BAREFOOT
DOCTORS
A barefoot
doctor performs acupuncture on a man
In China as part of a coordinated system, and there had been
provincial experiments after 1949, but after In his speech, Mao
Zedong criticized the urban bias of the
medical system of the time, and called for a system with greater focus on the
well being of the rural population.
China’s health policy changed quickly after this speech and
in 1968, the barefoot doctors program became integrated into national policy.
These programs were called “rural cooperative medical
systems” (RCMS) and strove to include community participation with the rural
provision of health services.
This funding came from collective welfare funds as well as
from local farmer contributions (from 0.5% to 2% of their annual incomes).
This program was successful in part because the doctors were
selected and paid by their own villages. By the 1960s, there were RCMS programs
in 90% of China's rural villages.[1]
The World Health Organization regarded RCMS as a “successful
example of solving shortages or medical services in rural areas”.
End of barefoot doctors in
China
Two-thirds of the village doctors currently practicing in
rural China began their training as barefoot doctors.[4] This includes Chen Zhu, China’s current Minister of Health,
who practiced as a barefoot doctor for five years before going on to receive
additional training.[4]
The barefoot doctor system was abolished in 1981 with the
end of the commune system of agricultural cooperatives. The new economic policy
in China promoted a shift from collectivism to individual production by the
family unit.[3] This shift caused a privatization of the medical system,
which could not sustain the barefoot doctors.[3] The barefoot doctors were given the option to take a
national exam, if they passed they became village doctors, if not they would be
village health aides. Village doctors began charging patients for their services,[3] and because of the new economic incentives,[1] they began to shift their focus to treatment of chronic
conditions rather than preventative care.[1]
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]
In 2003 the Chinese government proposed a new cooperative
medical system that is operated and funded by the government.[1] This program is run more like an insurance program.[2] It pays 10 Renminbi per year for each person covered by the
program, and by ensuring coverage for serious diseases.[1] This new program relies heavily on lessons learned from the
times of the barefoot doctors, but faces many challenges in providing
sufficient, cost-effective care for China’s rural populations.[1]
Historical legacy
The system of barefoot doctors was among the most important
inspirations for the WHO
conference in Alma Ata,
Kazakhstan in 1978 where the Alma Ata Declaration was signed unanimously. This was hailed as a revolutionary
breakthrough in international health ideology - it called for local communities
participating in deciding health care priorities, called for an emphasis on primary health care
and preventive medicine,
and most importantly sought to link medicine with trade, economics, industry,
rural politics and other political and social areas.
International development
with NGOs
In 1977, Jean-Pierre Willem
created an international humanitarian apolitical NGO
of doctors called Medecins Aux Pieds Nus in France.
Volunteers work in Burundi, Colombia
and Southeast Asia with local healers to develop "medical garden" for
herbalism and make essential oils for gemmotherapy.
In 1999, Jean-Claude
Rodet became the first president of
Medecins Aux Pieds Nus Canada
working with Mark Smith
in United States.
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