The Cuban health system is government run and aims to provide universal healthcare access. It has three tiers - hospitals, polyclinics, and family doctor units. Key aspects include preventative care through family doctors, community involvement, and allocating over 10% of GDP to healthcare. Cuba ranks highly on health indicators like life expectancy despite economic challenges. Critics argue the system favors political elites and faces resource constraints.

1. CUBA HEALTH ECONOMY
PGDHMHC SEM II
MS. NAZMA-18
DR. JAGTAP-22
DR. RATHOD-15

2. ABSTRACT
1976, Article 50 of the Cuban constitutions States:
“Everyone has the right to health protection and care. The state guarantees this right…..”
▪ The Cuban health system model is an efficient and equitable model with equal access to all its citizen. It
is fully integrated and controlled directly by its governments and ministers.
▪ 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 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 nation and introduce internal competition.
▪ The result has been the creation of new resources of revenue for the country, but not at the expense of
healthcare delivery to the citizens.

3. ORGANIZATION OF HEALTH SYSTEM

4. HEALTHCARE IN CUBA
The Cuban government operates a national health system and assumes fiscal and
administrative responsibility for the health care of all its citizens.
There are no private hospitals or clinics as all health services are government-run.
Cuba has historically – both before and during Communist rule – performed better
than other countries in the region on infant mortality and life expectancy. In 2016, the
World Health Organisation reported the average life expectancy at birth for Cubans as
being 77 years for males and 81 for females, which is higher than that of the United
States.

5. HEALTHSYSTEM IN CUBA
GOAL
Everyone has the right to health protection and
care
INTERMEDIATE
GOALS
Effectiveness
Decrease infant
mortality, death rate
Increase Life
expectancy
Efficiency
7.1% GDP for
universal
coverage
Equity
99%
accessibility in
rural and urban
Responsiveness
National health
plan and policy
Stewardship
National health
system
Decentralization
Financial
resources
Fully integrated
system funded by
general taxation
with low out of
pocket payments
Resource
allocation
Allocated through
national,
provisional and
municipal levels.
Service
provision
Polyclinics
Family doctor
program
Immunization
LEVERS

6. MILESTONES IN CUBAN HEALTH SYSTEM
Foundation 60s Convalescence 20sDeterioration 90sInnovation 80s
Consolidation
70s
• Rural health
service
• Nationalize
health care
• National literacy
campaign
• National
children's
immunization
programme
• Abortion law
• 4 corporate initiatives
- HIV/ AIDS
- Commitment to
Venezuela
- Vision restoration
program
- Disaster response
• National networks in-
- Health registry
- Blood banks
- Nephrology
- Medical images
• Soviet
partnership
collapse
• Epidemic crisis
• Tightening of US
embargo
• Reorientation of
the health
system
• Development
traditional
medicine
• New public
health law
• Strengthen
tertiary facility
and research
• Biotechnology
industry
• Family doctor
programme
• Establishment
of polyclinics
• National
comprehensive
health program
(maternal-child
health,
infectious
disease,
chronic)
• Increase in
health
professionals.

7. EVOLUTION OF HEALTH SYSTEM OF CUBA
Prior to
1960
Pre-Revolution era. Health services and facilities are concentrated in the cities. Provision of medical supplies is heavily dependent
on imports from other countries, mostly the U.S. Private sector healthcare is primarily for the wealthy. A poorly funded and
staffed public sector responds for the rest of the population.
1960s Soon after the revolution, universal healthcare is adopted and becomes a priority of state planning. U.S. government imposes
embargo against Cuba, which would lead to an increase in disease and infant mortality during this decade. Approximately half
the physicians in Cuba emigrate.
1970s The polyclinic model of primary care is reinforced and expanded, focusing on health education, prevention and environmental
monitoring. The number of medical graduates increase, thus enlarging the Cuban medical internationalism program
1980s Cuban healthcare system consolidates. Primary care is given impetus with the introduction of the Family Doctor-and-Nurse
Program. Biotechnology industry takes off
1990s Post Soviet era, starts with Cuba's Special Period of socioeconomic collapse, due to loss of funding from the dissolved U.S.S.R.
Cuba starts to accept U.S. donations of food, medicines and cash. At the same time, U.S. embargo tightens. Infectious diseases
rise while infant mortality continues to decline.
2000s-
present
Cuba's health indices rank extraordinarily at a developed country level, considering that Cuba is a country of poor resources and
economic underdevelopment. Cuba also boasts one of the highest physician-per-inhabitant ratios in the world, though massive
deployment of doctors on foreign missions can leave gaps in the country's domestic primary healthcare programs. Medical
tourism is also a thriving and growing industry today in Cuba. So far, it is widely believed that medical workers are Cuba's most
important export commodity. Cuba also successfully exports many medical products, such as vaccines.
https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Cuba

8. EVOLUTION OF CUBAN HEALTH SYSTEM
▪ Prior to the Cuban Revolution in 1959
▪ market-led model of health care – suboptimal distribution of its doctors, the majority of whom were in
cities such as Havana and Santiago de Cuba, which left significant numbers of people without access to
health care 1
▪ The idea of a national health system to reduce disparity and introduce universal care for Cuba
began in 1960 by the revolutionary and physician Che Guevara
▪ to provide public health services for the greatest possible number of persons
▪ to institute a program of preventive medicine
▪ to orient the public to the performance of hygienic practices 2
1 Demers RY, Kemble S, Orris M and Orris P. Family practice in Cuba: evolution in the 1990s. Family Practice
1993;10:164–8.
2 Guevara C.On revolutionary medicine. In: Gerassi J (ed) Venceremos! The Speeches and Writings of Che uevara.
New York: Macmillan, 1968.

9. EVOLUTION OF CUBAN HEALTH SYSTEM
▪ By 1961, a reduction in the cost of medicines, nationalization of pharmaceutical companies,
mutual aid co-operatives and private hospitals as well as widening the network of hospitals so
that the Cuban healthcare system was a totally socialist one 3
▪ Emigration of half doctors to US left only 3000 doctors 4
▪ Volunteer doctors from Latin America, and Cuban medical students in training, who were sent to
towns and villages ameliorated the chasm where no doctor had been previously seen5
▪ In its constitution 1976,
▪ guaranteed the right of everyone to have health protection and care, by providing free medical and
hospital care throughout the country.
3. Mesa-Lago C. Market, Socialist and Mixed Economies: comparative policy and performance, Chile, Cuba and Costa Rica.
Baltimore, Maryland: The Johns Hopkins University Press, 2000.
4. Baker EL. The Cuban Healthcare System and its Achievement. Cuba’s health system: an alternative approach to health delivery.
Houston Texas; University of Texas Health Science Center at Houston, 1975.
5. MacDonald TH. A Developmental Analysis of Cuba’s Healthcare System Since 1959. Lewiston: Edwin Mellen Press, 1999

10. ▪ in 1984,
▪ Initiated the Family Doctor Program, whose main goal was preventative medicine,
teaching and research
▪ US, in 1961, imposed its economic, commercial and financial embargo on Cuba – which is
still in place today this embargo includes an outright ban on the sale of food and denies
the availability of life-saving medicines to ordinary citizens 6
▪ Cuba turned to the Soviet Union and western and eastern European countries for
economic co-operation, which has provided the country with significant subsided
trade and aid 7
▪ Economic crisis 1991 – 60% decline of GDP
▪ Economic conditions in Cuba have been improving since 1994 due, in part, to joint
planned investment partnerships with western Europe and Canadian companies as
well as a planned strategy to increase tourism

11. NETWORK OF COMMUNITY HEALTH
CARE
Hospital
Polyclinic
Family physician
unit
▪ Community based practice
▪ 3 tier heath care system
▪ The public and social nature of medicine
▪ Access to services at no cost
▪ Preventive orientation
▪ Adequate application of scientific and technological
developments
▪ Community participation

12. POLYCLINIC RECONSTRUCTION AND
MODERNIZATION PROGRAM
▪ bringing a number of services closer to
the population
▪ Adapting services to the health
situation of each locale
▪ Training and continuing education for
staff
▪ Upgrading equipment and introducing
new technology
▪ [community-based] polyclinics
▪ services expanded through technology
transfer from secondary and tertiary
care levels (general and specialized
hospitals) to the primary care level (20-
30 services)
▪ Radiology, ultrasound, optometry,
endoscopy, thrombolysis, emergency,
rehabilitation and trauma care, family
planning, dental emergencies,
vaccinations, clinical laboratories, and
care for diabetics and older adults,
▪ Internal medicine, pediatrics, obstetrics
and gynecology, dermatology,
psychiatry, and cardiology

13. FAMILY PHYSICIAN UNIT
▪ 24-hour primary care and preventative services to the community
▪ generally family doctors, serve a population of between 600 and 900 patients (150–180 families) and
live in the vicinity of the practice
▪ Responsibilities of the family doctor - identifying, prioritizing and solving the health problems of the
individual, family and community
▪ assessment of the home environment, immunisation record and psychosocial information
▪ consulting with patients in the morning and undertaking home visits in the afternoon
▪ continuity, accessibility, health promotion and prevention are key issues at this level of health care
▪ every patient in their catchment area at least twice per year, even if they are healthy.
▪ The ethos of the family doctor is prevention, health promotion and rehabilitation
▪ family doctor
▪ teams are supported by a well-organized diagnostic and referral system

14. POLYCLINICS
▪ Provision of community based integrated curative-preventive, social and
environmental services to people in a specified area
▪ each serving a geographical region of approximately 25,000–35,000 people
▪ It further divided into health sectors all people are seen by the same medical teams
▪ consultants in other specialties visit polyclinics on a weekly basis to provide care and
advice to patients and staff.
▪ Nurses were observed delivering lectures on self-administered medication, with emphasis
being placed on taking the exact prescribed dose; drug interactions and reactions;
nutrition, exercise and aspects of health promotion
▪ These lectures were observed taking place in the waiting rooms of clinics

15. SERVICES PROVIDED BY POLYCLINICS
▪ Child health & School health services
▪ Psychology . Ophthalmology . X-rays, Ultrasound diagnostics
▪ Obstetrics and gynecology . Dentistry . Women’s health
▪ Social work . Optometry . Rehabilitation . Endoscopy
▪ Cardiac emergencies
▪ ‘medicine-in-the-community’ aims on disease prevention by identifying risks present in the
environment before they become health problems, as well as prioritizing those who are deemed
high-risk categories such as the elderly, adolescents and people with long-term conditions

16. TERTIARY CARE (HOSPITALS)
▪ 256 hospitals and 13 medical research centres
▪ Higher concentration of hospitals in the capital, Havana
▪ Cuba’s world-renowned Finlay Institute – vaccine HBV, Meningitis BV
▪ Inpatients receive free medication but other patients purchase medicines at a
subsidized price (hospital director, urban hospital) However, people with long-term
conditions such as insulin dependent diabetes and hypertension, do not pay for
their medication

17. HEALTH TOURISM AND HEALTH EXPORT
▪ practice of travelling to another country to obtain health care
▪ means of generating income, particularly since the collapse of the Soviet Union
▪ state tourism company, Cubanacan Tourism and Health, which supports tourism
services by providing physicians at hotels and international clinics
▪ Cuba also educates and trains medical students – Cubans as well as foreign
nationals – free of charge as a contribution to global health care

18. ▪ The public sector is dominant and health is a government priority
▪ Cuba’s social policy objectives have remained unchanged since 1960
▪ Government spends a relatively (10%) large part of the gross domestic product (GDP) on health, and
this spending remained high even during the mid- 1990s crisis, at the expense of defense
▪ High commitment of the Cuban government
▪ Cuba has demonstrated a remarkable capacity to mobilize the population, and community
participation is rather well ensured
▪ policies are based on comprehensive monitoring and evaluation, backed up with quality data
▪ Preventive health care achieves desirable health outcomes by changing people’s
behaviors.
▪ Because of the requirement of high community participation, preventive health care is
more labor-intensive but not capital-intensive and technology-intensive (Whiteford and
Branch, 2008).
▪ runs at a surprisingly low cost. Mainly because of their emphasis –
▪ community diagnosis and primary treatments, more effort into prevention beforehand than into cures after
the illnesses happen

19. HEALTH ECONOMY

20. HEALTH ECONOMY
BUDGET
https://www.ascecuba.org/asce_proceedings/an-evaluation-of-four-decades-of-cuban-healthcare/

21. CUBA - HEALTH EXPENDITURE
Cuba has a world-class health-care system. In 2014, 96% of spending was accounted for by the government.
https://www.economist.com/economic-and-financial-indicators/2017/04/29/health-care-spending

22. ECONOMY EFFECTS ON HEALTH SYSTEM
In 1991 collapse of soviet union 35% drop
in Cuba’s GDP.
Loss of approx. 80% of imports and
exports, along with food and medicines.
In 1993 Government reforms healthcare policy to adjust
to financial crisis; emphasis on first line healthcare, 97%
of medical students graduated as general practitioners,
prevention, better drugs and emergency medicines.
Cubanacan health
& tourism over
20,000 health
tourist received
treatment in 2006,
at prices 80% less
than US prices.
2003 drugs for
Debt- Havana’s
1.9bn US dollar
debt to Argentina
will be reduced by
75% in exchange
for drugs
Doctors exchanged
for $1bn subsidized
oil from Venezuela
annually. Est. 20000
doctors working in
china, Africa and
Bolivia.

23. Evolution of health
indicators

24. CUBAN SOCIO-ECONOMIC INDICATORS 1960-2007

25. INFANT MORTALITY RATE WITH
CHRONOLOGY OF VACCINATIONS
http://www.scielo.br/scielo.php?pid=S0103-40142011000200008&script=sci_arttext&tlng=en

26. INFANT MORTALITY RATE

27. UNDER 5 MORTALITY RATE
https://childmortality.org/data

28. NEONATAL MORTALITY RATE

29. MATERNAL MORTALITY RATE
https://www.who.int/gho/maternal_health/countries/cub.pdf?ua=1

31. CRITICS
▪ Governments economic model, which has directly affected the health of ordinary
citizens – poor domestic economy – rising cost of healthcare
▪ Cuban government has developed a two-tier ‘medical apartheid’ system, whereby
monies are spent on services for a privileged few who can pay in hard currency or
are members of the Cuban Communist Party elite, military high command and
members and staff of diplomatic missions
▪ AIDS problem, by instituting the world’s only mandatory quarantine policy for these
individuals, has been criticized for ignoring individual human rights
▪ government defends the policy by stating that HIV screening and quarantine were
necessary to control the disease but no systematic epidemiological studies of HIV
infection in Cuba
▪ unequivocally positive descriptions of the Cuban healthcare system in the social
science literature are misleading

32. ▪ As Vincent (2004) says that, pharmacies are often poorly stocked and the ration is
far less than enough (qtd. in Plant n.d.) (Vincent 2004 as cited in Plant n.d.)
▪ Hospitals are often in poor conditions and doctors have to bring their own supplies
and equipment to treat their patients (qtd. in Plant n.d.) (Associated Press 2004 as
cited in Plant n.d.).
▪ Inequity in medical education and employment - Latin American School of Medical
Science (ELAM), only open for international students (qtd. in Plant n.d.) (Huish 2008
as cited in Plant n.d.)
▪ Cuban doctors are paid on $50 dollar per month, which is only the price of a decent
meal in old Havana
▪ Cuban health care model good for resource scarce country like India

33. PROS & CONS OF CUBAN HEALTH SYSTEM
▪ The direct and indirect effects of the grave economic crisis in Cuba in the early
1990s caused physical deterioration of facilities, serious supply shortages,
deficiencies in professional performance and a lack of managerial training in health
system management at the health unit level.
▪ increase in demand for hospital services growing public dissatisfaction, even with
emergency services

34. ACCOMPLISHMENTS
Year Type of event Event
1960 Policy The Ministry of Public Health begins a program of nationalization and regionalization of medical services First U.S. embargo against Cuba
1962 Policy "Vaccination days" are established with the goal of reaching the entire population. Proving later to be effective in eliminating polio, it is subsequently adopted in other countries as a
primary strategy.
1963 Achievement Cuba declares free of polio
1965 Policy Cuban government creates a system of community-based polyclinics, with aims at providing primary-care, specialty services, and laboratory and diagnostic testing to a catchment
area of 25,000 to 30,000 people.
1970 Policy The Maternal–Child Programme (Programa Nacional de Atencion Materno-Infantil—PAMI) is launched with the purpose of assuring the health of women of child-bearing age and
their children
1972 Achievement Cuba declares free of neonatal tetanus
1979 Achievement Cuba declares free of diphteria
1984 Policy A Family Doctor-and-Nurse Program is launched, by which neighborhood/home clinic model is adopted. The physician and the nurse must live in the neighborhood they're serving.
They're also expected to conduct research and present their findings at congresses or in journals
1985-1990 Report Infant mortality rate levels at 13.01 deaths per 1,000 live births, the lowest in Latin America.
1993 Achievement Cuba declares free of measles
1994 Achievement Cuba declares free of pertussis
1995 Achievement Cuba declares free of rubella and mumps
2002 Report Cuba attains the second lowest infant mortality in the Americas, 20% below the U.S. rate for all ethnic groups and also below the rate for white Americans
2006 Policy The Cuban government spends about $355 per capita on health, 7.1% of total Gross Domestic Product (GDP).
2011 Achievement Cuba announces release of the world's first lung cancer vaccine
2015 Achievement Cuba becomes the first country to eradicate mother-to-child transmission of HIV and syphilis