Abstract
Developments in Cuba's healthcare system, infant mortality rate (IMR) trends, and commitment to universal healthcare have been examined by past research. Nevertheless, reductions of spatial inequality in human resources for health (HRH) distribution and IMR have received less attention. Drawing on Cuban Ministry of Health data, we examine changes in HRH distribution by personnel type and inequality in IMRs among Cuban provinces over time, emphasising the period since 1990. We contrast these with global, OECD, and developing country HRH distributions. Our research shows declining inequality in HRH and IMR across provinces in Cuba. A longitudinal data analysis of IMR shows that IMR decreases significantly as physician density increases within provinces. Within a global context of high between and within country disparities Cuba's experience is salient given high levels of spatial inequality prior to 1959 and material resource scarcity during the ‘special period’ of the 1990s.
Highlights
We examine Cuba’s efforts to reduce spatial disparities in human resources for health (HRH) and the infant mortality rate (IMR), and the relationship between them across provinces and over time
Has the provincial distribution of HRH and outcomes in Cuba become more equal over time, since the economic crisis of the 1990s, and if so, to what degree? Have the recent changes instituted in Cuba’s health sector led to an increase in inequality in healthcare personnel distribution among provinces? Have provincial differences in the IMR continued to narrow since 1989? has Cuba’s investment in training physicians led to a significant decrease in infant mortality?
As can be gleaned from the earlier discussion, Cuba’s experience reflects several highly relevant ‘natural experiments’: the revolution in 1959 and subsequent transformation of the health care system, the economic crisis of the 1990s, and the changes initiated by the Cuban government headed by President Raúl Castro as reflected in the Guidelines approved by the Sixth Congress of the Communist Party in April 2011
Summary
Past research has examined developments and transformations in Cuba’s healthcare system (Whiteford and Branch 2008; Feinsilver 1993; Iñiguez 2013; Ochoa and Serrano 2000), national trends in infant mortality (Franco et al 2007; McGuire and Frankel 2005; Corteguera 2000; Corteguera and Henríquez 2001; Álvarez 1999), and the government’s commitment to universal access to care in the face of economic difficulties (Borowy 2013; Nayari and Lopez-Pardo 2005; Chomsky 2000). Recent research examines the impact of the socio-economic changes taking place on the nature of Cuba’s evolving socialist model (Piñeiro Harneker 2014; Rodríguez 2014). Little has been done to examine the government’s goal of reducing spatial inequality of human resources for health in the context of Cuba’s various shifts in healthcare provision strategies. We examine Cuba’s efforts to reduce spatial disparities in human resources for health (HRH) and the infant mortality rate (IMR), and the relationship between them across provinces and over time. Has the provincial distribution of HRH and outcomes in Cuba become more equal over time, since the economic crisis of the 1990s, and if so, to what degree? Have the recent changes instituted in Cuba’s health sector led to an increase in inequality in healthcare personnel distribution among provinces? This work informs the larger debate between those who advocate a distribution of healthcare services by market logic and those who wish to promote healthcare as an inalienable human right
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