Lessons in CHW Recruitment and Retention: The Rise and Fall of the Barefoot Doctor in Rural China

Approximately half of China's population of 1.3 billion that live in rural areas have been significantly affected by the health care sector reforms that have been enacted since 2009. As the second phase of health reforms in China are being implemented, this paper critically assesses the current situation of the disappearing rural community health workers known as village doctors. Although, the integration of the predecessor of the village doctor, the barefoot doctor, into the rural health care system served as the model for  acheiving universal access to health care in the Declaration of Alma Ata, village doctors are now being disincentivized to continue in their practice. This situational analysis of rural community health workers is supported by semi-structured stakeholder interviews and a review of the literature. Comparative findings from multiple contexts concerning the successful recruitment and retentions of rural health care workers facilitate the development of recommendations for overcoming the current drug pricing policies that are serving to disincentivize village doctors.