Primary health care in the People's Republic of China

Abstract

In scarcely more than 30 years, the People's Republic of China has progressed from limited health care available only to a privileged few to a countrywide system providing basic services to one fifth of the world's population. The author gives his impressions of the current situation, based on a recent visit.

PIP: There has been a marked improvement in the health status of China's 1 billion inhabitants during the last 20 years due to the government's decision to develop a primary health care (PHC) system rather than to promote a system of specialized health care for a small segment of the population. Chairman Mao emphasized that the major task of medical personnel was to provide care for workers, peasants, and military personnel. He advocated the use of both traditional and modern health care practices. During the cultural revolution medical training was sharply curtailed, but since 1977 medical training has been given a high priority. In recent years the major focus has been on providing PHC services for the workers in the cities and for the 80% of the population living in rural areas. At the present time there are 117 modern medical schools and 24 traditional schools. Even those enrolled at the modern schools receive some training in traditional medicine. Since 1977 modern medical training has been provided in a 5-year program, including a year of hospital internship. Students enter medical school immediately upon graduation from high school and must pass competitive exams prior to acceptance. The top members of the medical class are provided with additional training and prepared for research and teaching posions. The students in the lower portion of the class are assigned to rural areas and provincial hospitals upon graduation. Traditional medical school; emphasize preventive and promotive health care. Currently, health services are provided by 360,000 modern doctors, 250,000 traditionally trained physicians, 420,000 middle doctors, 1.6 million barefoot doctors, 400,000 nurses, 120,000 herbalists, and 70,000 midwives. Barefoot doctors are individuals elected by their fellow workers to receive training primarily in preventive heath care. Following training they serve as health educators for their follow workers. Middle doctors have varied training ranging from 6 months to several years and work primarily in urban or factory clinics. The progress made in the provision of PHC is evidenced in the increase in life expectancy from 35 years to 60-62 years during the last 3 decades. During this same period, infant mortality decreased from 11.76-1.035% and the maternal death rate decreased from 0.7-0.015%.