it is short overview of health system in cuba .where it is considered as efficient public health system in the world with lowest levels of mortality and morbidity .

1. Health system in cuba
Designed by
Ezeddin oun Soula
Najib mohamed
Ibrahim elmasauri
Tareq omar Eljahouni
Istanbul Medipol university

3. Cuba health system
• Universal
• Free
• Accessible
• Everyone has the right to
health protection and care .

4. • Total population (2015) 11,390,000
• Gross national income per capita (PPP international $, 2011)
18,520
• Life expectancy at birth m/f (years, 2015) 77/81
• Probability of dying between 15 and 60 years m/f (per 1 000
population, 2013) 115/73
• Total expenditure on health per capita (Intl $, 2014) 2,475
• Total expenditure on health as % of GDP (2014) 11.1
• Latest data available from the Global Health Observatory

7. Stewardship (oversight)
• National (public) health system
• Health care is responsibility of the state.
• Preventive and curative services are integrated.
• The public participates in the health system’s development and
functioning.
• Health care activities are integrated with economic and social
development.
• Global health cooperation is a fundamental obligation of the
health system and its professionals.

8. Financial resources
• Fully integrated system funded by government as
general taxation .
• Very low percentage out of pocket payment OPP.

9. Resources allocation
• National level
• Provincial level
• Municipal level

10. Service provision
• Family Doctor
• Polyclinics ( consulturio)
• Immunization

11. • The health system has 22 faculties of medicine, 13
research institutes, 249 hospitals, and 444 polyclinics
which respond to the development of medical science,
research and teaching, with most of them offering care in
specialties and fields of great scientific relevance.
• There are also 143 old-age homes, 289 maternity
facilities and provincial and municipal hygiene and
epidemiology centres in the 14 provinces and 169
municipalities, which work together on promotional,
preventive, curative, and rehabilitative aspects.

12. Intermediate (instrumental)
goals
• Equity:- 99% accessibility in rural and urban .
• Efficiency:- 11.1 % of GDP as total expenditure on
health. (WHO 2014 ) .
• Effectiveness: infant mortality rate decreased
maternal mortality ratio decreased,
life expectancy increased .

13. Ultimate goals
• Responsiveness :- respect to patient at highest
level with indoor service delivery (family physician.
Polyclinics.Municipalization of the services as
decentralization )
• Fair public financing :- financial risk protected by
very minimum OPP ( outpatients medicines,
wheelchairs ,hearing aids , crutches .. all state
controlled at minimum cost ) .

15. • Cuba’s health system is strongly focused on
prevention .
• Education is a priority, and there is almost universal
literacy.
• Health and sexual education are promoted;
contraceptives are free.
• Universal health care is free, and everyone has a
family physician and nurse.

16. • the health care system is a nationalized public
program.
• The current system was initially created in 1961 by
the Cuban Ministry of Public Health, which was
charged with the task of developing universal care.
In the years since, the system has continued to
develop and diversify.
• The system is a relatively smooth combination of
public health and medicine.

17. • '' We sincerely hope that all of the world's
inhabitants will have access to quality medical
services, as they do in Cuba .”
• Margaret Chan, Director-General of the World
Health Organization (WHO), made this statement
soon after her visit to Cuba in July 2014.

18. • The deliberate planning and nationalized system has
created a very methodical structure for healthcare in Cuba.
• The levels of administration coincide with the
corresponding levels of government – municipal,
provincial, and national.
• Each tier finances and directs initiatives based on
community needs assessments, constituent interests, and
health indicators.
• Medical attention is also split into three common ranks –
primary, secondary, and tertiary.

19. HEALTH SERVICE
DELIVERY IN CUBA
Linked health, social and
education sectors —
focused on prevention.
One Polyclinic :
30,000—60,000 patient
20-40 family doctors –
nurse office

21. • Segmentation of assets and labor . The structure of
the health system builds upon the base level of
primary care,
• with primary care physicians or family doctors
distributed within the neighborhoods.
• The next level is the polyclinic, which coordinates
the majority of outpatient specialty activity.
• The third level is single specialty tertiary hospital
locations, which are distributed in the major cities.

24. • With over 67 physicians per 100,000 population,
Cuba has the best access to physicians.
• The physicians, particularly family doctors, are
located in neighborhoods, living within a mile or less
of their patient base.
• The physicians know the families, friends, behaviors
and risk factors for their neighborhoods.

25. • The Cuban government controls the supply of
healthcare services by organizing the medical training
and deployment of physicians and providers across the
country and the demand for services through paying
for the access to and use of services for the
population.
• This model allows an orchestrated balance of supply
and demand.
• When there are shortages or surpluses on either side
of the supply/demand equation, the government can
use its power to affect a more optimal balance.

26. Health services levels

28. • The Cuban healthcare system stresses preventive
health. Despite limited resources, Cuba has a
record unmatched by any economically
disadvantaged nation of dealing with chronic and
infectious diseases.
• These include polio (eradicated 1962), malaria
(eradicated 1967), neonatal tetanus (eradicated
1972), diphtheria (eradicated 1979), congenital
rubella syndrome (eradicated 1989), post-mumps
meningitis (eradicated 1989), measles (eradicated
1993), rubella (eradicated 1995), and tuberculous
meningitis (eradicated 1997).

29. Health system financing

30. • the Cuban system is nonprofit and not
reimbursement-based,
• there is no need to spend resources on coding
and billing claims for services rendered. The
office “statistician” focus is on quality indicators
• It concentrated additionally on knowledge and
innovation creating
• Creation national biomedical internet grid
INFOMED, vaccine production and discovery.

32. ISSUES IN CUBAN HEALTH SYSTEM
Vertical equity
• research suggests that foreign” health tourists”
paying with dollars and senior communist party
officials receive a higher quality of care than Cuban
citizen .
• 11.1 % of GPD spent on healthcare for universal
coverage with emphasis on prenatal - infant and
hospital care.
Technical Inefficiency
• Deterioration of basic health system infrastructure .
• Scarcity of medicines and other medical input.

33. Ineffectiveness
excess doctors and extremely low wages .
Aging (population-insufficient) facility to deal with
burden .
Scarcity of basic resources.
Lack of choice
the state provides the medical care citizens receive
.There are no additional providers and therefore
choice available . .
Medical personnel do not have a choice in where
they practice ..

35. • References :-
• www.who.int
• http://m.ije.oxfordjournals.org/content/35/4/817.long
• http://m.huffpost.com/us/entry/5649968
• http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid
=25223&Itemid=270&lang=en
• http://www.who.int/alliance-hpsr/alliancehpsr_overview_fr_eng.pdf?ua=1
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464859/
• http://upsidedownworld.org/archives/cuba/why-does-health-care-in-cuba-cost-96-
less-than-in-the-us/
• http://files.sld.cu/dne/files/2015/07/anuario-estadistico-de-salud-2014-ingles-e.pdf