barefoot doctors

In 1958, during the Great Leap Forward, health care was organized in health stations at the commune level, which employed peasants to work as part-time doctors. In 1965 Chairman Mao was concerned that the large peasant population had no access to medical services. Urban doctors were sent out to rural areas, where many trained paramedics. These ‘barefoot doctors’ were given a three-month training and a comprehensive manual was developed for their use. They worked part-time in agriculture (hence their name) and part-time in health care, receiving payment similar to other peasants. It was the village collective which ran and financed clinics and paid doctors’ salaries. Consistent with the basic guidelines of the First National Congress, the emphasis was on preventative medicine and the integration of traditional and Western medicine. The services included health education, immunizations, communicable disease reporting and basic medical care. The almost universal access to health with its emphasis on prevention (with the improvement of social conditions and stability after decades of war) contributed to vast reductions in mortality and morbidity.

In the 1980s the financing of, along with the popular and political support for, the cooperative medical system diminished. Although the basic tenets of health care policy were retained, after 1978, the economic reforms affected the financing and running of the health services.

An examination was established for all barefoot doctors and all those who passed became ‘township doctors’ who could charge for services. Some moved to more lucrative jobs, some moved into other areas of health care and others who failed examinations returned to agriculture.

It is very difficult to generalize for the whole of China as to what became of the 1.8 million barefoot doctors, but the system as it was no longer exists. The health bureau is responsible for provision of health care services at all levels and patients pay for their medication and hospital care. Immunizations and preventative health are organized by the Centres for Epidemic and TB Control. Private clinics and medicine shops also provide much of the health care. With the loss of the barefoot doctor, achieving universal accessibility to health care continues to present a major challenge.

Further reading

Zhu, Naisu et al. (1989). ‘Factors Associated with the Decline of the Cooperative Medical System and Barefoot Doctors in China’. Bulletin of the World Health Organisation 67.4:431–41.

Shi, Leiyu (1993). ‘Health Care in China: a Rural-Urban Comparison after the Socio-economic Reforms’. Bulletin of the World Health Organisation 71.6:723–36.

MARION TORRANCE