrated in this region. Constrained by economic conditions, most nations here face challenges such as weak healthcare systems and a shortage of medical professionals. For instance, Mozambique, designated by the United Nations as one of the Least Developed Countries and a Heavily Indebted Poor Country, has only one MRI scanner for its entire population of 30 million, reflecting an extreme scarcity of medical resources.

Meanwhile, Africa comprises numerous countries with diverse policies and regulations, leading to a more pronounced market fragmentation. Among them, Nigeria, Algeria, Egypt, Kenya, Uganda, and South Africa hold certain advantages in terms of business environment, market size, and access restrictions.

In the Middle East,Saudi Arabia, the United Arab Emirates, and Turkey are the three largest medical device markets. Among them, Saudi Arabia and the UAE are both developed countries with strong purchasing power and highly advanced medical tourism sectors, resulting in exceptionally high demands for medical technology and healthcare services.

In the past two years, both Saudi Arabia and the United Arab Emirates have accelerated the construction of public healthcare infrastructure and improved the quality of medical services. Against this backdrop, high-end medical devices have gained popularity in the Saudi and UAE markets. In contrast, Turkey’s market demand differs, with a greater preference for cost-effective products.

To date, approximately 154 countries have participated in the joint development of the Belt and Road Initiative (BRI), with significant market differences across each country. Among them,Southeast Asia, Central Asia, the Middle East, North Africa, and other markets are receiving greater attention from Chinese enterprises。

According to data from China Customs, Southeast Asian countries are the primary export destinations for domestically produced medical imaging equipment. The data shows that among the top ten countries and regions under the "Belt and Road Initiative" by export value of China's medical devices in the first half of 2024, six were Southeast Asian nations: Vietnam, Singapore, Malaysia, Thailand, Indonesia, and the Philippines.

Meanwhile, the medical device market in Central Asia is experiencing rapid growth. In the first half of the year, China’s medical device exports to Kazakhstan, Kyrgyzstan, and Tajikistan increased by 7.11%, 48.49%, and 30.54% year-on-year, respectively. Furthermore, numerous medical imaging companies are intensifying their expansion into the Middle East and North Africa markets, achieving large-scale installations.

Along the “Belt and Road” routes, countries exhibit significant differences in economic development, policy environments, business climates, religious beliefs, and market demands. Nevertheless, numerous Chinese medical imaging companies have secured orders and achieved large-scale installations in these countries. How have they broken into these diverse markets?

According to VCBeat, domestic medical imaging companies primarily enter the market through the following methods and channels.

First, leverage government-aided hospital construction and other healthcare cooperation initiatives to penetrate the local market.For example, since the launch of the Belt and Road Initiative, China has provided aid to African countries in the construction of more than 130 hospitals and clinics, including projects such as the Africa Centres for Disease Control and Prevention (Africa CDC) Headquarters, the Africa CDC Laboratory, the Maseru Regional Hospital and Eye Clinic in Lesotho, the China-Guinea Friendship Hospital, and the Niger General Hospital.

Among these hospitals and clinics built with foreign aid, the medical instruments and equipment for some hospitals were supplied by Chinese enterprises, enabling many medical imaging companies to successfully enter the local markets. For instance, the medical equipment at Levy Mwanawasa Hospital in Zambia was supplied by Mindray; the equipment for Phase I of the African Union Centers for Disease Control and Prevention project was supplied by Haier Biomedical; and the equipment for the expansion and renovation project of the General Hospital of Luanda Province in Angola was supplied by Anhui Jiapute Biology.

An anonymous industry insider stated, “Relevant institutions will pay corresponding fees to enterprises for supplying medical equipment to hospitals built under aid programs.”

Second, leverage overseas delegations, inspection tours, or economic and trade cooperation activities led by the government and industry associations to accelerate global expansion and secure orders.For example, in 2017, Sichuan Province intensified its “Ten Thousand Enterprises Going Global” initiative, organizing 218 provincial-level events in a tiered manner, with the Belt and Road Initiative as a key focus. In 2022, Zhejiang Province launched the “Thousand Delegations and Ten Thousand Enterprises Market Expansion and Order Securing Campaign,” coordinating enterprises to participate in overseas exhibitions and conduct business negotiations, thereby helping them expand into international markets.

In 2018, Chison Medical was invited to participate in the “Economic and Trade Mission to the Czech Republic, Hungary, and Belgium” hosted by the Wuxi Municipal Bureau of Commerce, and successfully signed a strategic cooperation agreement with Viamed Medical Technology Co., Ltd. of the Czech Republic to export ultrasound medical imaging diagnostic equipment to the Czech Republic and other regions. It is reported that, with professional after-sales service and support from Viamed, Chison Medical’s products have captured a significant market share in the Czech Republic.

Third, leverage traditional channels such as exhibitions and conferences to expand into markets in Belt and Road Initiative countries.. Prior to the proposal of the Belt and Road Initiative, companies such as Mindray and Neusoft had already achieved equipment installations in markets across Belt and Road countries through exhibitions, conferences, and other channels. For instance, in 2006, Neusoft’s CT scanners were deployed in Kazakhstan. Subsequently, Neusoft’s large-scale medical equipment successively entered markets including Kyrgyzstan, Uzbekistan, and Tajikistan.

In January 2024, medical imaging manufacturers including Mindray, Neusoft, Sonoscape, Xiangsheng Medical, and SIUI all participated in the 49th Arab Health Exhibition (Arab Health). During the event, CHG, Egypt’s largest private hospital group, signed a strategic cooperation agreement with Mindray; Prepaire Labs, a healthcare technology company in the United Arab Emirates, purchased a panoramic dynamic PET/CT system from United Imaging...

In addition to Arab Health, Chinese medical imaging companies are also actively participating in Europe’s largest medical device exhibition, “MEDICA (International Medical Trade Fair)”; Africa’s largest medical device exhibition, the “Kenya Medical Device Exhibition”; and South America’s largest medical equipment exhibition, the “São Paulo Medical Device Exhibition” in Brazil… Through these exhibitions, they are expanding into new markets.

It is worth noting that some countries and regions, despite having lower economic levels, still procure mid-to-high-end products. For instance, in the first half of 2024, WDM’s high-end new liquid-helium-free MRI system was successfully installed in Africa, Southeast Asia, and Central Asia, with orders subsequently received from countries and regions along the “Belt and Road” initiative. Similarly, during the same period, Mindray Medical secured high-end clients in the medical imaging sector, including the Aga Khan University Hospital in Pakistan.

Of course, markets in countries along the “Belt and Road” also favor cost-effective products. For instance, the high-quality yet affordable medical devices provided by Chison Medical Technologies have gained popularity in these markets.

The aforementioned industry insider added, “In many overseas markets, price sensitivity for medical imaging equipment is relatively low; customers place greater emphasis on brand reputation and after-sales service. Some markets also prioritize distributor resources.” Therefore, companies must flexibly adjust their strategies regarding international expansion and product selection based on their own resources.

As mentioned above, the domestic medical imaging market is expected to slow down in the short term due to factors such as industry rectification and delayed tenders.

In response to this situation, an increasing number of medical imaging companies are ramping up their investments in overseas markets, particularly those along the “Belt and Road” Initiative.

For example, in the first half of the year, WDM improved its overseas marketing organizational structure and functional system, advanced the “6+1” sales region layout in countries along the Belt and Road Initiative, and implemented a localization strategy, including establishing sales offices and overseas spare parts warehouses.

Mindray Medical has rapidly adjusted its marketing strategy in the international market (ultrasound sector), increased investment to expand coverage in overseas high-end markets, and accelerated the process of breaking through with high-end customers.

United Imaging continues to expand its international presence, with a focus on high-growth regions and emerging markets. Previously, United Imaging announced its active response to the Belt and Road Initiative, advancing localization and informatization within regional markets through its “Five-in-One, BRICS Layout” strategy.

At this stage, Chinese medical imaging enterprises have not yet formed a systematic approach to overseas expansion. However,In the “Belt and Road” markets, we have observed the experiences and approaches of early movers.

First, localization is a core priority. For instance, WDM has established offices in Uzbekistan (Central Asia) and Egypt (Africa), and set up overseas spare parts warehouses in select regions to firmly advance its localized layout. Neusoft Medical has built a service center, logistics center, and spare parts warehouse in Dubai, with a local staff rate exceeding 90%. Mindray is accelerating the implementation of overseas localized production, with more than 10 overseas localized production bases expected to be operational by the end of this year. United Imaging Healthcare has assembled a team of over 40 people in the Middle East and Africa, only two of whom are Chinese, achieving a thorough level of localization.

Localization enables the establishment of superior after-sales services and helps mitigate certain policy-related risks.

Secondly, there is a scarcity of medical talent along the “Belt and Road” routes, prompting medical imaging enterprises to vigorously develop clinical education and training. For instance, Neusoft has hosted the “Technical Training Course for Developing Countries” for 15 consecutive years, cultivating more than 400 professionals in total; it has also organized the “International Training Course on Digital Medical Imaging Equipment” for over a decade, training hundreds of technical personnel for multiple Central Asian countries.

Additionally, Mindray has partnered with top local universities and public teaching hospitals in Egypt to jointly establish four training centers and 13 training schools, having trained over 1,500 obstetrics and gynecology healthcare professionals. Furthermore, Mindray has opened more than 20 ultrasound training schools in several countries across the Middle East and Africa, including Morocco, South Africa, and Iraq.

Long-term clinical technical training will enhance brand reputation and drive the local market to choose domestically produced medical imaging equipment.

Finally, be mentally prepared to address the challenges of global expansion. When entering the “Belt and Road” markets, in addition to hurdles related to product registration and commercialization, companies also face delivery difficulties.

For example, the Republic of Mozambique procured a magnetic resonance imaging (MRI) system; however, the long distance, inadequate infrastructure, and arduous transportation conditions posed significant challenges. Furthermore, the local hospital’s facilities and utilities (water and electricity) were underdeveloped, making delivery and installation extremely difficult for the enterprise. These factors necessitate thorough preliminary investigations and contingency planning by the company.

Overall, Chinese medical enterprises are intensifying their global expansion efforts, yet they face numerous challenges in the process. To address this, VCBeat has launched an “Overseas Business Study Tour + Exhibition Participation Program” to support medical companies aspiring to go global. The first destination will be the 50th Arab Health. Entrepreneurs interested in joining our delegation are welcome to contact us.