CubaMinrex. Sitio del Ministerio de Relaciones Exteriores de Cuba

The priority given to health in the Cuban system

Providing free medical attention to the Cuban population became one of the revolutionary government’s basic social pillars from the time it assumed power.

Before the Revolution, health and hospital care were mainly privately or provided to members of mutual societies. Medical facilities and personnel were mostly to be found in Havana where 65% of doctors and 62% of hospital beds were concentrated. There were virtually no medical services in rural areas, where nearly half of Cuba's population lived, and there was only one rural hospital that had only 10 beds and no doctors.

The percentage of people suffering from parasites was high (36.10%) as was that of those suffering from tuberculosis (13.99%), typhus (13.25%) and malaria (30.03%). Infant mortality was over sixty deaths per one thousand live births and life expectancy was only about 58 years. State health service was less than adequate and only 8% of the population obtained free medical attention.

After the triumph of the Revolution, public health services in Cuba showed an impressive level of development in successive stages.

1960. Creation of the National Health System. Creation of rural medical services. Creation of health areas and polyclinics. Vaccination with the involvement of the population.

1970. Decentralisation of teaching and of the health sector, delegation of responsibility to the provinces. Initiation of Mother and Child Programme

1980. Creation of the Family Doctor Programme. Introduction of advanced technologies. Fast track development of the medico-pharmaceutical industry.

1990 Introduction and development of science and technology’s achievements. Withstanding the double whammy of the U.S. blockade and the collapse of socialism in eastern Europe and the USSR.

2000 The stage when the system was consolidated, reformed and modernised. Increased participation by the community in health measures and actions.

2002 to date. New programmes to put advances in medical care into practice. Development of polyclinics as centres of the highest quality primary medical care. Repairs to doctors offices and to polyclinics. Fast track training course for nurses.

Cuba’s achievement in the field of health mean that ever since 1983 it has more than met the requirements of Health for Everyone agreed to in the context of the World Health Organisation (WHO).

However, currently far reaching transformations to health services are underway in order to go beyond what we have already achieved. One of the most important of these is a programme to bring services closer to the population, the extensive retraining programmes for medical personnel —at the beginning of 2003 there were 34,451 people registered in this— and the continued development of pharmaceutical drug production.

In order to be able to execute these transformations and to continue improving the quality of medical services, the state budget allocated 2,270 million pesos for this key area.

Some of the Cuban public health’s achievements in the last ten years can be summarised as follows:

67% of the medicines the country need are domestically produced

Programme for pre-natal diagnosis of congenital diseases. This has helped to prevent the birth of more than four thousand children with congenital deformities

Medical genetics programme to reduce Down Syndrome and other diseases

Improvement of intensive pre-natal, paediatric and adults therapies

Increase in the number of organ transplants performed

Discovery of the group B anti-meningococcus vaccine, the only one of its kind in the world

Production of Hepatitis B Vaccine

Discovery of PPG (atheromix), first choice therapy for treating high cholesterol, the major contributing factor to coronary risk

Decrease in the number of cases of cancer in the advanced stage and an increase in the survival rate. Production of monoclonal antibodies for cancer treatment. Manufacture of vaccines against the disease.

More exact classification of leukaemia and its treatment

Cure or control of retinitis pigmentosa

Production of melagenina, a pharmaceutical obtained for human placenta and used for treating vitiligo.

Production of high-quality, low-cost medicines.

Manufacture of equipment such as Neuronica (used for monitoring during operations), the Medicid (digital electroencephalogram), the Ozomed (for ozone therapy treatment) and SUMA (Unilateral Micro-Analytic System)

MAIN STRATEGIES USED IN HEALTH CARE FIELD

1. Reorienting the health system towards primary health care and the cornerstone of this, the family doctor and nurse

Cuba today has 381 health areas which are fully covered by the family doctor programme, of whom there are more than 30,000 spread throughout the country. More than 97% of the Cuban population is covered by a family doctor and a nurse and it is expected that this will increase to 100% in the next few years. Continuing to give priority status to care for the population’s health has been a strategic challenge and goal for the state and society as a whole.

There are also the polyclinic, the first link the Cuban public health chain, which since 1997 is considered to be among the 28 most complete health services in the world, according to an assessment done by the World Health Organisation (WHO).

2. Revitalisation of hospital care

During the 80s the country made a huge effort to extend and modernise its hospital services network, which meant improving coverage, accessibility, capacity and comfort and incorporating the most up-to-date technology into the services offered. Although substantial progress was made, the programme was interrupted by the special period but it is today once again underway with new enthusiasm and more ambitious goals. In 2002, the country had 265 hospitals and 55,864 beds.

3. Cutting-edge technology programmes and research institutes

Cuba has developed a series of top class medical care programmes to protect the population’s health. Some of the most noteworthy of these are the programmes for preventing diagnosing and treating cancer, treatment for those with renal insufficiency, the cardiocentres, the early diagnosis of congenital complaints, comprehensive pre-natal services, blood donor programmes and the production of blood products.

4. Medical education and internationalist aid

Compared to 1959 when there was only one medical faculty in Cuba and one dentistry faculty, Cuba today has four higher institutions of medical science,
24 faculties of medicine and four of dentistry and more than 50 health and nursing polytechnics. Most of the hospitals are also teaching institutions or medical science faculties. As a result of the development of this educational structure, in 2002 there were 67,079 doctors in the country compared to the 3000 that the Revolution had when it emerged victorious —another 3000 emigrated in the first few years after the Revolution in response to the incentives offered for this very purpose by the United States government whose aim was to dismantle the Cuban health service.

By 2005 the Latin American School of Medical Sciences (ELAM) expects registration to rise to 10,000 with Latin American students whose numbers include representatives of 66 ethnic groups and indigenous peoples from very isolated places where there is no health care. That same year the first doctors will graduate from ELAM; they are committed to return to their own countries once they have completed their studies. Hundreds mores young people from the Caribbean and Africa are also studying medicine in Cuba.

Cuba’s solidarity in the health field is not limited to education foreign students here. Currently, 14 thousand 732 Cubans collaborate in areas of health in 65 different countries. Cuba has implemented the Comprehensive Health Programme (PIS) which is welcomed by Governments and by the populations that benefit directly from it alike. Under the programme 3117 Cuban cooperators are serving in 22 countries, of whom 2412 are doctors. Another 10,000 Cuban doctors have recently joined these numbers. They are carrying out important medical services in the Plan Barrio Adentro (Into the Neighbourhoods Plan) all over Venezuela.

Under the Comprehensive Health Programme tripartite cooperation projects have been developed with several countries. The programme is supported by 95 non-governmental organisations from various parts of the world and by international bodies such as the WHO/PHO, the UNDP and UNICEF whose financial contributions, medical equipment and supplies are sent directly to the countries or places where the Cuban health cooperants are working.

Based on Cuba’s experience in the epidemiological control of HIV/AIDS and on the fact that our country has the human resources necessary to deal with this pandemic, Cuba, in the special period of sessions of the UN Assembly General on HIV/AIDS held in New York from 25 to 27 June 2001 proposed :

Providing 4,000 doctors and health professionals to create an infrastructure to supply the population in countries in need with the medicines prescribed and the necessary follow-up. These same doctors, etc. could educate and train very many specialists, nurses and health technicians.

Providing the professors needed to set up 20 medical faculties in several of the world’s countries, many of whom could be selected from among the doctors who are already working as part of the Comprehensive Health Programme. 1000 doctors could be trained every year in the countries that most need them.

Sending the doctors, educators, psychologists and other experts needed to advise and collaborate with the AIDS and other disease prevention campaigns.

Supplying the equipment and kits needed for the basic prevention programmes

Anti-retrovirus treatment for 30,000 patients.

All that would be needed is that the international community contribute the raw materials for the medicines, equipment and material resources for these goods and services. Cuba would make no profit and would contribute the salaries of the Cubans in its domestic currency, salaries being the most expensive component for international health cooperation bodies. Cuba would also supply what is most difficult to find, trained people willing to carry out this mission in the most isolated areas.

Subsequently, in the Summit of Caribbean Heads of State held in Havana on 8 December 2002 to commemorate the 30th anniversary of the re-establishment of diplomatic relations between Cuba and the CARICOM countries, Cuba offered a programme supporting the regional strategy designed for fighting the HIV/AIDS epidemic in the Caribbean area. The programme proposed:

Sending 1000 health workers whose salaries would be paid by the Cuban State.

Sending the instructors and technicians needed to set up, in a country designated by CARICOM, a Technical Education Centre to teach nursing and other medical sciences at that level. Every year this institution could turn out up to two hundred young people from CARICOM countries who would be especially trained to treat patients with HIV/AIDS.

To provide free of charge no less than 30% of the value of the equipment and diagnostic kits produced in our country so that SUMA laboratories could be set up since this would it easier to carry out mass testing of the population. The cooperation offered would include installing, starting-up and technical assistance for the equipment and training local staff to use the aforementioned technology.

Cuba would be willing to share with other donors up to 40% of the value of these diagnostic kits and equipment in the case of Haiti.

Since its inception to date a total of 7,506 cooperators have served and are serving under the Comprehensive Health Programme.

Other aspects of the development of the Cuban Health System.

a) Mother and Child Programme. One of the most noteworthy aspects is the infant mortality rate which at the close of 2003 was 6.3 per 1000 live births.

b) The National Vaccination Programme. Cuba’s vaccination programme is one of those with the widest coverage in the world. Today all Cuban children are vaccinated against 13 infectious diseases and there is a broad range of projects to use other kinds of preventative and therapeutic vaccines for adults.

In 2004 the health service began to use the first Cuban tetravalent vaccine to protect children against four diseases (diphtheria, tetanus, whooping cough and hepatitis). Encouraging results have been obtained in the search for a pentavalent compound which would include antigens against haemophilus Influenzae type B. If the outcome is successful, this would be the first vaccine in the world against those five illnesses.

Also heartening are the advances in a therapeutic test vaccine against the human immunodeficiency virus (HIV) and in four therapeutic anti-cancer vaccines which are in the clinical trial stage in Cuba and other countries.

b) Chronic non-communicable diseases. Cuba’s epidemiological profile is characterised by the preponderance of death due to chronic non-communicable diseases. Heart diseases, malignant tumours, cerebrovascular illnesses and accidents cause almost two thirds of the deaths in the country. Diabetes mellitus, hepatic cirrhosis, asthma and high blood pressure should also be mentioned as significant causes of death.

c) Communicable diseases. This programme’s main objective is to control communicable diseases to continue reducing morbidity and to control risk factors to prevent outbreaks and epidemics. Infectious disease are the main cause of death in the world: many of these diseases can be controlled with vaccines. In Cuba, a significant number of such dieses has been eliminated.

d) Care for the elderly. There is a National Programme for Care for the Elderly.

Major causes of death

When the Revolution emerged victorious, 14.2% of deaths was caused by infectious diseases. Today the proportion of deaths from infectious diseases and parasites has fallen so greatly it has all but disappeared. The major causes of death are heart and cerebrovascular diseases, malignant tumours, etc.

Although HIV/AIDS is a veritable threat to the continuing existence of the human race in other parts of the world, Cuba, thanks to the early adoption of strategies and to a government group for coordinating the national response to the epidemic, has managed to keep slow the spread of the disease.

To date 4,979 people infected with the virus have been detected, of these 2,221 have become ill and 1084 of the latter have died from AIDS.

The epidemic is considered to be at a low level, there being a prevalence of 0.05 of people between the ages of 15 and 49 infected with the disease; this is the lowest in the Americas and one of the lowest in the world.

Under the National Programme for the Prevention and Control of Sexually Transmitted Diseases and AIDS people living with HIV and AIDS are provided with training, social and job security, specialised medical attention, which includes free anti-retroviral treatment and treatment for opportunistic diseases for 100% of those infected. An educational programme is being developed, which plans to offer sex education in schools, educational programmes specially designed for vulnerable groups, adolescents and the population in general. The programme’s main focus is on prevention.

Cuba has managed to contain this pandemic in spite of having limited access to 50% of the new drugs which are produced by U.S. companies or subsidiaries because of the severe economic, trade and financial blockade imposed on our country by the United States.

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