China's Barefoot Doctor program is undergoing significant change. Since 1977, the numbers have declined from 1,760,000 to 1,575,000, with 185,000 dismissed as incompetent or leaving for other reasons. Standards for training are rising with increased emphasis on medical work; a two-level system of examinations has been instituted. The Ministry of Health was willing and able to increase enrollments in medical schools, shorten medical education to a certain extent, and increase the physician manpower supply in this manner. But it wanted to do so in a way that maintained certain standards for medical education and medical practice. Medical work responsibility fell into several categories: overseeing environmental sanitation, rehabilitative care for discharged patients, immunization programs of various sorts, and the treatment of minor or common illnesses like colds, fever, eye infections, digestive tract and upper respiratory tract diseases, influenza, parasitic disease, and minute sprains and injuries.