Tenth International Conference on Health, Wellness & Society

Abstract

China made remarkable progress in strengthening its primary healthcare system in rural areas before 1978. Its barefoot doctor system was acclaimed worldwide for providing inexpensive and equally accessible medical care for rural populations. This model became internationally renowned in public health and health development circles and served as the inspiration of the World Health Organization’s Primary Healthcare Initiative. In the early to mid-1980’s, with the advent of post-Mao political and economic transition, specifically rural de-collectivization, the barefoot doctor system came to an end. Many barefoot doctors either became private doctors or gave up medical practice. It was feared that the fate of rural health care in China was seriously threatened. This paper, the first in a series on the history and development of the Chinese healthcare system, examines the role of health governance in shaping the primary healthcare delivery system in China from the before 1978. Several key points about the practice of rural primary health care under both Nationalist and Communist regimes are addressed, including their relative emphasis on primary care versus curing and secondary and tertiary care, relative emphasis on traditional Chinese versus Western medicine, training and professionalization of village health practitioners, structure and function of the rural three-tiered healthcare system and the Cooperative Medical Scheme. The objectives of this paper are to explore the broader social and political factors driving the development of this important part of the healthcare system and how this development created a foundation for more recent efforts to modernize the Chinese healthcare system.