Health for all: lessons from Cuba.

Abstract

As a low- and middle-income country, Cuba provides a remarkable level of access to health care for the entire population. In this article, Dr Awoh Abiyemi Benita from Oxford University explains how Cuba has pioneered in areas of public health despite low funds and can provide lessons not only to low-income countries but to developed countries also.Four years ago, the United Nations adopted the resolution on universal health care, urging governments to make universal access to health care without financial hardship their main social target. It is estimated that 1 billion people lack access to basic health care and 100 million more fall into poverty while trying to access it.[1] Without a doubt, there have been improvements globally in health access as indicated by increases in immunisation coverage rates, access to antenatal care services and skilled birth attendants at delivery, access to safe water supply and adequate sanitation, but the progress has been slow and level of access still largely unacceptable in most low- and middle-income countries (LMICs) with significant disparities within and between countries.Cuba stands out among LMICs with a remarkable level of access to health care, independent of an individual's socioeconomic status, and impressive health indices similar, and in certain circumstances, better than some developed countries. During a 2014 visit to the island, WHO's Dr Margaret Chan, while commending the Cuban government for its efforts in making health care an essential pillar of development, hoped that 'all of the world's inhabitants will have access to quality medical services, as they do in Cuba'.[2]The health system of Cuba is completely funded by the government which also oversees its administration, providing free and universal care for all its citizens. This health system is based on primary health care (PHC) and focuses on prevention.Beginning in the early 1960s, the Cuban government made special efforts to extend health services by establishing rural medical services. These were designed to prevent disease and provide health services to rural underserved communities and the poor and vulnerable populations. The multispecialty polyclinics set up within communities served as the mainstay of the PHC services, providing a basic set of preventive, curative and rehabilitative services with additional services tailored to the health needs of host communities. The range of additional services is based on community diagnosis from active population screening.[3]The health system is further strengthened by the government's investment in medical training of skilled health care workers: family physicians and nurses. The family doctor/nurse programme deploys family physicians and nurses to serve in the community and coordinate community efforts for prevention and control of diseases. Today, Cuba has about 32,000 family physicians and 32,000 nurses with a doctor: patient ratio of about 1:170. By expanding its reach and focusing on prevention, 95% of Cuba's population had been reached by these services as early as the 1990s.[4]Cuba spends 8.8% of its gross domestic product (GDP) on health but has achieved far more than countries with similar, and even higher, income levels. In the United States, for instance, total health expenditure is 17.1% of GDP, but it has a higher infant mortality rate, of 6 per 1,000 livebirths, than Cuba's 4 per 1,000; lower immunisation coverage (94%) and same life expectancy at birth (79 years).[5]Evidently, Cuba has overcome most of the public health challenges facing developing countries. Among Cuba's achievements are a couple of 'firsts' - the first to eliminate Polio (1962), the first to eliminate measles (1993) and the first to produce a vaccine for meningococcus B meningitis (1988). …