CUBA'S HEALTH SYSTEM
A great accomplishment of the Revolution has been health care, which is free to every citizen by right. No country has achieved such remarkable success in such a short period of time.
Basic health indicators are head and shoulders above the norms of most countries. According to UNICEF, the infant mortality rate in Cuba fell from 60 deaths per thousand in 1958 to 5.9 in 2006 (better than the USA which is at 6.3). That accomplishment is even more remarkable given that the country has a per capita gross domestic product lower than any other Latin American nation and less than a twentieth of that of the US. In fact, infant mortality continued to fall even during the privations of the special p
eriod. Average life expectancy is 75 years, far ahead of the third world average of 57.
Since the Revolution Cuba has developed a world class health system that achieves developed country demographic indicators, on a fraction of the budget and despite suffering more than 50 years of blockade.The Cuban health system focusses on health promotion and primary care in the community rather than relying on medicine alone, partly in response to having limited access to many of the medicines on the world market due to the US blockade. All doctors train to become primary care and community practitioners first; further specialisation comes later.
By locating family doctors in neighbourhoods and emphasising disease prevention, the health system – universal and free at all levels – makes care accessible and keeps people as healthy as possible, as long as possible, saving resources for more expensive treatments and interventions in the process. There is an impressive layered system of health care delivery from "consultorios" (small family clinics) to polyclinics (local medical centres), to hospitals and national research institutes. Family physicians and medical services are readily available from one end of the island to the other.
“If the accomplishments of Cuba could be reproduced across a broad range of poor and middle-income countries the health of the world's population would be transformed” the Lancet Journal said in 2014.
Health statistics
Cuba has the hightest ratio of doctors to patients in the world at 6.7 per 1,000 people
Life expectancy 80.45 years for women and 76.50 years for men
The 2014 infant mortality was 4.2 per 1,000 live births - one of the best in the world
World leading health research
In 2015, the World Health Organisation reported that Cuba had become the first country to eliminate mother-to-child transmission of HIV and syphilis
Cuba has developed a lung cancer vaccine, CimaVax, which is currently undergoing further research
Cuba has produced effective vaccines for cholera, malaria, meningitis B, hepatitis B and many more
Acknowledgement, Cuba-solidarity website
LESSONS LEARNED ABOUT SOCIAL SERVICES IN CUBA
Extract from the US National Association of Social Workers (NASW) report on two professional research trips to Cuba in early 2011
Through site visits and other interactions with Cuban colleagues, the NASW delegates were able to observe some of the strengths of the Cuban social service system:
- Promotion of biopsychosocial well-being through the systemic integration of health care and social services
- Promotion of family relationships and community connectedness
- Public health, prevention-oriented approach to health care delivery
- Availability of health care and social services regardless of ability to pay and employment or family status
- Neighbourhood-level network of health and social service programs that foster interaction among community members and accessibility of services
- Use of data on prevalence of disease, disabilities, and social conditions to plan and implement health care and social service programs
- Social welfare policy that supports pregnant and parenting women
- Community-based, outpatient programs that provide family-centered health care for children with special needs
- High esteem for elders, who give and receive strong family and community support
- Interdisciplinary gerontological assessment and community-based intervention for elders who are at risk for isolation and disability
- Promotion of resilience, social engagement, lifelong learning, creative expression, cognitive health, and participant decision making in programs serving older adults
- Widespread integration of social workers in health care and social service programs
Some of these characteristics reinforce directions in which the United States is moving; others may provide guidance to the United States as it struggles to meet increasing health care and social service needs with increasingly limited resources. The strengths of the Cuban system do not negate the challenges the country faces—some similar to the United States, some different— in providing social services to a diverse population.
Nonetheless, many individuals whom the delegates met during site visits exhibited an appreciation for their lives and a positive energy related to the activities in which they were involved.
WEST AFRICA NEEDS WHAT CUBA HAS: A WELL-TRAINED, COORDINATED HEALTHCARE SYSTEM. ANYTHING LESS AND EBOLA WINS SAYS CONNER GORRY
This article originally appeared in the Guardian | Thursday, 23 October 2014 | Click here for original article
Guatemala, Pakistan, Indonesia, Haiti. Four different nations that share a common experience: in the past decade, they were all struck by natural disasters which overwhelmed their under-staffed and under-funded public health systems. Into the rubble, flooding, and chaos of these distinct cultures and contexts, Cuba dispatched a specialised disaster and epidemic control team to support local health providers. It was a story of unprecedented medical solidarity by a developing country which few media outlets picked up - until now.
The Henry Reeve Brigade, as it’s known, was established in 2005 by more than 1,500 Cuban health professionals trained in disaster medicine and infectious disease containment; built on 40 years of medical aid experience, the volunteer team was outfitted with essential medicines and equipment and prepared to deploy to US regions ravaged by Hurricane Katrina (the offer was rejected by the Bush administration). Today, Cuba’s Henry Reeve Brigade is the largest medical team on the ground in west Africa battling Ebola.
The small island nation has pledged 461 doctors and nurses to provide care in Sierra Leone, Guinea and Liberia, the largest single-country offer of healthcare workers to date. While United Nations Secretary-General Ban Ki-moon decried the pallid aid commitment from around the globe calling for “a 20-fold resource mobilisation and at least a 20-fold surge in assistance” Cuba already had 165 of these specially-trained healthcare workers on the ground in Sierra Leone. Each of these volunteers, chosen from a pool of 15,000 candidates who stepped forward to serve in west Africa, has extensive disaster response experience.
Nevertheless, preparation for this mission required additional, rigorous training at Havana’s Pedro Kourí Institute of Tropical Medicine with biosecurity experts from the United States and the Pan American Health Organisation. This rapid mobilisation of sorely-needed health professionals begs the question: how can a poor developing country spare qualified, experienced doctors and nurses?
By pursuing a robust medical education strategy, coupled with a preventive, community-based approach, Cuba, a country of just 11.2 million inhabitants, has achieved a health picture on par with the world’s most developed nations. This didn’t happen overnight. Rather, Cuba’s admirable health report card results from decades of honing a strategy designed specifically for a resource-scarce setting.
By locating primary care doctors in neighbourhoods and emphasising disease prevention, the health system - which is universal and free at the primary, secondary and tertiary levels - makes care accessible and keeps people as healthy as possible, as long as possible, saving resources for more expensive treatments and interventions in the process.
But prevention and health promotion by community-based healthcare workers are only part of the story. Cuba’s policies and practices, both at home and abroad (currently more than 50,000 Cuban health professionals are serving in 66 countries) are built on several principles proven effective in resource-scarce settings.
First, coordinating health policies at the local, regional, and national levels is essential; this is particularly important where infectious diseases are concerned since uniform protocols are integral to containment.
Next, health initiatives must be cross-sectoral and based on integrated messages and actions. A fragmented, uncoordinated response by and among different agencies can prove dangerous and even deadly. This was tragically illustrated by the death of Thomas Eric Duncan in Dallas and the US Centers for Disease Control allowing a nurse who has Ebola to travel on a commercial flight.
Finally, infectious disease outbreaks must be addressed quickly - easier said than done in poor settings, where public health systems are already strained or collapsing already.
The Ebola outbreak snaps the need for Cuba’s approach into sharp relief: only a coordinated response, provided by well-trained and - equipped primary healthcare professionals will contain this - and future - epidemics. Indeed, policymakers such as World Health Organisation’s Margaret Chan and US secretary of state John Kerry have lauded the Cuban response, underscoring the importance of collaboration as the only solution to this global health crisis.
Forging this solution, however, requires harnessing the political will across borders and agencies to marshal resources and know-how. Havana took up the challenge by hosting a special Summit on Ebola with its regional partners and global health authorities on 20 October. Noticeably absent were US health representatives; if we’re to construct a comprehensive, integrated, and effective global response, all resources and experiences must be coordinated and brought to bear, regardless of political differences. Anything less and Ebola wins.
Acknowledgement, Cuba-solidarity website