China’s public health aid to Africa for over 60 years has achieved remarkable progress but it is still facing some challenges. This thesis aims to analyze the decision-making process of Chinese public health aid to Africa by using the Rational Actor model and the Bureaucratic Politics model from Graham Allison’s Essence of Decision (1971). Besides, the study will investigate China’s political and economic motivations in providing public health aid to Africa. The Rational Actor Model helps discuss the decision-making process in the Mao and Deng’s periods, and the Bureaucratic Politics model can help give some explanations after Deng’s period, while it also has its own characteristics: the leaders start to take advice from bureaucratic specialists and technical personnel in the decision-making process. In that way, more attention is paid to the management system of China’s health aid towards Africa and the features and changes of China’s foreign aid. In order to improve the effectiveness of China’s public health aid to Africa, China should improve its management of public health aid to Africa, increase its transparency and openness of its decision-making process, and make the functional orientation of Chinese health aid clear in the future.