Brief overview of Cuban health care system

1. Concept, process, reforms and challenges of
Cuba’s health care model
KOOKO RONALD
Introduction
In spite of Cuba’s polarized political climate coupled with trade embargoes over
the past decades, it has developed a rather unique health care system that
continues to deliver strong results against all odds.
The Cuban health system is recognized worldwide for its excellence and its
efficiency because it has managed to guarantee access to care for all segments of
the population and obtain results similar to those of the most developed nations
amidst extremely limited resources and the dramatic impact caused by the
economic sanctions imposed by the United States for the past few decades.
Cuba provides more medical personnel to the developing world than all the G8
countries combined. In the 1970s, the Cuban state initiated bilateral service
contracts and various money-making strategies. Cuba has entered into
agreements with United Nations agencies specializing in health.
Cuba's national health system is made up of multiple tiers mostly based on
preventive medicine:
❖ the community containing individuals and families,
❖ family doctor-and-nurse teams,
❖ basic work teams,
❖ community polyclinics,
❖ hospitals, and
❖ medical institutes
Comprehensive National Health Policy Goals
The single health system was developed and later enshrined in the 1976
constitution and 1983 Public Health Law under the following principles:
✓ Health care is a right, available to all equally and free of charge.
✓ Health care is the responsibility of the state.

2. ✓ 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.
A National System for Universal Access
Cuba has extensively extended health services to its population by training
urgently needed professionals, and integrating fragmented health care delivery
models into a single public system capable of responding to the most pressing
health problems of the times. Rural Medical Service (RMS) scheme was
established, posting newly graduated physician volunteers in remote whose
mandate was to play a role as health and hygiene educators as well as clinicians.
This was the beginning of ongoing efforts to distribute personnel and facilities
according to health needs, and a precursor of later models to embed health
professionals in the communities they served and meld public health with clinical
medicine. The infectious disease control and prevention national programs were
established, targeting principally malaria, and acute diarrheal and vaccine-
preventable illnesses.
Ministry of Public Health was tasked with the responsibility to define the
knowledge base, competencies, and scope of responsibility for each of the
university-level health sciences professions.
Medical and nursing schools were also established in different provinces to
decentralize training and encourage professionals to practice in the regions where
they grew up, in almost all cases in areas more underserved than the nation’s
capital. Another financial incentive was provided by free tuition, academic
achievement being the sole prerequisite for admission.
Community Based Health
This was initiated in order to;
➢ Reduce time for waiting to see physicians and increase time spent with
doctors.
➢ Integrate preventive and curative services, coordinate and monitor
continuity of medical care.
This was achieved through creation of a new model community-based
polyclinics where essential primary care specialists such as obstetrics and

3. gynecologists, pediatricians, and internists are virtually posted in every Cuban
community to provide comprehensive care to residents where they lived.
These efforts were accompanied by establishment of 4 main national programs,
designed as both guides to practice and yardsticks for measuring success in
improving population health: maternal and child health, infectious diseases,
chronic noncommunicable diseases, and older adult health.
Cuba also began giving higher priority to tertiary care facilities and research in
early 1980s, expanded accreditation of medical specialties to 55 fields,
established national institutes as centres of excellence, initiated and quickly
accelerated investment in biotechnology, developed national programs for
prenatal screening, established an organ transplant program, and installed the first
nuclear magnetic resonance equipment in Latin America.
Family Physician and Nurse Program
Cuban was country the first in the developing world to cover the health needs of
every citizen founded on comprehensive family practice.
Principles of public health and clinical medicine were combined into a single
professional duo emphasizing prevention and epidemiologic analysis with
improvement of individual and population health outcomes as the central
purpose. The following objectives for family doctor and nurse teams illustrate the
melding of medical and public health activities in their practice:
✓ Guarantee early diagnosis, ambulatory services, and hospitalization, as
well as timely, continuous, and comprehensive medical care in the
community.
✓ Develop community-based rehabilitation for physically or psychologically
disabled persons.
✓ Achieve improvements in neighbourhood environmental clean-up and in-
home hygiene.
✓ Achieve improvements in social relations and integration of
neighbourhood residents and families.
✓ Develop studies that respond to the health needs of the population.
✓ Promote health through positive changes in the population’s knowledge,
sanitary habits, and lifestyle.
✓ Prevent the emergence of diseases and damage to the population’s health.
Strengthening the Curriculum

4. Based on family medicine model, the medical and nursing curricula was
overhauled, adjusting to emphasize the expectation that Cuban family physicians
and nurses would be responsible for the health of their patients, not just the
treatment of disease and injury. This new curriculum was designed to match
graduates’ professional competencies with the NHS’s workforce needs and the
population’s health needs, incorporating skills to understand and act upon shifting
population health profiles. Curricular changes included the following:
• Increased proportion of epidemiological and public health sciences
(including social communication),
• Emphasized service learning in the community,
• Introduction of problem-based and other active learning methods, and
• Introduction of clinical skills early in training with the basic medical
sciences
CURRENT NATIONAL HEALTH SYSTEM OF CUBA
Before 2000, Cuba had a full population health coverage achieved and this has
continued to improve over the past decade. By the new millennium, data showed
the impact of universal primary care on hospitals, decongesting the latter’s
outpatient and emergency services
Neighbourhood Health Diagnosis
Cuba’s NHS is a socialized system where almost all facilities are government
owned and operated, and almost all professionals are government employees. The
health institutions are guided methodologically by ministry of public health
though supervised by community, municipal, provincial, and national
governments, depending on the jurisdiction of the institution.
The system’s principles, policies, and procedures are centrally developed, but
local flexibility is required to respond appropriately to particular health
circumstances extant in each geographic area served by community polyclinics
and their family medicine teams. The analysis of diseases, risk factors, and
environmental influences on health must be updated twice yearly, its findings
used to set local priorities for health promotion, disease prevention, diagnosis and
treatment, and rehabilitation activities
Continuous Assessment and Risk Evaluation (CARE)
This process was adopted as a way to ensure that information from the patient’s
medical history, physical examination, home environment, and neighbourhood
characteristics could be used to both monitor and affect the health of individuals

5. and families. Family physician and nurse offices and polyclinics alike undergo
evaluation to become accredited as teaching facilities. There are currently 488
polyclinics across the country, each serving a population between 20 000 and
60 000.
Community Support
Nurses and family doctors are integral part of their neighbourhoods, where their
work is both supported and evaluated by community members, primarily through
the Popular Councils, the most grassroots level of the Cuban government.
Additionally, neighbourhood organizations are important resources for family
physicians when it comes to organizing health education opportunities,
vaccination campaigns, mosquito control, and the like.
Data Collection and Evaluation
There is a fairly robust national health data collection and analysis system centred
in its National Statistics Division, which gathers data from all levels of the health
system, beginning with the family medicine offices. The system provides
strategic analysis of epidemiological data from the national, provincial, and
municipal level to elucidate disease patterns and predict disease behaviors to
develop and prioritize intervention strategies.
Criticism
Despite Cuba’s tremendous success in its health acre model, it has faced a lot of
challengers within its health system, including:
❖ Low pay of doctors.
❖ Poor facilities buildings in poor state of repair and mostly outdated.
❖ Poor provision of equipment.
❖ Frequent absence of essential drugs.
❖ Concern regarding freedom of choice both for patient and doctor
❖ Lack of specialists’ services and primary care doctor making continuity of
care problematic
❖ Limited resource to foster the intended goals and objectives of the system
because Cuba is a poor country more especially after the trade ban by the
USA
Conclusion
Lack of resources is a foregone conclusion to lack of access to health care more
especially in developing or less developed countries as Cuba gives the true
reflection of same, it is instead lack of political will on the part of leaders to
protect their most vulnerable populations. With political will and commitment of

6. the concerned stakeholders in health service delivery, limited resources can’t be
the sole reason for lack of access to health.
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