Shanghai, China ? There are no official statistics tallying the toll in suffering, but by most accounts, after nearly two decades of neglect, China is confronting a rural health crisis on a monumental scale.

Up to 90 percent of the 800 million people in China’s countryside lack affordable medical care. Children go unvaccinated. AIDS patients can get free drugs, but can’t afford the monitoring and additional medicine they need.

“Most of the people in rural areas dare not to see a doctor when they get sick simply because they cannot afford it,” said Zhang Deyuan, an expert on rural problems at Anhui University. About 70 percent of China’s population of 1.3 billion receive less than 20 percent of spending on medical services, he said.

Communist leaders are now promising to rebuild a rural health care system that has fallen apart with the decline of farm cooperatives during two decades of economic reform.

It’s part of a package of policies to redress the huge gap between China’s fast-growing cities and the rural areas where protests over poverty and corruption are spreading. Such issues are expected to dominate the annual meeting of China’s parliament, opening today.

A plan issued last week by the Cabinet promises that by 2010, “farmers can expect safe, effective, convenient and low-cost health services,” with an extra $1.1 billion in new spending to guarantee treatment to anyone in the countryside, and a propaganda campaign featuring smiling farmers and heroic doctors is under way to lure city-trained physicians to rural posts.

The challenge is how to make the system work when even urban health services are underfunded and doctors make money by prescribing unneeded drugs and tests, said Ray Yip, director of the Beijing office of the U.S. Centers for Disease Control and Prevention. In China, he said, 60 percent of all medical spending is for drugs, compared with a world average of 10 to 12 percent.