Cuban Pharmacy, Healthcare

1. CUBAN PHARMACY IN THE CONTEXT OF
ITS HEALTHCARE SYSTEM:
TRANSITIONING TOWARD
PHARMACEUTICAL CARE PRACTICE
Alina Martinez Sanchez, Ph.D.
Faculty of Health Sciences
San Jorge University
Campus Universitario de Gállego
J. Warren Salmon, Ph.D.
Professor of Health Policy and Administration
School of Public Health
University of Illinois at Chicago
Business and Health Administration Association
Chicago, Illinois, March 2012

2. Back Story: Cuba, in the Caribbean, is made
up of 14 provinces, divided into 169
municipalities, with a population of
11,242,628 in 2010, approximately 75.8% in
urban areas.
 Professional Pharmacy is moving from a
product orientation (dispensing medications) to
a focus on patient care in Cuba. Such
transformations are most difficult, especially for
developing nations

3. The public health aspect of the Cuban system,
combined with a formal primary care system,
was early on institutionalized with very limited
resources at times. Its health care system was
not a straight trajectory, given the ups and
downs of a poor developing economy.
Natural disasters, the end of Soviet aid, the embargo
imposed by the United States, among other factors,
limited health sector developments, but achievements
have been sustained.

4. Achievements in Cuban Health Care
 Changes in Cuban Pharmacy
Care toward ensuring a
greater contribution of
pharmaceutical services for
quality health improvements
have generally gone
undocumented. Our analysis
here shares the
pharmaceutical care
emergence in Cuba and
assesses its barriers, for
learning by other developing
nations.
 International health
assessments have
been favorable of its
prenatal programs; an
infant mortality rate of
4.9/1000 live births;
childhood vaccination
rates; accessible
neighborhood clinics
and pharmacies; and
life expectancy
reaching 77 years.

5. Equity in allocation of health resources
established with high level of health
achievement in the population
Synergies from social interventions;
well-educated with very high literacy rates.

6. Cuba Exports Doctors
 Since 1973 an estimated 37,041 health workers sent to
77 countries
 Cuba’s developmental aid to nations in great need
(earthquakes, hurricanes, other natural disasters)
 Highest physician/population ratio in the world (2x U.S.
ratio)
 Activity for reconstructing Haitian health care system not
publicized in U.S. media
 Health workers as goodwill ambassadors to many
countries

7. Fall of Baptista regime in 1959
 Physicians left with
Baptista and the
people got healthier
 Remaining doctors
rebuilt a public
health/primary care
system to serve all of
the population
 WHO acclaims Cuba
as one of the most
effective public health
systems in developing
world.
 Most infectious
disease wiped out
 Infant mortality rate of
4.9 per 1000 live births

8. Hallmarks of Cuban Health Care
since the 1980s
Global research on medicines for neglected
disease across Southern Hemisphere
Est. US $300 million exports in 2005
Family doctor program in most communities
for easy access

9. System Data
 329,669 qualified health work force
 74,880 physicians
 34,261 nursing and auxiliary personnel
 133,778 technicians and assistants
 2,993 pharmacists 2,117 pharmacies
 Financed out of State budget, services are free--preventive, curative
and rehabilitation
 Out of pocket cost for out-patient drugs, hearing aids, dental and
orthopedic apparatus, wheel chairs, crutches, eyeglasses remain low-
priced, being subsidized by the State
 9.9% of GDP higher than other Latin American nations

10. Results of Organized System of Care
 Life expectancy 77
years average (79.2
women)
 MINSAP plans for
economic efficiency and
public satisfaction
 Cuba’s trajectory of
development has not
been steady
 Cuba is a poor
developing nation
facing a U.S.
blockade and
embargo that keeps
medical technology
and brands out of
drug supply

11. Pharmaceutical Services in Cuba
 Objective is to
achieve excellence in
contribution to
population’s health
maintenance through
optimal management
of resources
 Move the profession
toward a philosophy
of pharmaceutical
care
 Pharmacoepidemiology
strategy creating a
national network for
evaluating and
controlling rational drug
use in each territory
 Pharmacy Clinical
Services, Drug
Information Services,
Pharmacovigilance, &
Pharmacoepidemiology

12. Curriculum for New Professional Model
of Practice
Revamping community pharmacies and
institutional settings for pharmaceutical care

13. Educational Innovations
 Problem-based
learning instituted
 Experiments, case
studies, discussion
groups, practical
experiences, class
assignments,
demonstrations, etc.
 Incorporation of Social
Pharmacy to prepare
pharmacist to take
responsibility at a
societal level.
 New model is far from
standardized and not
embraced by majority
of pharmacists

14. Barriers in the Path Toward
Pharmaceutical Care
 Barriers to
resources
 Barriers relate to
attitudes and
opinions
 Barriers related
to education and
skills
 While all developing
nations face several
imperatives for
enhancing drug delivery
systems for care,
implementing new
models of practice takes
time and often proceeds
along an arduous path for
change

15. Cuba‘s Municipal Home Pharmacy
Network (MHPN) for evaluation and
control for rational drug use in each
territory
Pharmacoepidemiological surveillance
system is unique and holds great benefit
as a model for export and adaptation
across the developing world

16. Cuba’s MHPN Model
 Addressing social epidemics, neglected diseases,
rising chronic degenerative disease patterns.
 Multinationals drug firms targeting pharmerging
nations with rising incomes willing to buy modern
medicines
 Pharmacy profession worldwide seeking to upgrade
performance in new systems of care
 Need for documentation of efforts and studies to
design best practice models.