Before the communist revolution of 1949, China had a scarcity of doctors to treat its expanding population. There were an estimated 40,000 doctors serving a population of about 540 million people. Most of these doctors worked in urban areas. As a result, there was an increase in illness and disease in many rural areas. One such disease was the snail transmitted schistosomiasis, which can be contracted while wading in the water of swamps and rivers. By orders of Chairman Mao Zedong of the Chinese Communist Party, health workers were dispatched to rural areas of the country.
The health workers who were dispatched achieved some success in halting the spread of schistosomiasis and claimed to have examined 2.8 million peasants in the year 1958 alone. They also coupled their interventions with the building of latrines and rolling out sanitation programs.
Where Did the Health Workers Come From?
By 1965, when the Communist revolution was struggling, Mao still pushed for aggressive health and medical programs to be rolled out in rural China. As a result, rural men and women in their 20s and individuals with a high school education were enrolled into a three to six month course in elementary medical training in county or community hospitals. These trainees were taught anatomy, bacteriology, disease diagnosis, acupuncture, prescribing conventional and Western medicines, birth control, and maternal and infant care. After they finished the training they became what was called a “barefoot doctor”. Their core mission was focused more on disease prevention, not curing diseases, according to a World Health Organization (WHO) report.
The term "barefoot doctor" originated in Shanghai in the late 1960s, supposedly because farmers in South China worked barefoot in paddy fields. Even after being designated as barefoot doctors, the trainees continued farm work in the communal fields along their rural peers. However, they also could respond quickly to those in illness related distress. The barefoot doctors also provided basic health care like first aid, as well as immunizations against diseases like diphtheria, whooping cough, and measles. Their work also included teaching their fellow villagers health education and hygiene, like hand washing prior to meals and after visiting the latrines. The illnesses that were beyond the scope of training of the barefoot doctors were referred to doctors in communal health centers.
By 1965, the program had placed an estimated 1 million barefoot doctors around China. In the 1970s its success even caused WHO, a few developing countries, and the Soviet Union to consider China’s barefoot program as an alternative to Western styled health care. They viewed this model as a plausible and cost effective option to delivering health care to rural populations.
Lack of funding from the Chinese central government led to the collapse of the barefoot program in the 1980s and 1990s. Also the new system of capitalism encouraged farmers to pay for their health care. Western critics claimed the barefoot doctor program could not be deemed a success due to lack of credible data. However, the Communist Party declared it a success for the reason alone that it had helped to counter schistosomiasis.