China's village doctors take great strides

Abstract

China's barefoot doctors were a major inspiration to the primary health care movement leading up to the conference in Alma-Ata, in the former Soviet Republic of Kazakhstan in 1978. These health workers lived in the community they served, focused on prevention rather than cures while combining western and traditional medicines to educate people and provide basic treatment. Dr Philip Lee, then a professor of social medicine at the University of California in San Francisco, wrote glowingly in the Western Journal of Medicine about China's primary health care system after visiting the country in 1973 as part of a United States of America (USA) medical delegation. He said prior to the founding of the People's Republic of China in 1949, epidemics, infectious disease and poor sanitation were widespread. picture today is dramatically different ... there has been a pronounced decline in the death rate, particularly infant mortality. Major epidemic diseases have been controlled ... nutritional status has been improved [and] massive campaigns of health education and environmental sanitation have been carried out. Large numbers of health workers have been trained, and a system has been developed that provides some health service for the great majority of the people. [ILLUSTRATION OMITTED] Dr Zhang Zhaoyang, the deputy director general of China's Department of Rural Health Management, says the barefoot doctor scheme had a profound influence on the Declaration of Alma-Ata. research in the 1970s found problems relating to the health-cost burden and unequal distribution of health resources. To try to solve the inequality, it did research in nine countries, including four cooperation centres in China. China's experience inspired WHO to launch the health for all by 2000 programme. Zhang says the barefoot doctor scheme, initiated by central government but largely administered locally, had its origins in the 1950s. name barefoot doctor became popular in late 1960s after an editorial in the People's Daily by Chairman Mao in 1968, he says. name 'barefoot doctor' originated in Shanghai because farmers in the south were often barefoot working in the paddy field. But China's village doctors had been there long before. In 1951, the central government declared basic health care should be provided by health workers and epidemic prevention staff in villages. In 1957, there were already more than 200 000 village doctors across the nation, enabling farmers to receive basic health care at home and work every day. The barefoot doctor scheme was simply the reform of medical education in the 1960s. In areas lacking medicine or doctors, village doctors could go through short-term training--three months, six months, a year--before returning to their villages to farm and practise medicine. Zhang says the scheme has evolved over the decades, though the term barefoot doctor is no longer used. scheme has never stopped. In the early 1980s, the State Council (the Central People's Government, the highest executive organ in China) directed that barefoot doctors, after passing an examination, could qualify as a 'village doctor'. Those who failed would be health workers and practise under the guidance of the village doctors. The village doctors and rural health workers still undertake the most primary health work--prevention, education, maternal and child health care, collecting disease information. The quality of [care provided by] rural doctors keeps increasing in line with social and economic development. Dr Liu Xingzhu, the programme director at the Fogarty International Centre at the National Institutes of Health in the USA, was a barefoot doctor from 1975-1977. Aged 19, his senior secondary school classes were interrupted during the Cultural Revolution drive to equip people with practical skills. county's health bureau organized medical training in my school and provided free accommodation and food. …