Presentation Health System In Cuba Version 3 2811


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  • Presentation Health System In Cuba Version 3 2811

    2. 2. ABSTRACT <ul><li>STATEMENT: </li></ul><ul><li>The Cuban Health system model is an efficient and equitable model with equal access to all its citizens. It is fully integrated and controlled directly by the government and its ministries. It has achieved its mission of reducing the health divide between socio-economic groups. The system is under constant evaluation to meet the needs of the population in the most cost-efficient manner, but has never strayed from its original focus. Although politically isolated, Cuba has generated new resources and withstood international pressure to devolve their system and introduce internal competition. The result has been the creation of new sources of revenue for the country, but not at the expense of health care delivery to the citizens. The World Bank has constantly endorsed and held the system up as the example for Latin American countries to follow. </li></ul>Health System in Cuba
    3. 3. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References
    4. 4. CONTENTS Health System in Cuba Background Health System Analysis Accomplishment Conclusion References
    5. 5. REPUBLIC OF CUBA Health System in Cuba <ul><li>Independence </li></ul><ul><li>1868: Declared from Spain </li></ul><ul><li>1902: Socialist Republic declared from US </li></ul><ul><li>1959: Cuban Revolution </li></ul><ul><li>Cuba is organized territorially into 14 provinces and 169 municipalities. </li></ul><ul><li>Population Density: 102/km² (97th worldwide) (Wikipedia contributors) </li></ul><ul><li>Human Development Index: 0.838 (51 st worldwide) (Wikipedia contributors) </li></ul>
    6. 6. ECONOMIC INDICATORS Health System in Cuba % % % Indicators (%) 2007 GDP-real growth rate 9.5 Inflation rate 5.0 Unemployment 1.9
    7. 7. MILESTONES IN CUBAN HEALTH SYSTEM Health System in Cuba 1959 Cuban revolution <ul><li>Rural Health Service </li></ul><ul><li>Nationalize Health </li></ul><ul><li>Care </li></ul><ul><li>National Literacy </li></ul><ul><li>Campaign </li></ul><ul><li>National children’s </li></ul><ul><li>immunization </li></ul><ul><li>program </li></ul><ul><li>Abortion law </li></ul><ul><li>Establishment of </li></ul><ul><li>Polyclinics </li></ul><ul><li>National </li></ul><ul><li>comprehensive </li></ul><ul><li>health program </li></ul><ul><li>-maternal-child </li></ul><ul><li>health </li></ul><ul><li>-infectious diseases </li></ul><ul><li>-chronic diseases </li></ul><ul><li>-the elderly </li></ul><ul><li>Increase in health </li></ul><ul><li>professionals </li></ul><ul><li>New Public Health Law </li></ul><ul><li>Strengthen tertiary </li></ul><ul><li>facility and research </li></ul><ul><li>Biotechnology industry </li></ul><ul><li>Family Doctor </li></ul><ul><li>Program </li></ul><ul><li>Soviet partnership </li></ul><ul><li>collapse </li></ul><ul><li>Epidemic crisis </li></ul><ul><li>Tightening of US </li></ul><ul><li>embargo </li></ul><ul><li>Reorientation of the </li></ul><ul><li>health system </li></ul><ul><li>Development </li></ul><ul><li>traditional medicine </li></ul><ul><li>4 cooperate initiatives </li></ul><ul><li>- HIV-AIDS </li></ul><ul><li>- commitment to </li></ul><ul><li>Venezuela </li></ul><ul><li>- Vision restoration </li></ul><ul><li>program </li></ul><ul><li>- Disaster Response </li></ul><ul><li>Contingent </li></ul><ul><li>National networks in </li></ul><ul><li>- Health Registry </li></ul><ul><li>- Blood Banks </li></ul><ul><li>- Nephrology </li></ul><ul><li>- Medical Images </li></ul>
    8. 8. Health System in Cuba Everyone has the right to health protection and care HEALTH SYSTEM IN CUBA Levers GOAL Intermediate Goals Financial Resource Fully integrated system funded by general taxation with Low out of pocket payments Equity 99% accessibility in rural and urban Steward- ship National Health System Decentralization Service Provision Polyclinics Family Doctor Program Immunization Resource Allocation Allocated through national, provincial and municipal levels Efficiency 7.1%GDP for Universal coverage Responsiveness National Health Plan and Policy Effectiveness Infant mortality death rate Life expectancy
    9. 9. GLOBAL COMPARISON Health System in Cuba Source for Cuba indicators:  Annual Health Statistics Yearbook, 2006. National Health Statistics Bureau. Havana: 2007. Source for US indicators:  Health, United States, 2006. National Center for Health Statistics. Hyattsville, MD: 2006. UNITED STATES CUBA CARIBBEAN LATIN AMERICAN LIFE EXPECTANCY 77.6 77.8 69.3 77.3 PHYSICIANS (PER 10,000 INHABITANTS) 62.7 26.3 NA NA NURSES (PER 10,000 INHABITANTS) 78.9 79.5 NA NA % BIRTHS ATTENDED BY SKILLED HEALTH PERSONNEL 99.9 99 NA NA INFANT MORTALITY RATE (PER 1,000 LIVE BIRTHS) 5.3 6.8 22 22 UNDER 5 MORTALITY RATE (PER 1,000 LIVE BIRTHS) 8 8 33.4 27.7 MATERNAL MORTALITY RATE (PER 100,000 LIVE BIRTHS) 49.4 13.1 NA NA % OF ONE-YEAR OLDS IMMUNIZED WITH DPT3 99 96 NA NA DEATH DUE TO HIV/AIDS (PER 100,000 INHABITANTS ANNUALLY ) 1 5 NA NA GENERAL GOVERNMENT EXPENDITURE ON HEALTH AS % OF TOTAL GDP FOR 2004 87.8 44.7 NA NA
    10. 10. <ul><li>System is operating below its utility possibility frontier. Due to the significant stress exerted by the current political climate, breakdown in technical and allocative efficiency has resulted. Available health resources are being directed away from citizens (Cubanacan: Tourism & Health, Doctors for Oil exchange) in order to increase country’s monetary reserves. </li></ul><ul><li>The impact of sending doctors to other countries as a method of earning foreign money is having a negative impact on the provision of healthcare to the ordinary citizens. </li></ul><ul><li>With an increasing aging population, (12.7% of the population≥60+yrs) projected to increase to 21% by 2025 there is a serious threat to the economic sustainability of health and welfare systems. </li></ul><ul><li>The initial goals of the system (reduce infant mortality rate, control communicable diseases) were met but the rise of non-communicable diseases which are more costly to treat will present a serious threat to resource allocation over the next ten years. </li></ul><ul><li>Medical Tourism poses a threat to Cuban citizens receiving equitable health care i.e Cuban hospitals have dedicated wards for exclusive use by foreigners who pay cash. These wards have better facilities and are better equipped than the ones for the citizens. High ranking members of the Communist Party can use these hospitals for free. </li></ul>Health System in Cuba THREATS
    11. 11. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References
    12. 12. DEMOGRAPHICS Health System in Cuba Global Health Facts WHO Statistical Information System (WHOSIS) Diagram from Earth Trend Indicator 2007 Population 11,394,043 <ul><li>Urban </li></ul>76% <ul><li>Rural </li></ul>24% Growth Rate 0.27% Age range <ul><li><15 </li></ul>19% <ul><li>15-65 </li></ul>65% <ul><li>>65 </li></ul>16% Life Expectancy 77 (average) <ul><li>Male </li></ul>75 <ul><li>Female </li></ul>79
    13. 13. DEMOGRAPHIC Health System in Cuba Rate / 1,000 Year The World Health Organization gives Cuba’s single-payer healthcare system high marks in areas such as infant mortality. Global Health Facts WHO Statistical Information System (WHOSIS) Diagram from Earth Trend Indicator (per 1,000) 2007 Infant Mortality 6.04 Total Fertility Rate 1.6 Birth Rate 11.4
    14. 14. EPIDEMIOLOGICAL Health System in Cuba
    15. 15. EPIDEMIOLOGICAL Health System in Cuba (PAHO, 2007) DISEASES STRATEGY OUTCOME Cardiovascular disease and cancer <ul><li>Community base support </li></ul><ul><li>Door to needle time <30 min </li></ul><ul><li>ST elevation on electrocardiogram for all </li></ul><ul><li>patients </li></ul><ul><ul><li>Decreased but caused high % of deaths. </li></ul></ul>Infectious disease <ul><ul><li>High levels of community participation </li></ul></ul><ul><ul><li>Aggressive public health approach </li></ul></ul><ul><ul><li>Universal Immunization </li></ul></ul><ul><li>Immunization coverage: </li></ul><ul><li>99% for HBV, MCV, Polio; </li></ul><ul><li>93% DTP3 </li></ul><ul><li>Elimination: poliomyelitis, </li></ul><ul><li>diphtheria, measles; </li></ul><ul><li>Suppression: tuberculosis </li></ul><ul><li>meningitis, neonatal tetanus </li></ul>HIV/AIDS <ul><li>Studies of the highest risk groups </li></ul><ul><li>Epidemiological investigation of 100% cases </li></ul><ul><li>Analysis of hospital admission and outpatient </li></ul><ul><li>records since 1993 </li></ul><ul><li>Comprehensive program of health education </li></ul><ul><li>for general population </li></ul><ul><li>Decrease Prevalence 0.1% </li></ul><ul><li>(2007) </li></ul>Tuberculosis <ul><ul><li>Tuberculosis Prevention and Control </li></ul></ul><ul><ul><li>Program: improvements in detection and </li></ul></ul><ul><ul><li>diagnosis in the majority of the provinces </li></ul></ul><ul><li>Decrease Prevalence </li></ul><ul><li>10/100,000 (2006) </li></ul><ul><li>detection rate: 94%, success </li></ul><ul><li>treatment: 91% </li></ul>
    16. 16. POLITICAL <ul><li>February 2008; Raul Castro promised to make the government smaller and more efficient. ( Cuba’s Political Succession: From Fidel to Raúl Castro. ) </li></ul><ul><li>Cuba is NOT a member of the World Bank or the International Monetary Fund. Yet 2001 James Wolfensohn, president of the World Bank acknowledged that “Cuba has done a great job on education and health” (IPS 2001). </li></ul><ul><li>Health care and its’ indicators are viewed as measures of government efficiency. It has a prominent place in government policy making (Erickson et al . 2002). The Ministry of Public Health drafted a policy to ensure system sustainability and the efficient and equitable distribution of health care. </li></ul><ul><li>Provides neutral aid and support to disaster stricken countries as a form of international cooperation. </li></ul>Health System in Cuba
    17. 17. LEGAL AND REGULATORY Health System in Cuba <ul><li> Castro mandated that the State assure that there shall be “ sick person who does` `does not receive medical attention...” Cuba set up a comprehensive, unified public health system with no separation between providers and purchasers functions. </li></ul><ul><ul><li> Cuban law established a constitutional framework for the development of a comprehensive and universal program of health services. ( THE DEVELOPMENT OF THE CUBAN HEALTH CARE. ) </li></ul></ul><ul><li> </li></ul><ul><li>Pan American Health Organization, the World Bank and the Inter-American Development Bank establish strategy for the reform of Latin American health systems. Mandated the separation of provider and purchaser functions, the decentralisation of control and the entry of a private sector encouraging a free market to promote cost-efficiency. </li></ul><ul><li> </li></ul><ul><li> Cuba resisted and maintained its’ fully integrated system. Colombia, Chile and Argentina implemented the strategy. The result was an increase in the number of people with no access to health coverage. In 2000 46% of Colombia’s population was without coverage, an increase of 4.6% from 1997 with the poorest fifth of the population being even more adversely affected. </li></ul>1965 1976 2000 1990
    18. 18. ECONOMIC EFFECTS ON HEALTH SYSTEM Health System in Cuba 1991 Collapse of Soviet Union 35% drop in Cuba’s GDP Loss of approx. 80% of imports & exports. Along with food and medicines, 99% of the oil Cuba imported from the USSR. 1993 Government reforms health care policy to adjust to financial crisis; emphasis on first-line health care, 97% of medical students graduated as general practitioners, prevention, better drugs and emergency medicine. Cubanacan Health & Tourism Over 20,000 health tourists received treatments in 2006, at prices 80% less than US prices Doctors exchanged for $1bn subsidized oil from Venezuela annually. Est. 20,000 doctors working in Bolivia, China and Africa 2003 Drugs for Debt – Havana’s 1.9bn US dollar debt to Argentina will be reduced by 75% in exchange for drugs
    19. 19. ECONOMIC ADDITIONAL FUNDING Health System in Cuba <ul><li>Highly decentralized: 92.4% of expenditures are financed from municipal budgets. In turn financed from </li></ul><ul><li>the state budget. The state budget for the Ministry of Public Health was 7.1% of GDP in 2006. </li></ul><ul><li>Low out-of-pocket expenses , which are subsidized by State: prescriptions, glasses, hearing aids, dental </li></ul><ul><li>and orthopaedic apparatuses and wheelchairs. </li></ul><ul><li>PAHO/WHO, United Nations Population Fund, UNDP and UNICEF in addition to other international </li></ul><ul><li>organisations and NGOs lend and send grants. </li></ul>Total Health Expenditure (THE) as % of GDP (PAHO, 2007) % Year Private sector expenditure on health as % of THE General government expenditure on health as % of THE 90.7% 9.3% External Funding Agency Commitment (US$) PAHO/WHO 771,000.00 UNFPA 308,000.00 UNICEF 826,922.00 UNDP/UNAIDS 20,000.00 UNDP/Govt. of Japan 284,837.00 UNDP/AIDS 2,879,081.81 WFP 258,000.00 Grants 21,963,943.00 Total 27,311,783.81
    20. 20. SOCIO-CULTURAL Health System in Cuba WHO Statistics <ul><li>Cuba has the highest literacy rates of all Latin </li></ul><ul><li>American countries, in addition to the highest </li></ul><ul><li>educational attainment. Tertiary educational uptake, </li></ul><ul><li>particularly in science and technology, is equally high </li></ul><ul><li>as it is the most important socially and economically. </li></ul><ul><li>Focus on prevention of diseases through education </li></ul><ul><li>both in schools and polyclinics in the community. </li></ul><ul><li>Polyclinics deliver instant care. </li></ul><ul><li>The overall high tobacco consumption has led to high </li></ul><ul><li>percentage of malignant neoplasm, such as lung </li></ul><ul><li>cancer. </li></ul><ul><li>Cuba has instituted specific school programs that </li></ul><ul><li>encourage healthy lifestyles in the younger </li></ul><ul><li>generations. Leading to a general culture of </li></ul><ul><li>personal and public health protection, and a </li></ul><ul><li>decrease in HIV/AIDS rates. </li></ul><ul><li>The state is the main employer, since 1990 it has </li></ul><ul><li>dropped from 95% to 77% in 2000. 40% of the </li></ul><ul><li>population are employed in services, of which the </li></ul><ul><li>largest majority are employed by the health services </li></ul><ul><li>section. </li></ul>Indicators % Prevalence of current tobacco use among: <ul><li>13-15 year female </li></ul>9.5 (2004) <ul><li>13-15 year male </li></ul>10.9 (2004) <ul><li>>=15 year female </li></ul>28.3 (2005) <ul><li>>=15 year male </li></ul>43.4 (2005) Literacy rate in both sexes <ul><li>Adult </li></ul>97 (2002) <ul><li>Youth (15-24) </li></ul>100 (2002) Net primary school enrolment ratio 96.5 (2006) Population under poverty line 1 % (2006)
    21. 21. Health System in Cuba <ul><li>Climate : Sub-tropical, average temperature daily 25 C. Yearly range from 18 to 32C. </li></ul><ul><li> Average relative humidity 81%. </li></ul><ul><li> Driest month are Jan/Feb 38mm of rain, September is the wettest with 183mm </li></ul><ul><li>2 008. &quot;Basic data.&quot; Country Profile. Cuba : 3-3. Business Source Complete , EBSCO host (accessed November 30) </li></ul><ul><li>Agriculture : Even though environmental protection is constitutional, up until 1997 sugar cane farming and </li></ul><ul><li>other agricultural practices contributed a lot to pollution and soil damage. New reforms have steered the </li></ul><ul><li>country towards alternative energy sources and organic farming to contain level of pollutants affecting </li></ul><ul><li>citizens’ health. </li></ul><ul><li>Sanitation/Potable Water </li></ul><ul><li>Since the government took over in 1959, they increased the expenditure in water provision and sewage </li></ul><ul><li>programs in poor urban and rural areas. They also developed landfills for the efficient disposal of household </li></ul><ul><li>waste. </li></ul>ECOLOGICAL WHO Statistic 2006 <ul><li>Government Reaction to Hurricanes and Ecological Threats: The National Health System with the Civil </li></ul><ul><li>Defence System have been integrated, to create a concerted effort in responding to natural disasters </li></ul><ul><li>predominantly hurricanes, enhancing the country’s capacity for disaster management. These comprise of civil </li></ul><ul><li>defence workers and the public-at-large to ensure equitable and efficient distribution of medical and essential </li></ul><ul><li>supplies, equipment for disease prevention and aid, limiting the disruption/interruption in local services. In </li></ul><ul><li>particularly early evacuation of at-risk populations has resulted in fewer lives being lost. </li></ul>Population with sustainable access to Rural (%) Urban (%) Drinking water 78 95 Sanitation 95 98
    22. 22. TECHNOLOGICAL Health System in Cuba <ul><li>BREAKTHROUGHS IN THE TECHNOLOGY FIELD ARE ALL REVENUE GENERATORS FOR THE GOVERNMENT. </li></ul><ul><li>CENTER FOR GENETIC ENGINEERING AND BIOTECHNOLOGY, CUBA (CIGB): </li></ul><ul><li>The Cuban government initiated the growth of the Biotechnology industry and the development of the </li></ul><ul><li>education sector establishing a large base of scientific personnel and the research centre known as </li></ul><ul><li>CIGB in 1986. Subsequently there has been created a demand for biotechnology and developed </li></ul><ul><li>products. The research centre has also made significant breakthrough discoveries in vaccines against </li></ul><ul><li>diseases such as Hepatitis-B, Polio, Influenza, Prosthetic heart valve thrombosis, etc. (Mola E. et al.,2006). </li></ul><ul><li>Cuba is in the position to produce and sell its vaccines to less developed nations in Latin America, the </li></ul><ul><li>Caribbean Island and parts of Africa. </li></ul><ul><li>THE INFOMED INFRASTRUCTURE : </li></ul><ul><li>Key role in development and diffusion of Cuba’s health care services and products globally and internally. </li></ul><ul><li>Ensures Cuban doctors are up to date in training and therefore valuable resources. </li></ul><ul><li>OBJECTIVES OF INFOMED </li></ul><ul><ul><li>Facilitate electronic information access through the Virtual Health Library linked to provincial resources </li></ul></ul><ul><ul><li>as well as regional and international databases available on the Internet. </li></ul></ul><ul><ul><li>Continuing education for health care professionals through the Virtual University. </li></ul></ul><ul><ul><li>Support communication and create a virtual workspace linking health care institutions within Cuba and </li></ul></ul><ul><li>outside the country. </li></ul><ul><ul><li>To promote Cuban scientific research and publication in the field of health information science. </li></ul></ul><ul><ul><li>(Seror AC, 2006) </li></ul></ul>
    23. 23. TECHNOLOGICAL Health System in Cuba (Seror AC, 2006)
    24. 24. SUMMARY KEY DRIVER KEY CHANGE OPPORTUNITIES THREATS Demographics <ul><li>Increase Life Expectancy (77yrs) </li></ul><ul><li>Lower mortality rate </li></ul><ul><li>Improvement in social welfare, </li></ul><ul><li>quality of life </li></ul><ul><li>Strengthen functions of primary </li></ul><ul><li>care and elderly health care </li></ul><ul><li>Ageing population , resulting in </li></ul><ul><li>higher dependency rate on the </li></ul><ul><li>working population </li></ul>Epidemiological <ul><li>Reduction in infectious diseases </li></ul><ul><li>Implementation of universal </li></ul><ul><li>immunization program </li></ul><ul><li>This translates to more </li></ul><ul><li>international recognition by other </li></ul><ul><li>countries and organisations </li></ul><ul><li>Increase in chronic diseases </li></ul><ul><li>Increase in diabetes due to high </li></ul><ul><li>level of obesity </li></ul>Political <ul><li>Collapse of Soviet Union . </li></ul><ul><li>Imposition of US Embargo. </li></ul><ul><li>Remains communist under Raul </li></ul><ul><li>Castro 2006. </li></ul><ul><li>More open to negotiate with US to </li></ul><ul><li>end the economic embargo </li></ul><ul><li>Quicker passing of laws and acts </li></ul><ul><li>(especially as it relates to Health) </li></ul><ul><li>Still regarded as a terrorist nation? </li></ul><ul><li>Does not enjoy the rewards for its - </li></ul><ul><li>health efforts as a result of </li></ul><ul><li>alienation by developed nations. </li></ul>Legal and regulatory environment <ul><li>Establishment of a constitutional </li></ul><ul><li>framework for the development of </li></ul><ul><li>a comprehensive and universal </li></ul><ul><li>program </li></ul><ul><li>Free healthcare at point of delivery </li></ul><ul><li>Easily accessible by all </li></ul><ul><li>Expensive to maintain </li></ul><ul><li>Dependent on the values of </li></ul><ul><li>communism and could change if </li></ul><ul><li>Cuba leans towards Capitalism </li></ul>Economic <ul><li>Increased trade relations and </li></ul><ul><li>collaboration with countries like </li></ul><ul><li>Venezuela , Argentina and China. </li></ul><ul><li>Emergence of international </li></ul><ul><li>cooperation with other countries </li></ul><ul><li>paving way for donor income. </li></ul><ul><li>Increase foreign earnings </li></ul><ul><li>Too much reliance on trade relations </li></ul><ul><li>for foreign income. </li></ul><ul><li>Trade relations could be hampered </li></ul><ul><li>by political factors or external </li></ul><ul><li>pressure from international </li></ul><ul><li>community </li></ul>Socio-cultural <ul><li>Higher literacy rate </li></ul><ul><li>Increase level of tobacco </li></ul><ul><li>consumption. </li></ul><ul><li>Offering medical training to foreign </li></ul><ul><li>students </li></ul><ul><li>Higher literacy rate increases skilled </li></ul><ul><li>human resource base for Health </li></ul><ul><li>and Biotechnological sectors </li></ul><ul><li>Over 25,000 Cuban doctors now </li></ul><ul><li>working in over 64 countries. [New </li></ul><ul><li>source of foreign income] </li></ul><ul><li>Stretch and strain on few doctors </li></ul><ul><li>left in Cuba who now have to cope </li></ul><ul><li>with greater number of patients </li></ul><ul><li>Maintaining academic quality of </li></ul><ul><li>education may be difficult </li></ul><ul><li>Medical training may prove </li></ul><ul><li>expensive in the long run </li></ul>Ecological <ul><li>Improve the sanitary and water </li></ul><ul><li>supply </li></ul><ul><li>Organic agriculture products </li></ul><ul><li>Increase environment pollution from </li></ul><ul><li>Biotech industry growth. </li></ul>Technological <ul><li>Embraced Biotechnology </li></ul><ul><li>Creation of INFOMED </li></ul><ul><li>Increase capability in producing </li></ul><ul><li>vaccines for internal use and </li></ul><ul><li>export. </li></ul><ul><li>Increase foreign earnings </li></ul><ul><li>Suspicion of using Biotech for </li></ul><ul><li>Weaponry </li></ul>
    25. 25. DYNAMIC MAPPING Health System in Cuba Strength High Low Short Long Time Horizon: 5-10 years D Ep P L En El S T D Demographic Ep P L En S T El Epidemiological Political Legal/Regulatory Economic Social Ecological Technological
    26. 26. DYNAMIC MAPPING Health System in Cuba Strength High Low Low High Certainty D Demographic Ep P L En S T El Epidemiological Political Legal/Regulatory Economic Social Ecological Technological D Ep P L En S El T
    27. 27. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References
    29. 29. HEALTH SYSTEM FINANCING Health System in Cuba First-level providers Second-level providers Government Population & Business Patient Compulsory, income related specific contribution or general taxes or income from foreign patients Ownership of buildings employment of staff Salaries and budget Ownership of buildings employment of staff Salaries and budget Deferral Service Service
    30. 30. HEALTH SYSTEM RESOURCE ALLOCATION Health System in Cuba <ul><li>Resource Allocation within the Health System is primarily based on the following factors </li></ul><ul><li>Number of Provinces and Local Communities </li></ul><ul><li>- Incidence and Prevalence of Local diseases </li></ul><ul><li>Labour and Capital Cost: </li></ul><ul><li>- Number of Physicians, Nurses and Health personnel </li></ul><ul><li>- Cost of training Medical staff and Health personnel </li></ul><ul><li>- Drugs and medical supplies </li></ul><ul><li>Resource Allocation entails mapping prevalence, incidence and distribution of different </li></ul><ul><li>types of diseases and the specialists available in the local community (Medicc, 2007). </li></ul><ul><li>For diseases such Cancer and HIV AIDs, the Health System commits resources towards </li></ul><ul><li>developing capacity for diagnosis and health screening (Medicc, 2007). </li></ul>
    31. 31. HEALTH SERVICE DELIVERY PRIMARY HEALTH CARE Health System in Cuba <ul><li>Doctor Family Program </li></ul><ul><li>Neighbour based care provide comprehensive medical attention </li></ul><ul><li>Drop medical cost due to the decrease of hospitalization and emergency room use </li></ul><ul><li>Improve health fitness </li></ul><ul><li>Polyclinics </li></ul><ul><li>‘ Medicine in the community’ </li></ul><ul><li>serves as the point-of-entry for patients </li></ul><ul><li>Attend to 95% of population </li></ul><ul><li>Alleviate the heavy use of hospital service </li></ul><ul><li>Addresses 80% of health problem </li></ul><ul><li>Emphasises health promotion and education </li></ul>Linked health, social and education sectors – focused on prevention. 1 Polyclinic : 30,000-60,000 patient :20-40 Family Doctor-Nurse Office MINSAP, Annual Health Statistics 2005 Indicator 2005 Health Workforce Physicians (per 10, 000) 62.7 Population covered by family physicians 99.4% Nurses (per 10, 000 population) 79.5 Dentists (per 10, 000 population) 9.4 Infrastructure Total No of Hospitals 248 Total No of Polyclinics 470 Total No of Maternity Homes 289 Medical Care Beds (per 1000 population) 4.9
    32. 32. SUMMARY Health System in Cuba FUNCTION STRENGTHS WEAKNESSES Stewardship, Organization and Regulation <ul><li>Government control means Health laws and </li></ul><ul><li>acts can be passed quickly without interest or </li></ul><ul><li>political group interference . </li></ul><ul><li>No provider competition and scarcity of resources has resulted in poor level of service. </li></ul>Financing <ul><li>Non-exploitative as it is all government </li></ul><ul><li>financed </li></ul><ul><li>High priority on health financing by the </li></ul><ul><li>government </li></ul><ul><li>May be expensive for the government in the </li></ul><ul><li>long run. </li></ul><ul><li>Neglect of other sectors which require </li></ul><ul><li>financing which may have some effects on </li></ul><ul><li>the well being of the population. </li></ul>Resource Allocation, Provider Payment Systems <ul><li>Efficient and Effective use of Health Personnel </li></ul><ul><li>and Physicians (Family Doctor-Nurse </li></ul><ul><li>programme) </li></ul><ul><li>Relatively Free of Charge </li></ul><ul><li>The decision to allocate resource by the </li></ul><ul><li>government could be viewed as authoritarian </li></ul><ul><li>and may not necessarily represent the true </li></ul><ul><li>need of the population i.e. Too much </li></ul><ul><li>emphasis on Infant mortality as opposed to </li></ul><ul><li>the needs of the ageing population. </li></ul><ul><li>Instances of under-utilisation of Clinics and </li></ul><ul><li>Polyclinics. </li></ul>Service Provision <ul><li>Closer to the community (i.e. Polyclinics and </li></ul><ul><li>Family Doctor-Nurse programme) </li></ul><ul><li>Family Centred </li></ul><ul><li>Cost Effective ( as most ailments are dealt </li></ul><ul><li>with at a primary level without need for </li></ul><ul><li>referring to hospitals) </li></ul><ul><li>Relatively accessible </li></ul><ul><li>Low wage rate deters and discourages Health </li></ul><ul><li>personnel and physicians from practicing. </li></ul>
    33. 33. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References
    34. 34. ISSUES IN CUBAN HEALTH SYSTEM Health System in Cuba Ineffectiveness <ul><ul><li>The state provides the medical care citizens receive. There are no additional providers and therefore no choice available. </li></ul></ul><ul><ul><li>Medical personnel do not have a choice in where they practice. </li></ul></ul>Lack of Choice
    35. 35. ACCOMPLISHMENTS Health System in Cuba Richard SC. Health in Cuba. International Journal of Epidemiology 2006 First country to eliminate polio—1962 First country to eliminate measles—1996 Lowest AIDS rate in the Americas Most effective dengue control program in the Americas Comprehensive health care: 1 physician per 120–160 families Highest rates of treatment and control of hypertension in the world Reduction in cardiovascular mortality rate by 45% Crude infant mortality rate of 5.8 per 1000 Development and implementation of a ‘comprehensive health plan for the Americas’ Free medical education for students from Africa and Latin America Indigenous biotechnology sector; producing the first human polysaccharide vaccine Support of 34 000 health professionals in 52 poor countries Creation of a national biomedical internet grid (INFOMED)
    36. 36. RECOMMENDATIONS <ul><li>Government should relax current regulations on economy (adoption of some aspects of capitalism) to generate wealth and resources to support its health and welfare system similar to China’s. </li></ul><ul><li>Reinvestment of economic gains from drugs, vaccines and medical tourism into the infrastructure of health care system. Increasing clinicians pay will alleviate some of the patient/doctor stresses and defection. </li></ul><ul><li>Government should exert same amount of attention on the other sectors which might have an indirect impact on people’s health e.g. agriculture where it only spends 5.2% of GDP. Large areas of fallow land can be opened up to allow farmers to grow more produce and further reduce imports of food, rather than remain under-utilized and state controlled. </li></ul><ul><li>Reallocate some resources used for infant/maternity care to elderly service provisions. This will help tackle under utilization problems. </li></ul>Health System in Cuba
    37. 37. CONCLUSION <ul><li>It was once stated “The existence of resources is dependent on the wealth of a country, without wealth there are no resources essentially.” The Republic of Cuba was founded on the grounding principle that citizens, regardless of socio-economic background, are entitled to good health and an education. In fact, it was a right that the State guaranteed and paid for. The social inequalities that characterized Cuban society pre-1959 were to be eradicated. The country is poor and dependent on other nations for its survival with limited resources, yet its health indicators rival most OECD members. Castro mobilized the population into education and addressed their health care needs. He created a currency out of the people that could be traded with other countries, most notably neighboring Latin American countries for the nations’ benefit. </li></ul><ul><li>The system is constantly evaluating and monitoring in quantifiable terms (through the health indices) the needs of the population it serves. It utilizes the most cost-efficient methods of prevention and education, and concentrated on building an infrastructure to ensure sustainability. It concentrated additionally on knowledge and innovation; creating INFOMED, vaccine production and discovery. </li></ul><ul><li>The creation of wealth is of paramount importance to increase the available resources and further expand the benefits of the system. A system that during the high of the communist crisis in the 1990s, its focus allowed the country to weather storm when its neighbors fell. This small communist country is adapting and making a foray into the free market in an effort to increase the wealth of the nation. It is not through lack of fairness that there are voids in the system or failures of it. Unlike larger health systems whose failures are systematic, Cuba suffers from a severe lack of resources. </li></ul>Health System in Cuba
    38. 38. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References
    39. 39. <ul><li>Abelardo RM, Candido LP. (June 2005) A Monitoring System for Health Equity in Cuba. [Online] Available from: [Accessed 27/11/2008]. </li></ul><ul><li>Annual Health Statistic Report 2005: Cuba Health Profile. (2006) [Online] Available from: [Accessed 28/11/2008]. </li></ul><ul><li>Cuba Pan American Health Organization 2007 Report. (2007) 2. Health in the Americas. </li></ul><ul><li>Cuba’s Political Succession: From Fidel to Raúl Castro. [Online] Available from: [Accessed 28/11/2008]. </li></ul><ul><li>Cuban System of Health. [Online] Available from: [Accessed 27/11/2008]. </li></ul><ul><li>2008. &quot;Basic data.&quot; Country Profile. Cuba : 3-3. Business Source Complete , EBSCO host (accessed November 30, 2008. </li></ul><ul><li>De Vos P, et al. (2008) Cuba’s Health System: Challenges Ahead’. Health Policy and Planning Oxford University Press in Association with the London School of Hygiene and Tropical Medicine., 23 (288-290), . </li></ul><ul><li>Elderhorst M. (1994) Will Cuba’s Biotechnology Capacity Survive the Socio-Economic Crisis? Biotechnology and Development Monitor, 20 (22), 11-13. </li></ul><ul><li>Evenson D. Medicc Review. [Online] Available from: [Accessed 27/11/2008]. </li></ul><ul><li>Gutierrez S, et al. (2003) Comparison of Four Health Systems: Cuba, China, Japan and the USA, An Approach to Reality. SouthEast Asian J Trop Med Public Health, 34 (4), . </li></ul><ul><li>Hart P. (2006) Doctors for oil - international trade Cuban-style - Telegraph. [Online] Available from: [Accessed 28/11/2008]. </li></ul><ul><li>¡Salud - Cuba's Health System. (2006) [Online] Available from: [Accessed 28/11/2008]. </li></ul>REFERENCE Health System in Cuba
    40. 40. <ul><li>Marquez, A.R MD PhD A Monitoring System for Health Equity in Cuba , MEDICC Review Vol VII No 9 – Nov/Dec 2005 </li></ul><ul><li>McGuire, J.W. et al Mortality Decline in Cuba; Patterns, Comparisons and Causes , Latin American Review, Vol. 40, No. 2, June 2005. </li></ul><ul><li>P.D. Vos et al. Contrasting HSR models in Latin America, Tropical Medicine and International Health, Vol 11, No. 10 Oct 2006 </li></ul><ul><li>Mola E, et al. (2006) Biotechnology in Cuba: 20 years of scientific, social and economic progress. Journal of Commercial Biotechnology, 13 (1-11), . </li></ul><ul><li>Medical Education Cooperation with Cuba (MEDICC), 2007. </li></ul><ul><li>Ochoa FR, Visbal LA. (2007) Civil Society and Health System in Cuba: A case study commissioned by the Health Systems Knowledge Network. Latin American Association of Social Medicine (ALAMES). </li></ul><ul><li>PAHO Health Expenditure for Latin America & the Caribbean . (2002) . </li></ul><ul><li>PAHO, Health in the Americas. (1998) Report number: 2. </li></ul><ul><li>PAHO, Health in the Americas. (2007) Report number: 2. </li></ul><ul><li>Perez-Lopez J. Cuba's second economy: From behind the scenes to center stage [monograph on the Internet]. New Brunswick, N.J. and London:; 1995. [cited November 29, 2008]. Available from: EconLit. </li></ul><ul><li>Population, Health, and Human Well-Being-- Cuba. [Online] Available from: [Accessed 28/11/2008]. </li></ul><ul><li>Reed G. (2008) ‘Cuba’s Primary Health Care Revolution: 30 years on’. Bulletin of the World Health Organization, 86 (5). </li></ul><ul><li>Richard SC. Health in Cuba. International Journal of Epidemiology 2006; 35:817-824. </li></ul><ul><li>Seror AC. (2006) A Case Analysis of INFOMED: The Cuban National Health Care Telecommunications Network and Portal | Séror | Journal of Medical Internet Research. [Online] Available from: [Accessed 28/11/2008]. </li></ul>Health System in Cuba REFERENCES CONTD.
    41. 41. <ul><li>THE DEVELOPMENT OF THE CUBAN HEALTH CARE. [Online] Available from: [Accessed 27/11/2008]. </li></ul><ul><li>The Economist Intelligence Unit Limited 2007, </li></ul><ul><li>United Nations Office of the Resident Coordinator in Cuba From: Office of the Resident Coordinator in Cuba Subject: [Online] Available from: [Accessed 27/11/2008]. </li></ul><ul><li>WHO Stastic 2006. [Online] Available from: </li></ul><ul><li>Wikipedia contributors. Cuba. [Online] Available from: [Accessed 28/11/2008]. </li></ul>REFERENCES CONTD. Health System in Cuba