Twenty-First Century Barefoot Doctor: Good Quality Primary Healthcare at Affordable Cost


Established in the 1960’s, China’s “barefoot doctors” (akin to community health workers) produced major health gains at very low costs and provided everyone affordable access to primary health care (PHC). A core characteristic of barefoot doctors was that they were an integral part of the community and trusted by the community. A modernized barefoot doctor system that leverages big biomedical data and novel machine learning methods—“21st-century barefoot doctors” (21BFD)—holds promises for providing high quality PHC that people trust. Under a 21BFD system, PHC providers at the grassroots level would be supported by clinical decision support systems to enable them to make accurate diagnoses and timely referral, and achieve effective management and treatment.


The primary objective is to design a pilot model of the “21st-century barefoot doctors” (21BFD) system that can be evaluated and scaled up.

Research Activities

The primary research is to design, implement, and evaluate a social experiment in a integrated delivery system centered on primary care. Primary health care providers serve as gatekeepers and focus on prevention, health promotion, and disease management, and their competency will be enhanced by an artificial intelligence enabled clinical decision support (CDS) system. We will design a combination of financial and non-financial incentives, organizational changes, management information system, and management and governance mechanisms to improve quality and efficiency of care and coordination of services across primary, secondary and tertiary services. We ultimately aim to develop a smart CDS system that will enable 21BFDs to make accurate diagnoses, deliver effective treatment for common health conditions, issue timely referrals to hospitals for more complicated health conditions, and provide health promotion and disease management for non-communicable diseases. At the end of the project, we expect to have a prototype of 21BFD model designed to improve quality of PHC, targeting rural areas and LMICs settings.

Partners and Funding

The 21BFD project requires collaboration across big-data science, health system/policy science, and clinical science. Our team includes faculty from the Harvard T.H. Chan School of Public Health, Departments of Global Health and Population, Biostatistics, and Epidemiology; and Harvard Medical School.