Health, health services, and health planning in Cuba.

Abstract

The profound changes which have occurred in the Cuban health services since 1958 are described and appraised in this article. The first part treats the main socioeconomic policies, particularly the urban and agrarian reforms, that have had an equalizing effect on the distribution of resources (including health resources) between regions and social classes. These socioeconomic developments have determined changes in mortality and morbidity patterns, particularly in the control of waterborne diseases, in the reduction of the level of malnutrition, and in the increasing prevalence of chronic conditions. The second part describes the main characteristics of the health services development in the last decade: centralization of inpatient facilities; decentralization of ambulatory ones; and the training of large numbers of physicians, paramedical personnel, and, especially, auxiliary personnel. The health services are structured according to a regional model that aims at the integration of preventive with curative services, personal with environmental, and medical with social services. Within this model, great priority is given to primary care, especially in the rural areas, where the greatest benefits of the restructuring of the system have been realized. The education and training of human resources, particularly of physicians, in response to the requirements of the system and the flight of nearly half the medical manpower after the Revolution, are also discussed in this section. The third part of the article describes the process of decision—making and planning in Cuba today, with special emphasis on the health sector. This process is highly centralized in plan preparation but highly decentralized in plan implementation. The medical profession has a definitive and decisive influence in the preparation of the plans, through the very powerful advisory planning task forces. The advantages and disadvantages of this active participation are discussed. Plan implementation is accomplished with massive participation by the population and its organs, the mass organizations, which partly explains the great achievements of the public health programs. The relationship between decision—makers and planners, not always an easy one, is also analyzed.