The Barefoot Doctors of China

Primary health care may feel like a luxury and domain of the western society, but in fact the concept was seen in early china when an attempt was made to provide care to millions of people in the Chinese people’s republic,

The initial plans were laid out in 1930s as part of the rural construction movement which in it self was born in the 1920s

China had suffered from lack of a uniform infrastructure for years, and with the lack of a uniform provision of health care the rural villages were not the ideal places for a doctor to settle, a situation we still see in many developing nations today, with Pakistan not being an exception.

The barefoot doctors were village farmers who in most cases after finishing school would receive a 6 months of less training in local hospitals and would then settle in the rural areas to provide basic health care, the system took hold due to the lack of availability of doctors from the urban areas who were willing enough to settle in rural China

In 1965 after a speech by chairman Mao the system was developed and institutionalized.

Barefoot doctors acted as a primary health-care provider at the grass-roots level. They were given a set of medicines, both Western and Chinese, that they would dispense. Often they grew their own herbs in the backyard. As Mao had called for, they tried to integrate both Western and Chinese medicine, like acupuncture and moxibustion. An important feature was that they were still involved in farm work, often spending as much as 50% of their time on this – this meant that the rural farmers perceived them as peers and respected their advice more. They were integrated into a system where they could refer seriously ill people to township and county hospitals.

Two-thirds of the village doctors currently practicing in rural China began their training as barefoot doctors.[1] This includes Chen Zhu, China’s former Minister of Health, who practiced as a barefoot doctor for five years before going on to receive additional training.[1]

The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. By 1984, village RCMS coverage had dropped from 90% to 4.8%.[2] In 1989 the Chinese government tried to restore a cooperative health care system in the rural provinces by launching a nationwide primary health care program.[2] This effort increased coverage up to 10% by 1993.[2] In 1994 the government established “The Program”, which was an effort to reestablish primary health care coverage for the rural population.[2]

[1] Watts, Jonathan (2008). “Chen Zhu: From Barefoot Doctor to China’s Minister of Health”. The Lancet 372 (9648): 1455. doi:10.1016/S0140-6736(08)61561-5. PMID 18930519

[2] Carrin, Guy; et al. (1999). “The Reform of the Rural Cooperative Medical System in the People’s Republic of China: Interim Experience in 14 Pilot Countries”. Social Science & Medicine 48 (7): 961–967. doi:10.1016/S0277-9536(98)00396-7. PMID 10192562