How does Cuba manage to achieve first-world health statistics?

How does Cuba manage to achieve first-world health statistics?
The island's medical system is envied throughout the region and is a
major foreign revenue earner
Havana 10 FEB 2017 - 16:08 CET

Cuba's healthcare system is a source of pride for its communist
government. The country has well-trained, capable doctors, the sector
has become an important export earner and gives Cuba valuable soft power
– yet the real picture is less rosy. A lot of health infrastructure is
deteriorating and there is a de facto two-tier system that favors those
with money.

Cuba's child mortality rate is on par with some of the world's richest
countries. With six deaths for every 1,000 births, according to World
Bank data from 2015, Cuba is level with New Zealand. In 2015, the global
average was 42.5 deaths for every 1,000 births. Despite more than half a
century of a US economic embargo, Cuba's average life expectancy matches
that in the US: 79.1 years, just a few months shorter than Americans
who, on average, live to 79.3 years, according to 2015 data from the
World Health Organization (WHO).

Much of Cuba's success in these areas is due to its primary healthcare
system, which is one of the most proactive in the world. Cuba's
population of 11.27 million has 452 out-patient clinics and the
government gives priority to disease prevention, universal coverage and
access to treatment.

Cuba has also produced innovations in medical research. In 1985 the
country pioneered the first and only vaccine against meningitis B. The
country's scientists developed new treatments for hepatitis B, diabetic
foot, vitiligo and psoriasis. They also developed a lung cancer vaccine
that is currently being tested in the United States. Cuba was also the
first country on earth to eliminate the transmission of HIV and syphilis
from mother to child, a feat recognized by the WHO in 2015.

In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than
the global average. According to the World Bank in 2014, the European
average spending GDP spending was 10%, compared to 17.1% in the United
States.

Two-tier system
A lesser-known characteristic of Cuba's healthcare system is the
existence of special clinics, reserved for tourists, politicians and
VIPs. The state reserves the best hospitals and doctors for the national
elite and foreigners, while ordinary Cubans sometimes must turn to the
black market or ask expatriate friends or family to send medicine.

"Cuba's health service is divided in two: one for Cubans and the other
for foreigners, who receive better quality care, while the national
population has to be satisfied with dilapidated facilities and a lack of
medicines and specialists, who are sent abroad to make money for Cuba,"
says Dr. Julio César Alfonzo, a Cuban exile in Miami and director of the
NGO Solidaridad Sin Fronteras.

In 1959, the country had only 6,000 doctors, half of whom emigrated
after the Cuban revolution. By 2014, Cuba had 67.2 doctors for every
10,000 inhabitants, with only Qatar and Monaco ahead of it.

However, despite these impressive statistics, the quality of primary
healthcare, which has been fundamental to Cuba's success, has been
declining in recent years. Between 2009 and 2014 there was a 62% fall in
the number of family doctors, from 34,261 to 12,842, according to Cuba's
National Statistics Office (ONEI).

An army of white coats
In the words of Fidel Castro, Cuba's "army of white coats" was formed in
1960, when a medical brigade was sent to Chile after an earthquake left
thousands dead. Since then, Cuba has sent more than 300,000 healthcare
workers to 158 countries in Latin America, Africa and Asia, according to
Cuba's state news agency. Today, around 50,000 Cuban medical workers are
present in 67 countries.

"Cuban doctors are rooted in solidarity and in the Hippocratic Oath. Our
job would be unthinkable without foreign missions," says Salvador Silva,
a doctor specializing in infectious diseases who has worked in Haiti and
Liberia.

"Yes, our salary is low and maybe that pushes us to go abroad, but it
also makes us proud when we see our work recognized throughout the
world, on top of just helping in our own country," he adds.

Doctors are arguably Cuba's most profitable resource and the country's
medical missions have proved to be a lucrative diplomatic tool. The
healthcare industry is also one of the country's main sources of income.
In 2014, Cuban authorities estimated overseas healthcare services would
bring in $8.2 billion, putting it ahead of tourism.

Cuba has a different deal with each country it works with. For example,
in exchange for sending 3,500 health care workers to work in and provide
training in Venezuela, a close Cuban ally, Venezuela sends oil.

With such a high demand for personnel, some suspect that the Cuban
government has been reducing educational requirements to hasten
students' entry into the work force.

"They are giving doctors licenses in record time to meet the need to
export them, and this has been detrimental to the quality of training
and medicine, which used to be the best. This has been happening since
they started the program in Venezuela, between 2003 and 2004," says Dr
Alfonzo.

Doctors are also eager to be sent abroad, not only to help the less
fortunate, but also for money. Salaries are higher – depending on the
location, with doctors abroad reportedly making up to $1,000 per month
(minus taxes), whereas those in Cuba make around $50. On the island, it
isn't rare to find taxi drivers, shopkeepers or construction workers
with medical degrees.

Juan drives a 1950s Chevrolet he bought with his brother and he uses it
as a taxi from 6pm to midnight. He's also a doctor in the clinic
Hermanos Ameijeiras.

"The wage is a pittance. We find ourselves obligated to make a living
doing other things. I have coworkers who sell prescriptions to
pharmacies, who work in unlicensed clinics or help their families in
shops. It's frustrating," he says. "It's like they're pushing us to
enlist in international missions, the business of Cuba."

The country's medical missions abroad have been an important escape
route for Cubans looking to defect. Before migratory reforms were passed
in January 2013 allowing Cubans with passports and visas to travel
abroad, the preferred way to abandon Cuba was via Venezuela. In 2013 and
2014, more than 3,000 doctors deserted the island to go to the United
States through a special visa program called Cuban Medical Professional
Parole, a program started by George W. Bush to help healthcare workers
who had escaped while working abroad.

Lucia Newman, a former CNN correspondent in Habana, said Cuban doctors
complain that travel restrictions prevent them from attending
conferences or keeping abreast of the latest medical advances. The US
trade embargo on Cuba includes some textbooks, but the major problem is
that Cuban doctors cannot buy medical equipment from the United States
or from any US subsidiaries.

For Odalys, a young patient waiting at the Hospital Salvador Allende,
"the situation is becoming unsustainable in this country and it's not
because of a lack of specialists, it's because we have to bring
everything ourselves. I just bought a light bulb for the hospital room.
I've called home so that they can bring me bedding, towels and even
toilet paper. There aren't even stretchers, I saw a family carrying
their sick son into a room. Free and universal health care, yes, but
it's a bit of a mess and very informal," she says.

English version: Alyssa McMurtry.

Source: Cuba's healthcare system: How does Cuba manage to achieve
first-world health statistics? | In English | EL PAÍS -
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