Communicable disease control in China: From Mao to now

Hipgrave, David

Many barefoot doctors were selected from, functioned in the context of and were largely funded by local production brigades (roughly 1000-2000 people in a geographic area) or teams (200-400 people). These brigades had replaced the failed, larger communes established during the Great Leap years, and apart from their commitment to providing grain to the national coffers at fixed prices, were semi-autonomous. Other barefoot doctors were selected from among the urban youths who were "sent down" to the countryside, ill-equipped to farm but educated and literate enough to be trained in basic health care. As a result, and also because each brigade had variable financial capacity to fund its CMS, the quality of health care provided by the barefoot doctors (and an even more basic cadre of community health worker, the health aide, whose numbers added an additional 3.7 million to the community health workforce in 1970) varied widely (Figure 1 ). It also depended on the level and quality of training (which varied from one to six months in duration) and supervision. Some villages also benefited from physicians who had been sent down from the cities for ideological re-education but continued to provide health care, and also from oversight by the EPS team at county level (6, 12, 14) .