Health Care in Cuba From revolution to evolution

Royal Society of Medicine, Professor Patrick Pietroni

a) What drew me to Cuba

b) Brief outline of Geography and History

c) Health Care in Cuba

d) What lessons can be learnt?

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What drew me to Cuba

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“I have never seen a more beautiful country, with palm leaves so big they can roof a house, with thousands of shells on the beach, with such limpid water, and always the deafening symphony from the songbirds.”

Christopher Columbus, 1492

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Brief outline of Geography and History

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Area: 110,860 sq km Population:11,257,105 (Jan 2007) Largest country in Caribbean and westernmost island of the Greater Antilles

1492- Christopher Columbus

1511- Spanish colony

1762- Havana captured by English

1840- Slave importation

Slave rebellion

1868- Revolt of planters: First War of Independence

1895- Second War of Independence: Jose Martí

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1898- Sinking of the Maine1902- Cuba ‘nominally’ independent1902-1952 – Series of corrupt and client

governments (revolution in 1933)1952- Batista’s coup d’etat1953- Moncada attack1956-59 Guerrilla revolutionary war1959- Castro in Havana

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1961- Bay of Pigs

1963- Nuclear stand-off

1970-89 - ‘Soviet’ period

1989 - Collapse of Soviet Union

1991- ‘Special period’

2003- Links with Venezuela (Bolivarian revolution)

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Health Care in Cuba

a) Pre Castro- up to 1959

b) Revolutionary period – 1959-63

c) Russian period 1963 - 1982

d) Reformation period – 1983-1995

e) Current position

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a) Infant mortality 60/1,000

b) Maternal mortality 125/100,000

c) Life expectancy c.60 years

d) Doctors 6,000 (4,000 in cities, 50% fled after 1959)

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Pre Castro period- up to 1959

Revolutionary Period 1959-63MINSAP (Ministry of Public Health)a) Health of the people is the full

responsibility of the stateb) Universal coverage is guaranteed to all

citizens without discriminationc) Preventative care is the prinary goal of

health cared) The people must participate actively to

maintain good health

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Russian period 1963-82

a) 43 health regions

b) Comprehensive vaccination programme

c) Hospital and polyclinic building programme

d) ‘Specialist’ primary care

e) 21 medical schools

f) 1959: 8 doctors/10,000 1980: 25/10,000

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Reformation period 1983-95

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Current position

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Cuba & The Region, Selected Indicators

Region

Infant mortality per 1,000 live births

Under 5 mortality per 1,000 live births

Life Expectancy Male

Life Expectancy Female

Life Expectancy Both Sexes

Caribbean 22 33.4 66.9 71.7 69.3

Latin America 22 27.7 70.3 76.4 73.3

United States 7 8 75 80.4 77.7

Cuba 5.3 8 75.8 79.5 77.6

Source: UNFPA, State of World Population, 2006, except for Cuba: UNDP Human Development Index 2006 & MINSAP, Annual Health Statistics, 2005 & 2006

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UK CubaPopulation 59.67 11.26m

Health budget as % of GDP

8.0 7.3

Health budget $187.38bn $2.94bn

Cost per capita $3,140 $261

Doctors 133,641 70,594

Doctors per 1,000 pop 2.3 6.3

Family Doctors 32,738 33,769

Family doctor/patient ratio

1/1,822 1/333

Medical schools 33 21

Medical Schools annual intake

8,042 25,000

Nurses per 1,000 pop 12.12 7.95

Maternal mortality rate per 100,000 live births

28.7 37.3

Infant mortality rate per 1,000 live births

5.5 5.3

Children reaching 5 years %

99.45 99.2%

Life expectancy 78.5 77.6

Sources: WHO World Health Statistics country reports 2006http://www.who.int/en/CIA World fact book https://www.cia.gov/cia/publications/factbook/index.htmlMedical Education Cooperation with Cuba reports, http://www.medicc.org/publications/cuba_health_reports/cuba-health-data2.phpRoyal College of General Practitionershttp://www.rcgp.org.uk/pdf/ISS_INFO_01_JUL06.pdf Council of Heads Of Medical Schoolshttp://www.chms.ac.uk/schools/index.htmhttp://www.cemach.org.uk/publications/WMD2000_2002/wmdt20-01.htm

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Medical Diplomacy

a)Medical Brigades

b)Medical Disaster Teams

c)Latin American School of Medicine

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What lessons can be learnt?

a) Integration of public health and primary care

b) Doctor Patient Ratio

c) Generalist emphasis on medical education

d) Collection of data at front line sites

e) Integration of hospitals/community/primary care

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What lessons can be learnt? (2)

f) Multi-professional approach and good inter-agency collaboration

g) Managerial system without professional managers

h) Extensive involvement of ‘patient’ and public in decision making at all levels

i) Central government support – political and economic

j) Features that caused concern

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‘When first in the dim light of early morning, I saw the shores of Cuba rise and define themselves from the dark blue horizons, I felt as if I sailed with Captain Silver when first he gazed on Treasure Island. Here was a place where real things were going on. Here was a scene of vital action. Here was a place where anything might happen. Here was a place where something would certainly happen. Here I might leave my bones.’

Winston Spencer Churchill, My Early Life

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