currently practicing in rural china began their training as barefoot doctors. this includes chen zhu, china's former minister of health, who practiced as a barefoot doctor for five years before going on to receive additional training. the barefoot doctor system was abolished in 1981 with the rise of deng xiaoping and the end of the commune system of agricultural cooperatives. the new economic policy in china promoted a shift from collectivism to individual production by the family unit. the barefoot doctor model officially ended during the chinese medical reformation of 1985, when the term 'barefoot doctor' was removed from the healthcare system and replaced with the term and concept of 'village doctors'. this shift caused a privatization of the medical system, which marginalized barefoot doctors and their focus on preventive medicine and primary healthcare. the barefoot doctors were given the option to take a national exam, if they passed they became village doctors, if not they would become village health aides. some village doctors later entered medical school. soon after the barefoot doctor system came to an end, in the years between 1977 and 1989, village doctors began charging patients for their services. because of the new economic incentives, they began to shift their focus to treatment of chronic conditions rather than preventative care. by 1984, village rcms coverage had dropped from 90% to 4.8%. without the public-service oriented work of barefoot doctors, "health-care crises of peasants substantially increased after the system broke down in the 1980s." with health care privatization, the central government played an increasingly smaller role in the national healthcare. most importantly, the central government began contributing less funds to healthcare, placing the responsibility on local governments. these individual, local governments had to collect funds through taxation, which led to imbalances between areas with wealthy and poor citizens. new healthcare systems in 1989 the chinese government tried to restore a cooperative healthcare system in the rural provinces by launching a nationwide primary healthcare program. this effort increased coverage up to 10% by 1993. in 1994 the government established a program to reestablish primary healthcare coverage for the rural population, but the efforts remain largely unsuccessful due to the market-oriented nature of healthcare. eventually, the severe acute respiratory syndrome epidemic exposed the struggles of china's healthcare system and drove the government to reinvent the medical system to prevent any future epidemics. in 2003 the chinese government proposed a new cooperative medical system, known as the new rural cooperative medical scheme, that is operated and funded by the government. this program is run more like an insurance program. by 2010, over 90% of rural chinese residents received healthcare through nrcms. it pays 10 renminbi to 20 renminbi (sources disagree) per year for each person covered by the program, and ensures coverage for serious diseases. households themselves also contribute a fee of 10 renminbi. this new program relies heavily on lessons learned from the times of the barefoot doctors, but faces many challenges in providing sufficient, cost-effective care for china's rural populations. currently, the rural population in china attempts to migrate to urban areas to seek better healthcare, which is becoming increasingly limited due to growing costs. outcomes and reception results the work of the barefoot doctors effectively reduced healthcare costs in the people's republic of china, and provided primary care treatment to the rural farming population. the world health organization (who) regarded rcms as a "successful example of solving shortages of medical services in rural areas". china's entrance into the united nations (un) and who, raised the visibility of the barefoot doctors' effectiveness of providing primary healthcare at an affordable cost. moreover, the success of the barefoot doctor model demonstrates that many diseases in poor countries can be prevented and solved without significant financial resources or technological transformation. instead, both zhang and unschuld (2008) and cueto (2004) show that the barefoot doctor system exemplifies that adequate political focus on support of rural-based and non-commercial forms of preventive healthcare and primary care treatments can change the health landscape of a nation. according to research by hu (1975), the barefoot doctor system increased the ratio of doctors to rural residents from 1: 8000 before the cultural revolution to 1: 760 between 1969 and mid-1974. public health improvements attributed to the barefoot doctor system are numerous. nationwide, chinese citizens were living longer, with an " of 35 to 68 years" and infants were more likely to survive, with an infant mortality drop "from 200 to 34 deaths per 1000 live births". through such significant improvements, the state of china's public health was nearing that of more western countries toward the end of the barefoot doctor era. the main health issues of chinese citizen became "more chronic conditions" that came along with the new longer life expectancy, such as heart disease, rather than "infectious diseases" and preventable illnesses, which were instead minimized through the new healthcare structure. how much of this can be attributed to the barefoot doctors themselves is difficult to establish, but, at least in rural areas, they certainly played a role. historical legacy photo from 1978 conference on primary health care in alma-ata, kazakhstan the system of barefoot doctors was one of the inspirations for the world health organization (who) conference, according to the who itself (2008) and lee and kim (2018). the conference occurred in partnership with unicef and took place in alma-ata, kazakhstan in 1978. there, the alma ata declaration (otherwise known as the primary health care initiative), which lauded the benefits of primary care, as seen in the barefoot doctor system, was signed unanimously. this was hailed as a revolutionary breakthrough in international health ideology - it called for local communities participating in deciding healthcare priorities, called for an emphasis on primary and preventive healthcare, and most importantly sought to link medicine with trade, economics, industry, rural politics and other political and social areas. the resurgence of interest in preventive medicine, primary healthcare, and holistic approaches to social welfare worldwide is leading to positive revisitations of the legacy of barefoot doctors. political restrictions against discussion of the cultural revolution in china, however, limit the extent of this debate in china itself. international development with ngos mapd's logo in 1977, jean-pierre willem created an international humanitarian apolitical non-governmental organization of doctors called médecins aux pieds nus (mapd) in france. the name of the organization means "barefoot doctors", an homage to the barefoot doctors of china. volunteers work in burundi, colombia and southeast asia with local healers to develop "medical garden" for herbalism and make essential oils for gemmotherapy. in 1999, jean-claude rodet became the first president of médecins aux pieds nus canada working with mark smith in the united states. this ngo leads ethnobiological missions based on "proximity, prevention and humility".