Off the Cuff: 21st-Century Barefoot Doctors

Chi-Man (Winnie) Yip
Chi-Man (Winnie) Yip, Professor of the Practice of Global Health Policy and Economics

Fifty years ago, during the Cultural Revolution in China, a cadre of “barefoot doctors”—some 1.5 million peasants who received intensive three- to six-month training in anatomy, bacteriology, birth control, maternal and infant care, and other topics—were dispatched to provide basic health care for their rural communities. Even in the midst of the revolution’s social upheaval, this low-tech medical corps (named for the fact that many worked in their own rice paddy fields when they weren’t tending to their neighbors) was highly successful, significantly reducing infectious disease and boosting life expectancy. 

In the 1980s, with market reform, the barefoot doctor system came to an end. But the program served as a model and inspiration for the famous 1978 Alma-Ata Declaration on primary health care. Harvard Chan’s Chi-Man (Winnie) Yip, professor of the practice of global health policy and economics, believes the program continues to hold lessons for today.

“The barefoot doctor program was a low-cost strategy that achieved high health outcomes. Its core principle was to keep people healthy. And the program reached everybody—it was universal health care in its very core. Just as impressive, barefoot doctors were part of the community, understood the community, cared about the community, and were trusted by the community.

Today, many low- and middle-income nations are trying to build strong primary care systems that provide health promotion, disease prevention, accurate diagnosis, effective treatment, timely referral, and management of noncommunicable diseases—such as hypertension, diabetes, even some cancers and mental health problems. Unfortunately, lack of highly trained staff is a major bottleneck in building such systems.

My idea of a 21st-century barefoot doctor is someone with two to three years of training post–junior high school, who will be enabled with artificial intelligence and big-data-assisted decision support. Apps or web-based tools will use data analytics to prompt the doctors to ask the right questions, supply the likelihood of various diagnoses, and recommend treatment. It’s an algorithm decision tree, but supported by big-data analysis.

Twenty-first-century barefoot doctors will be most suitable in areas that are remote and rural and have older people left behind in the global wave of migration to cities. These doctors will need to be respected as the foundation of the health care system. They will also need to earn a decent income—although income alone is not what will keep them in their jobs. If 21st-century barefoot doctors become a reality, it could transform today’s treatment-centric health care systems into systems that keep people healthy—and at scale.”

Illustration: John Jay Cabuay