International Journal of History

The emergence of the Barefoot Doctor system in Mainland China during the late 1960s was a product of complex historical, political, social, and economic developments. This study aims to explore the multifaceted background that led to the formation of this rural medical system and to clarify the factors that sustained it until the early 1980s. Methodologically, the paper adopts a historical-analytical approach, using official documents, government reports, and prior scholarly works to trace the institutional evolution of Chinese health administration from the late Qing Dynasty through the early People’s Republic of China. The results reveal four key factors influencing the rise of the Barefoot Doctors: first, the political trend toward the nationalization of health from the late Qing through the Republican era; second, the severe medical shortages and rural health crises following the establishment of the PRC; third, the economic and institutional foundation of the rural people’s commune system, which integrated politics and production to support collective health care; and fourth, Mao Zedong’s populist and revolutionary directives that redirected medical priorities toward rural areas. These elements collectively shaped a unique model of primary health care emphasizing prevention, mass participation, and low-cost, locally trained medical personnel. The conclusion highlights that the Barefoot Doctor system not only filled a critical gap in rural health services but also reflected the broader socialist vision of healthcare equity and community mobilization. Despite its shortcomings in medical standardization and sustainability, the model significantly influenced China’s later rural health reforms and global public health paradigms.