Public Meeting on Cuba's Health-Care System

A public meeting was held on February 11^th at the University of Winnipeg, addressed by Dr. Alfonso Garcia Asensi, a neurophysiologist from Holguin, Cuba. The meeting was organized by the Manitoba-Cuba Solidarity Committee as part of its mandate to educate Canadians about Cuba and oppose the U.S. blockade, in effect for more than 40 years. At a time when Canadians are very concerned with solutions to the problems facing our health-care system, it is worthwhile to look at the experiences of others in dealing with theirs.

Dr. Garcia Asensi outlined the structure of the Cuban health-care system, showing how each level was linked with the appropriate level of government to assist delivery of service and accountability. With relatively limited financial resources as compared to countries like Canada (Cuba's Gross Domestic Product is only one-twentieth that of Canada's, in large part due to more than 40 years of the U.S. embargo), Cuba has been able to provide its citizens with a very high standard of primary health-care. Cuba has equalled or surpassed many western industrialized countries in several key indicators of health such as life expectancy and infant mortality rates. In fact, for children under the age of one year, Cuba's rate of 6.2 deaths per 1000, is better than that of the U.S. and is equalled in the western hemisphere only by Canada. In the past decade alone, Cuba has succeeded in reducing the mortality rate from meningitis by 93 percent, and the vaccine they have developed to fight it is recognized by the World Health Organization as the most effective in the world. Cuba has also succeeded in reducing mortality from Hepatitis B by 52 percent; this is a disease which is on the increase in many parts of the world, including Canada and the U.S.

Dr. Garcia Asensi explained that the three cornerstones of Cuba's health-care system are that it is universal, free and accessible. One of the ways that its health-care system ensures these principles is by devoting more than 50 percent of its human resources to family doctor practices. In fact, Cuba has the highest per capita ratio of doctors in the world, approximately 60 doctors per 10 000 people. Medical clinics exist in every community, with the doctors, and sometimes the nurses as well, living above the clinics, so that the principle of 24-hour access is realized. The doctors become part of the community, get to know all the residents well, and practice preventative medicine to a degree unprecedented in North America. This integration has been so successful that more than 100 doctors have been elected from their communities to sit as representatives in the People's Assembly.

In addition, one of the key elements of Cuba's system is its internationalism. In spite of its own economic hardships, Cuba has sent more than 40,000 health-care workers, including doctors, to more than 83 underdeveloped countries of the world, completely free of charge. It is currently building six medical faculties in Africa. Its internationalist spirit has also led to the establishment of the Latin American School of Medical Science in Havana which trains medical students from many countries, also free of charge. Last year, this included five students from New York City. The goal of the program is to produce highly trained doctors who will go back to their communities to carry on their work.

Dr. Asensi spoke about the hardships caused by the continued U.S. blockade as well as the crisis in the economy following the collapse of the Soviet Union in 1991. Sources of raw materials became difficult because of the loss of their key trading partner, the USSR, and their lack of hard currency (U.S. dollars) with which to purchase supplies on the world market. They could no longer continue delivering the type of medical care in the way they were had done before. For example, they used to import their pharmaceuticals, which became impossible. Out of necessity, they turned to examining and developing their own natural and traditional medicines, carefully separating what was truly effective from what was not. They also focussed on preventative medicine, which is based more on human resources than medical supplies, in order to deal with their shortages. What came out of these and other changes in the organization and delivery of health care was an improved system, based on self-reliance. So even though Cuba's hard currency budget is still a problem, it has not hindered it from delivering a very high level of primary care, which is undergoing constant improvement. In the 1998-99 year alone, 21 new hospitals were opened, as well as 16 polyclinics, 10,000 new doctors' offices, three dental clinics, 44 homes for the elderly, six homes for the disabled, and12 research institutes among other new facilities.

Dr. Garcia Asensi explained that Cuba has basically solved the problem of how to provide excellent primary care to all of its people. They have all the human resources and technological knowledge they need. What is required to further develop the areas of research and modernization of their facilities is money to purchase raw materials for the production of their own pharmaceuticals, to computerize their facilities outside of the urban areas, and to purchase the advanced equipment they need, much of it produced by Cuban companies themselves. He pointed out that Cuba has the capacity to export several pharmaceuticals already, including the WHO-acclaimed meningococcal virus vaccine, but political interference is hindering their sale to other countries.

Dr. Asensi is on a cross-Canada tour seeking support for specific projects, including the computerization of the Lenin Provincial Hospital in Holguin and the establishment of Cuba's third Sleep Disorder Clinic.