Barefoot doctors

The concept of “barefoot doctors” originated in China. Although the barefoot doctors programme was institutionalised after 1965, following Chairman Mao’s healthcare speech, and subsequently integrated into national policy, barefoot doctors had been around for a few decades before then.

What are, or were, barefoot doctors? According to Wikipedia, these were “farmers, folk healers, rural healthcare providers, and middle or secondary school graduates who received minimal basic medical and paramedical training and worked in rural villages in China. Their purpose was to bring healthcare to rural areas where urban-trained doctors would not settle. They promoted basic hygiene, preventive healthcare and family planning, and treated common illnesses…. Barefoot doctors continued to introduce Western medicine to rural areas by merging it with Chinese medicine. With the onset of market-oriented reforms after the Cultural Revolution, political support for barefoot doctors dissipated, and healthcare crises of peasants substantially increased after the system broke down in the 1980’s”.

Indeed, the success of the Chinese barefoot doctors’ programme was part of the inspiration behind the World Health Organisation (WHO) and its member countries adopting the Alma Ata Declaration (or Primary Health Care Initiative) in 1978.

It is clear that, particularly for emerging and poor nations, a programme of barefoot doctors can radically change the health and mortality outcomes for a nation. The programme could be further enhanced with Cuban-style home visits.

A policy and system of barefoot doctors can address a number of issues for a nation, such as:

·      Rapid production of primary healthcare providers.

·      Cost-effectiveness at the training level.

·      Cost-effectiveness at the provision level.

·      Assistance with adherence to treatment regimens for debilitating illnesses, including HIV-AIDS, diabetes, TB, etc.

·      Rapid improvement of the health status of the poorer sections of the population.

·      Reduction of unemployment in poorer areas such as rural areas, townships and informal settlements.

The need, and potential benefits, of barefoot doctors, are particularly apparent during a pandemic such as Covid-19. If a country like South Africa had barefoot doctors, the response (and outcomes) to Covid-19 would have been radically different. Not only the population as a whole would have been better mobilised, the healthcare system would have had people in closer proximity to communities in townships, informal settlements and rural areas to immediately inform and encourage adherence to health guidelines such as hand-washing, social distancing, mask-wearing, and undertaking testing.

Given the experience of the lack of preparedness for Covid-19, it is perhaps time to consider a strategy to deal with emerging and future health crises and pandemics. In this regard, a system of barefoot doctors would greatly enhance the country’s preparedness, while being beneficial on an ongoing basis.