Healthcare System in Cuba
8) Sources ……………………………………………………………… 16 ) HISTORY Modern Western physic has been accustomed in Cuba by controlmally trained doctors gundivided at balanceest the start of the 19th conclusion and the chief surgical clinic was disposely in 1823. Cuba has had coagulated cosmos-body rank trainers, including Carlos Finlay, whose mosquito-grounded scheme of yelcheap broil transmission was dedicated its definite examination inferior the dispose of Walter Reed, James Carroll, and Aristides Agramonte. During the era of U. S influence (1898–1902) yelcheap broil was essentially eliminated attribuboard to the efforts of Clara Maass and surgeon Jesse W. Lazear.
In 1976, Cuba’s sanityarrangement program was enshrined in Article 50 of the revised Cuban constitution which propounds “Everysingle has the fit to sanity security and arrangement. The propound insures this fit by providing at-liberty medical and hospital arrangement by media of the installations of the grassy medical labor network, polyclinics, hospitals, peaceorative and deal-outicularized tenor centers; by providing at-liberty dental arrangement; by promoting the sanity circulation campaigns, sanity information, disposely medical examinations, social vaccinations and other measures to thwart the extinguishedburst of ailment.
Entire the population cooperates in these impressivities and guiles through the collective and concretion organizations. Cuba’s trainer to resigned connection grew suggestively in the perishing half of the 20th conclusion, from 9. 2 trainers per 10,000 separates in 1958, to 58. 2 per 10,000 in 1999. In the 1960s the synod implemented a program of almost universal vaccinations. This helped uproot coagulated transmitted ailments including polio and rubella, though some ailments growthd during the era of economic burden of the 1990s, such as tuberculosis, hepatitis and chicken pox.
Other campaigns middle a program to impoverish the infant decease objurgate in 1970 directed at affectionate and prenatal arrangement. 1. POST-SOVIET UNION The privation of Soviet subsidies brought famine to Cuba in the controlthhereafter 1990s. In 2007, Cuba announced that it has inferiorcaptured computerizing and creating generally-knacknowledge networks in Blood Banks, Nephrology and Medical Images. Cuba is the remedy kingdom in the cosmos-body with such a result, simply preceded by France.
Cuba is preparing a Computerized Sanity Register, Hospital Management Guile, Original Sanity Arrangement, Academic Affairs, Medical Genetic Projects, Neurosciences, and Informational Software. The serve is to protect virtue sanity labor at-liberty control the Cuban body, growth modify unmoulded experts and boost lore-fruit projects. An consideroperative connect in wiring rule is to insure vestibule to Cuba’s Grounds Transmission Netachievement and Sanity Worksite (INFOMED) to entire items and achievementers of the generally-knacknowledge sanity ystem. 2) PRESENT | | | | |WHO sanity statistics control Cuba | |[Source: WHO kingdom page on Cuba] | |Morals confluence at lineage m/f: |76. 0/80. (years) | |Healthy morals confluence at lineage m/f: |67. 1/69. 5 (years) | |Child decease m/f: |8/7 (per 1000) | |Adult decease m/f: |131/85 (per 1000) | |Completion sanity expense per capita: |$251 | |Completion sanity expense as % of GDP: |7. 3 | Rank |Countries | |Statistic |Conclusion of | | |surveyed | | |Information | |125 |167 |HIV/AIDS adult extension objurgate |0. 10% |2003 est. | |162 |175 |Fertility objurgate |1. 66 (children/woman) |2006. | |153 |224 |Lineage objurgate |11. 9 (births/1,000 population) |2006 est. | |168 |226 |Infant decease objurgate |6. 04 (deaths/1,000 subsist lineages) |2006. | |129 |224 |Death objurgate |6. 33 (deaths/1,000 population) |2005. | |37 |225 |Morals confluence at lineage |77. 23 (years) |2006. est | |17 |99 |Suicide objurgate |18. 3 per 100,000 body per year |1996. | 3) COMPARISON OF PRE- AND POST-REVOLUTIONARY INDICES |Cuba: Social sanity 1950-2005 | | |Years | | | 1. HEALTH INDICATORS AND ISSUES Cuba began a prop connectionning program in 1962 to insure entire themes a balance basket of basic props.
As of 2007, the synod was splimit encircling $1 billion annually to subsidise the prop connectionn. The connectionn would require encircling $50 at an mediocre grocery shop in the Itemed Propounds, excluding the Cuban theme pays simply $1. 20 control it. The connectionn includes rice, legumes, potatoes, repast, eggs, and a smentire quantity of wood. It agrees encircling 30 to 70 percent of the 3,300 kilocalories that the mediocre Cuban consumes daily. The body achieve the peace of their prop from synod shops (Tiendas), at-liberty traffic shops and cooperatives, communication, their acknowledge gardens, and the sombre traffic.
According to the Pan American Sanity Organization, daily caloric intake per separate in diverse places in 2003 were as follows (item is kilocalories): Cuba, 3,286; America, 3,205; Latin America and the Caribbean, 2,875; Latin Caribbean countries, 2,593; Itemed Propounds, 3,754. The board beneath shows the referable-absolute substance of alienoperative ailments, non-alienoperative ailments (e. g. , exactingihood ailment and cancer) and injuries, in diverse accommodation of the cosmos-people. Grounds is from the Cosmos-body Sanity Organisation and is control year 2004. Distribution of years of morals past by account (%) | |Place |Alienoperative |Non-alienoperative |Injuries | |Cuba |9 |75 |16 | |Cosmos-body |51 |34 |14 | |Excellent proceeds countries |8 |77 |15 | |United Propounds |9 |73 |18 | |Cheap proceeds countries |68 |21 |10 | | | |Source: Cosmos-body Sanity Organisation. Cosmos-body Sanity Statistics 2009, Board 2, “Cause-specific | |decease and morbidity”. | Like the peace of the Cuban arrangement, coagulated communications possess shacknowledge that Cuban medical arrangement has covet suffered from stern embodied shortages accountd by the US restraint. The limit of Soviet subsidies in the controlthhereafter 1990s has as-polite fictitious it. While contrariant medical arrangement, diagnostic tests and medication control hospitalized resigneds are at-liberty, some aspects of sanityarrangement are remunerated control by the resigned.
Items which are remunerated by resigneds who can bestow it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a resigned can achieve these items at propound shops, prices incline to be cheap as these items are subsidized by the propound. Control resigneds on a cheap-income, these items are at-liberty of carry. 2. SEXUAL HEALTH • According to the UNAIDS communication of 2003 there were an estimated 3,300 Cubans determinedation with HIV/AIDS (approx 0. 05% of the population). In the mid-1980s, when inconsideroperative was knacknowledge encircling the bane, Cuba compulsorily tested thousands of its themes control HIV. Those who tested enacted were captured to
Los Cocos and were referoperative entireowed to concession. The prudence threaten stricture from the Itemed Nations and was discontinued in the 1990s. Gundivided 1996 Cuba began the resultion of generic anti-retroviral drugs reducing the requires to polite beneath that of educeing countries. This has been made feasible through the existing synod subsidies to tenor. • In 2003 Cuba had the cheapest HIV extension in the Americas and single of the cheapest in the cosmos-people. The UNAIDS reported that HIV contagion objurgates control Cuba were 0. 1%, and control other countries in the Caribbean betwixt 1 – 4%. Information in Cuba abextinguished issues of HIV contagion and AIDS is implemented by the Cuban Generally-knacknowledge Cinvade control Sex Information. According to Avert, an interdiplomatic AIDS charity, “Cuba’s transmitted offscourings by distant the slendepeace in the Caribbean. ” They gather eventually that … fantastic HIV contagions are on the loosen, and Cuba’s thwartive measures answer referoperative to be custody gait with provisions that favour the unfurl of HIV, including amplening proceeds inequalities and a growing sex diligence. At the corresponding season, Cuba’s thwartion of mother-to-child transmission guile offscourings extremely operative. Entire teeming women are tested control HIV, and those testing enacted accept antiretroviral drugs. • In fresh years beaccount of the loosen in prostitution attribuboard to tourism, STDs possess growthd. 3. 3 EMBARGO
During the 90s the ongoing United Propounds restraint opposite Cuba caused problems attribuboard to peacerictions on the ship-produce of physics from the US to Cuba. In 1992 the US restraint was made advance aastringent with the paragraph of the Cuban Democracy Impress resulting in entire U. S. promotive traffic, including traffic in prop and physics, substance prohibited. The congress did referoperative propound that Cuba canreferoperative escheatment physics from U. S. companies or their controleign subsidiaries; eventually, such permit requests possess been routinely robbed. In 1995 the Inter-American Commission on Human Fits of the Organization of American Propounds assured the U. S. Synod that such impressivities hurt intergenerally-knacknowledge regulation and has requested that the U. S. ake instant steps to permitted physic from the restraint. The Lancet and the British Medical Register as-polite condemned the restraint in the 90s. A 1997 communication disposed by Oxfam America and the Washington Office on Latin America, Myths And Facts Encircling The U. S. Restraint On Physic And Medical Supplies, concluded that the restraint controlced Cuba to interpretation advance of its scant instrument on medical imports, twain beaccount equipment and drugs from controleign subsidiaries of U. S. firms or from non-U. S. sources incline to be excellinvade priced and beaccount shipping requires are senior. The Democracy Impress of 1992 advance exacerbated the problems in Cuba’s medical guile. It prohibited controleign subsidiaries of U. S. orporations from selling to Cuba, thus advance limiting Cuba’s vestibule to physic and equipment, and amelioration prices. In gatherition, the impress controlbids ships that prune in Cuban ports from pruneing in U. S. ports control six months. This drastically peacericts shipping, and growths shipping require some 30%. 3. 4 MEDICAL STAFF IN CUBA According to the Cosmos-body Sanity Organization, Cuba agrees a trainer control perfect 170 residents, and has the remedy original trainer to resigned connection in the cosmos-body succeeding Italy. Medical professionals are referoperative remunerated excellent salaries by intergenerally-knacknowledge awaitards. In 2002 the balance monthly perfectowance was 261 pesos, 1. 5 seasons the generally-knacknowledge balance. A trainer’s perfectowance in the tardy 1990s was equipollent to encircling US$15–20 per month in purchasing faculty.
Therefore, some advance to achievement in opposed occupations, control in in the representationful itinerant diligence where rights can be abundant excellenter. The San Francisco Chronicle, the Washington Post, and Generally-knacknowledge Social Radio possess entire communicationed on Cuban trainers defecting to other countries. 3. 5 BLACK MARKET HEALTHCARE The difficulty in gaining vestibule to unmistakoperative physics and tenors has led to sanityarrangement unreserved an increasing role in Cuba’s burgeoning sombre traffic economy, sometimes termed “sociolismo”. According to controlmer promotive Cuban neurosurgeon and dissident Dr Hilda Molina, “The trainers in the hospitals are charging resigneds inferior the board control improve or quicker labor. ” Prices control extinguished-of-surgery X-rays possess been quoted at $50 to $60.
Such “under-the-board payments” communicationedly conclusion tail to the 1970s, when Cubans interpretationd gifts and tips in dispose to secure sanity benefits. The discordant economic downhinge knacknowledge as the “Particular Era” in the 1990s solemn these payments. The aspect of the “dollar arrangement”, a scant legalization of the dollar which led some Cubans to accept dollars from their referable-absolutes externally of Cuba, balancet that a rank of Cubans was operative to achieve medications and sanity labors that would referoperative be availoperative to them incorrectly. 4) CUBA AND INTERNATIONAL HEALTHCARE In the 1970s, the Cuban propound prepared bilateral labor contracts and diverse money-making strategies.
Cuba has invadeed into agreements with United Nations agencies deal-outicularizing in sanity: PAHO/WHO, UNICEF, the United Nations Prop and Agriculture Organization (FAO), the United Nations Population Fund (UNFPA), and the United Nations Fruit Fund (UNDP). Gundivided 1989, this collaboration has denoteed a very consideroperative role in that Cuba, in gatherition to achieveing the benefits of substance a limb kingdom, has strengthened its kindred with institutions of brilliance and has been operative to spread some of its acknowledge advances and technologies Cuba prevalently ship-produces consideroperative sanity labors and separatenel to Venezuela in modify control subsidized oil. Cuban trainers denote a original role in the Mission Barrio Adentro (Spanish: “Mission Into the Neighborhood”) collective prosperity program disposely in Venezuela inferior prevalent Venezuelan president Hugo Chavez.
The program, which is current unmoulded Venezuela’s indigent and is calculated to fetch trainers and other medical labors to the most unconnected slums of Venezuela, has referoperative been externally its detractors. Operacion Milagro (Operation Miracle) is a junction sanity program betwixt Cuba and Venezuela, symmetrical up in 2005. Human Fits Watch complains that the synod “bars themes occupied in attested peregrination from gate their end with them balanceseas, essentially pursuit the end sponsor to insure the parents’ restore. Dedicated the ampleunfurl apprehension of controlced parentage disjunction, these peregrination peacerictions agree the Cuban synod with a facultyful utensil control punishing defectors and silencing critics. ” Doctors are communicationed to be monitored by “minders” and theme to curfew.
The Cuban synod interpretations referable-absolutes as sponsors to thwart trainers from defecting. According to a pamphlet informed in The Lancet medical register, “growing collection of Cuban trainers sent balanceseas to achievement are defecting to the USA”, some via Colombia, where they possess sought scant sanctuary. Cuban trainers possess been portio of a large-scale guile by the Cuban propound to agree at-liberty medical promote and labors to the intergenerally-knacknowledge society (especially third cosmos-body countries) aftercited symmetrical disasters. Prevalently dozens of American medical students are trained to support in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba. 4. 1 HEALTH TOURISM AND PHARMACEUTICS
Cuba attracts encircling 20,000 paying sanity itinerants, generating revenues of environing $40 pet a year control the Cuban arrangement. Cuba has been serving sanity itinerants from environing the cosmos-body control advance than 20 years. The kingdom operates a deal-outicular removal of hospitals specifically control the tenor of controleigners and diplomats. Controleign resigneds peregrination to Cuba control a ample file of tenors including eye-surgery, neurological disorders such as multiple sclerosis and Parkinson’s ailment, cosmetic surgery, gatherictions tenor, retinitis pigmentosa and orthopaedics. Most resigneds are from Latin America, Europe and Canada, and a growing estimate of Americans as-polite are hereafter.
Cuba as-polite prosperityfully ship-produces coagulated medical results, such as vaccines. By 1998, according to the Economic Commission control Latin America and the Caribbean, the Cuban sanity sector had loosenn to busy environing brace percent of completion tourism. Some of these revenues are in hinge communicated to sanity arrangement control humdrum Cubans, although the magnitude and avail of these transfers is twain unknacknowledge and controversial. At single generally-knownly extended hospital/lore ordain, exacting circulation payments by controleigners possess financed the interpretation of a fantastic bathroom in the splanic surgery wing; anecdotal averment suggests that this sample is sordid in Cuban hospitals. 5) ALTERNATIVE HEALTHCARE
Economic constraints and peacerictions on physics possess controlced the Cuban sanity guile to incorporate alternative and herbal solutions to sanityarrangement issues, which can be advance vestibuleible and bestowoperative to a wideer population. In the 1990s, the Cuban Ministry of Social Sanity officially recognized symmetrical and traditional physic and began its integration into the already polite disposely Western physic awaitard. Ins of choice techniques interpretationd by the clinics and hospitals include: flower existence, neural and hydromineral therapies, homeopathy, traditional Chinese physic (i. e. acupunctural anesthesia control surgery), symmetrical dietary supplements, yoga, electromagnetic and laser devices.
Cuban biochemists possess performed a estimate of fantastic choice physics, including PPG (policosanol), a symmetrical result deal-outial from sugarcane wax that is operative at reducing completion cholesterol and LDL levels, and Vimang a symmetrical result deal-outial from the bark of mango trees. 6) MEDICAL RESEARCH IN CUBA The Cuban Ministry of Sanity produces a estimate of medical registers including the ACIMED, the Cuban Register of Surgery and the Cuban Register of Symbolical Physic. Beaccount the U. S. synod peacericts investments in Cuba by U. S. companies and their inoculates, Cuban institutions possess been scant in their ability to invade into lore and fruit portionerships, although adversative possess been made control suggestive drugs. In April 2007, the Cuba IPV Study Collaborative Clump communicationed in the New
England Register of Physic that inactivated (killed) poliobane vaccine was operative in vaccinating end in symbolical provisions. The Collaborative Clump consisted of the Cuban Ministry of Social Sanity, Kouri Ordain, U. S. Centers control Ailment Control and Thwartion, Pan American Sanity Organization, and the Cosmos-body Sanity Organization. This is consideroperative beaccount countries with excellent stroke of polio are now using subsist unwritten poliobane vaccine. When polio is eliminated in a kingdom, they must plug using the subsist vaccine, beaccount it has a disregard abandon of reverting to the exposed controlm of polio. The collaborative clump determined that when polio is eliminated in a population, they could safely switch to killed vaccine and be defended from reprevalent transmitteds.
Cuba has been at-liberty of polio gundivided 1963, excluding continues with concretion immunization campaigns. In the 1980s, Cuban scientists patent clear a vaccine opposite a lixiviate of bacterial meningitis B, which eliminated what had been a important ailment on the island. The Cuban vaccine is interpretationd throughextinguished Latin America. Succeeding extinguishedbursts of meningitis B in the Itemed Propounds, the U. S. Treasury Department supposing a permit in 1999 to an American promotive of the pharmaceutical society SmithKline Beecham to invade into a chaffer to educe the vaccine control interpretation in the U. S. and elsewhere. 7) ANALYSIS In 2006, BBC flagship fantastics guile Newsnight featured Cuba’s Sanityarrangement guile as portio of a course realizeing “the cosmos-people’s best social labors”.
The communication referableed that “Thanks chiefly to the American economic blockade, excluding portioly as-polite to the work of stfile rules and regulations that constrict Cuban morals, the arrangement is in a shocking mess: generally-knacknowledge proceeds per gathering is minuscule, and instrument are amazingly tidy. Sanitycare, eventually, is a apex generally-knacknowledge priority” The communication propoundd that morals confluence and infant decease objurgates are nforthhereafter the corresponding as the USA’s. Its trainer-to-resigned connections await comparison to any kingdom in Western Europe. Its annual completion sanity disburse per gathering, eventually, comes in at $251; fitting balance a tenth of the UK’s. The communication concluded that the population’s admiroperative sanity is single of the guide reasons why Castro is quiescent in faculty.
A 2006 poll carried extinguished by the Gallup Organization’s Requirea Rican inoculate — Consultoria Interdisciplinaria en Desarrollo (CID) — determined that encircling three-quarters of modish Cubans responded enactedly to the interrogation “do you possess reliance to your kingdom’s sanity arrangement guile”. In 2001, limbs of the UK Hointerpretation of Sordids Health Select Committee travelled to Cuba and issued a communication that remunerated customs to “the prosperity of the Cuban sanityarrangement guile”, grounded on its “strong seriousness on ailment thwartion” and “commitment to the custom of physic in a society”. CUBA’S COMPREHENSIVE HEALTH PROGRAM: 1. Confronting the Real Disaster • Direct covet-term medical arrangement • Applying lessons from Cuban experiment On-the-ground grafting of topical separatenel • Fruit and sharing of lore • Academic grafting control Cubans at intergenerally-knacknowledge sites • Trilateral treaty • Scholarships control medical information • 29 countries complicated (21 in Africa) 2. Direct Medical Labors – Strengthening Sanity Guiles • Bilateral synod accords, realize scarcitys • Bolster social sanity infrastructure, capabilities • Shared financial allegiance • Mainly unconnected, grassy postings • Separate commitment/institutional commitment • Collection of professionals sufficient to perform a distinction 3. Challenges and Opportunities – Bolstering Topical Social Sanity Guiles OpportunitiesChallenges ___________________________________________________________________ SustainabilityFrustration with topical infrastructure Growth inferiorstanding topicallyBend to topical opinions Covet-file perspective, inferiorstandingVulneroperative to govt changes, collective conciliate Horizontal awaitard, wide influenceIntegobjurgate perpendicular programs Growth staffing control sanity guileCreate felt scarcity in population Wide aptitude symmetricalMismatched, straight aptitude symmetrical 4. Grafting Professionals control Global Sanity • At balanceest 100,000 fantastic trainers by 2015 • Remedy Latin American Medical School • Cuba has determineded 11 medical schools and 2 nursing schools awide • Cuban professors train in a dozen others 5. Sanity Equity & Treaty: Challenges They Face $$ Instrument |Lacking |Wise interpretation (quiescent lacking…) | |Goals |Ailment driven |Healthy body driven | |Programs |Silos |Blankets | |Models |Stand-alsingle |Building sanity guiles | |Priorities |Donor driven |Operative topical leadership | |Investments |In buildings |In body | |Reach |Pilot programs |Scaling Up | |Way |Independent |Real treaty | |Movement |Band promotes |Change | 8) SOURCES • The Cosmos-body Sanity Organisation, and its tract-of-landal bifurcation, the Pan American Sanity Organization, inform disposely communications as polite as making grounds availoperative on the work. • Cosmos-body Sanity Organisation, Cosmos-body Sanity Statistics 2009 consists in-great-measure of boards (. df controlmat) of sanity indicators, control most countries, control clarified years betwixt 1990 and 2008. Cosmos-body Sanity Organisation, Generally-knacknowledge Accounts Course consists of statistics on the financing of sanity arrangement in diverse countries. Cuba boards covers years 1995-2007. • Pan American Sanity Organisation, Sanity birth in the Americas: Basic Indicators 2008. Board of sanity indicators control countries, single datum from a fresh year (2000-2008) control each indicator. Pan American Sanity Organisation, Sanity in the Americas 2007 is primarily a passage communication; as-polite contains boards. Chief separateity is on the tract-of-land as a gross, remedy separateity is communications on separate countries, including Cuba.