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Prescribing medicine, providing contraception, delivering babies – although we may turn to physicians, rural Rajasthani women turn to Barefoot Doctors out of necessity. Such care is available courtesy of the Barefoot College, a pioneering NGO that transforms the skills of the illiterate poor into local infrastructure. Barefoot Doctors are innovative because of their origins as dais (traditional midwives); once abundant across South Asia, dais are mostly extinct due to government/NGO interventions emphasizing “modernity”, like the Accredited Social Health Activist program. Why, then, have dais survived as Barefoot Doctors when they are extinct elsewhere? Ecological niche differentiation refers to when competing species successfully coexist; one species adapts to fulfill another role. Using over fifty interviews with stakeholders, I explain the persistence of Barefoot Doctors as health resources using “professional niche differentiation”. Barefoot Doctors exemplify how health infrastructure can be sustainable in resource-poor settings when created according to local needs and ideologies.

Professional Niche Differentiation: Understanding Dai (Traditional Midwife) Survival in Rural Rajasthan