Healthcare System in Cuba

8)Sources 16 )HISTORY Modern western medicine has been practiced in Cuba by form every(prenominal)y traineddoctorssince at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world contrastingiate doctors, includingCarlos Finlay, whose mosquito-based theory ofyellow fevertransmission was given its final proof chthonic the direction ofWalter Reed,James Carroll, andAristides Agramonte. During the period of U. S presence (18981902) yellow fever was essentially eliminated due to the efforts ofClara Maassand surgeon Jesse W. Lazear.In 1976, Cubas wellness care program was enshrined in Article 50 of the revisedCuban constitutionwhich pronounces Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers by providing f ree dental care by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease.All the population cooperates in these activities and plans through the social and mass organizations. Cubas doctor to patient ratio grew signifi advisetly in the latter half of the 20th century, from 9. 2 doctors per 10,000 inhabitants in 1958, to 58. 2 per 10,000 in 1999. In the 1960s the government example a program of al most(prenominal) universalvaccinations. This helped eradicate many contagious diseases includingpolioandrubella, though virtually diseases change magnitude during the period of economic hardship of the 1990s, such astuberculosis,hepatitisandchicken pox.Other campaigns included a program to reduce the infant mortality rate in 1970 enjoin at maternal and prenatal care. 1. POST-SOVIET UNION The loss of Soviet subsidies brought famine to Cuba in the early 1990s. In 2007, Cuba anno unced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and medical examination Images. Cuba is the second domain in the world with such a product, only preceded by France.Cuba is preparing a Computerized health Register, Hospital Management System, Primary health Care, faculty member Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost look for-development projects. An grave connective in wiring process is to guarantee access to Cubas Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health ystem. 2)PRESENT WHOhealth statistics for Cuba SourceWHO country page on Cuba Life apprehension at birth m/f 76. 0/80. ( social classs) Healthy spiritedness expectancy at birth m/f 67. 1/69. 5 ( classs) Child mortality m/f 8/7 (per 1000) Adult mortalit y m/f 131/85 (per 1000) nub health expenditure per capita $251 Total health expenditure as% of GDP 7. 3 Rank Countries Statistic Date of surveyed Information 125 167 HIV/AIDS bad prevalence rate 0. 10% 2003 est. 162 175 Fertility rate 1. 66 (children/woman) 2006. 153 224 Birth rate 11. 9 (births/1,000 population) 2006 est. 168 226 Infant mortality rate 6. 04 (deaths/1,000 cash in ones chips births) 2006. 129 224 decease rate 6. 33 (deaths/1,000 population) 2005. 37 225 Life expectancy at birth 77. 23 (years) 2006. est 17 99 Suicide rate 18. 3 per 100,000 people per year 1996. 3)COMPARISON OF PRE- AND POST-REVOLUTIONARY INDICES Cuba Public health 1950-2005 Years 1. HEALTH INDICATORS AND ISSUES Cuba began a food rationing program in 1962 to guarantee all citizens a low-priced ring of basic foods.As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an sightly grocery store in the Uni ted States, but the Cuban citizen pays only $1. 20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 ki topical anestheticories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market. gibe to the Pan the Statesn Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories) Cuba, 3,286 America, 3,205 Latin America and the Caribbean, 2,875 Latin Caribbean countries, 2,593 United States, 3,754. The table on a lower floor shows the sexual relation seriousness of communicable diseases, non-communicable diseases (e. g. , heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004. Distribution of years of life lost by cause (%) Place Communicable Non-communicable Injuries Cuba 9 75 16 World 51 34 14 High income countries 8 77 15 United States 9 73 18 Low income countries 68 21 10 Source World Health Organisation. World Health Statistics 2009, send back 2, Cause-specific mortality and morbidity. Like the rest of theCuban economy, numerous reports kick in shown that Cuban medical care has long suffered from severe material shortages caused by theUS embargo. The ending of Soviet subsidies in the early 1990s has also affected it. Whilepreventive medical care,diagnostic testsandmedicationfor hospitalized patients are free, some aspects of healthcare are remunerative for by the patient.Items which are paid by patients who can afford it are drugs prescribed on anoutpatientbasis, hearing,dental, andorthopedicprocesses,wheelchairsandcrutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these ite ms are free of charge. 2. cozy HEALTH According to theUNAIDSreport of 2003 there were an estimated 3,300 Cubans living withHIV/AIDS(approx 0. 05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens forHIV. Those who tested confirmative were taken toLos Cocos and were not allowed to leave. The policy drew criticism from the United Nationsand was discontinued in the 1990s. Since 1996 Cuba began the production of genericanti-retroviraldrugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment. In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. TheUNAIDS inform that HIV infection rates for Cuba were 0. 1%, and for other countries in the Caribbean between 1 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by theCuban National Center for Se x Education. According toAvert, an internationalAIDScharity, Cubas epidemic remains by far the smallest in the Caribbean. They institute however that new HIV infections are on the rise, and Cubas preventive measures appear not to be keeping pace with conditions that favour the spread of HIV, including railroad siding income inequalities and a growing sex industry. At the same time, Cubas prevention of mother-to-child transmission programme remains highly effective. All pregnant women are tested for HIV, and those testing positive receive antiretroviral drugs. In recent years because of the rise inprostitutiondue totourism,STDs boast increased. 3. 3 EMBARGODuring the 90s the ongoingUnited States embargo against Cubacaused problems due to restrictions on the export of medicines from the US to Cuba. In 1992 the US embargo was made more stringent with the passage of theCuban Democracy Actresulting in all U. S. subsidiary trade, including trade in food and medicines, being prohibited . The legislation did not state that Cuba cannot purchase medicines from U. S. companies or their foreign subsidiaries however, such license requests have been routinely denied. In 1995 theInter-American Commission on Human Rightsof the Organization of American States informed the U. S. Government that such activities violate international law and has requested that the U. S. ake speedy steps to exempt medicine from the embargo. The Lancetand theBritish Medical Journalalso condemned the embargo in the 90s. A 1997 report prepared byOxfamAmerica and theWashington Office on Latin America,Myths And Facts About The U. S. Embargo On Medicine And Medical Supplies, concluded that the embargo forced Cuba to use more of its restrict resources on medical imports, both because equipment and drugs from foreign subsidiaries of U. S. firms or from non-U. S. sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cubas medical system. It prohibited foreign subsidiaries of U. S. orporations from selling to Cuba, thus further limiting Cubas access to medicine and equipment, and raising prices. In addition, the act forbids ships that dock in Cuban ports from docking in U. S. ports for six months. This drastically restricts shipping, and increases shipping cost some 30%. 3. 4 MEDICAL STAFF IN CUBA According to the World Health Organization, Cuba provides a doctor for every 170 residents, and has the second highest doctor to patient ratio in the world after Italy. Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1. 5 times the national mean. A doctors salary in the late 1990s was equivalent to about US$1520 per month in purchasing power.Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher. TheSan Francisco Chronicle, theWashington Post, andNatio nal Public Radiohave all reported on Cuban doctors defecting to other countries. 3. 5BLACK MARKET HEALTHCARE The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cubas burgeoningblack marketeconomy, sometimes termed sociolismo. According to former leading CubanneurosurgeonanddissidentDrHilda Molina, The doctors in the hospitals are charging patients under the table for better or quicker service. Prices for out-of-surgery X-rays have been quoted at $50 to $60.Such under-the-table payments reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the Special Period in the 1990s aggravated these payments. The advent of the dollar economy, a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans was able to obtain medications and health serve that wo uld not be available to them otherwise. 4)CUBA AND INTERNATIONAL HEALTHCARE In the 1970s, the Cuban state initiated bilateral service contracts and various money-making strategies.Cuba has entered into agreements withUnited Nationsagencies specializing in healthPAHO/WHO,UNICEF, theUnited Nations Food and culture Organization(FAO), theUnited Nations Population Fund(UNFPA), and theUnited Nations Development Fund (UNDP). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies Cuba currently exports considerable health work and personnel to Venezuela in exchange for subsidizedoil. Cuban doctors play a primary role in theMission Barrio Adentro (Spanish Mission Into the Neighborhood) social well-being program established in Venezuela under current Venezuelan presid entHugo Chavez.The program, which is popular among Venezuelas poor and is intended to bring doctors and other medical services to the most remote slums of Venezuela,has not been without its detractors. Operacion Milagro (Operation Miracle) is a joint health program between Cuba and Venezuela, set up in 2005. Human Rights Watchcomplains that the government bars citizens meshed in authorized touch off from taking their children with them overseas, essentially holding the children hostage to guarantee the parents return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics. Doctors are reported to be monitored by minders and subject to curfew.The Cuban government uses relatives as hostages to prevent doctors from defecting. According to a paper published inThe Lancetmedical journal, growing numbers of Cuban doctors sent overseas to work are defecting to the USA, some via Colombia, where they have sought temporary asylum. Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especially third world countries) following natural disasters. Currently dozens of American medical students are trained to instigate in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba. 4. 1HEALTH TOURISM AND PHARMACEUTICSCuba attracts about 20,000payinghealth tourists, generating revenues of around $40 million a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments includingeye-surgery,neurologicaldisorders such asmultiple sclerosisandParkinsons disease,cosmetic surgery, addictions treatment,retinitis pigmentosaand orthopaed ics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming.Cuba also successfully exports many medical products, such as vaccinums. By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around two percent of arrive tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splanic surgery wing anecdotal evidence suggests that this pattern is common in Cuban hospitals. 5) alternate(a) HEALTHCAREEconomic con agate linets and restrictions on medicines have forced the Cuban health system to incorporatealternativeandherbalsolutions to healthcare issues, which can be more accessible and low-priced to a broader population. In the 1990s, the Cuban Ministry of Public Health officially recognized natural andtraditional medicineand began its integration into the already well established Western medicine model. Examples of alternative techniques used by the clinics and hospitals includeflower essence, neural and hydromineral therapies,homeopathy,traditional Chinese medicine(i. e. acupuncturalanesthesia for surgery), natural dietary supplements,yoga, electromagnetic and optical maser devices.Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol), a natural product derived from sugarcane wax that is effective at reducing total cholesterin and LDL levels, and Vimang a natural product derived from the bark ofmango trees. 6)MEDICAL RESEARCH IN CUBA The Cuban Ministry of Health produces a number ofmedical journalsincluding theACIMED, theCuban Journal of Surgeryand theCuban Journal of Tropical Medicine. Because the U. S. government restricts in vestments in Cuba by U. S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs. In April 2007, the Cuba IPV Study Collaborative Group reported in theNewEngland Journal of Medicinethat inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kouri Institute, U. S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely s witch to killed vaccine and be protected from recurrent epidemics.Cuba has been free of polio since 1963, but continues with mass immunization campaigns. In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U. S. exchequer Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U. S. and elsewhere. 7)ANALYSIS In 2006,BBCflagship news programmeNewsnightfeatured Cubas Healthcare system as part of a series identifying the worlds best public services.The report noted that Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess national income per he ad is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority The report stated that life expectancy and infant mortality rates are nearly the same as the USAs. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251 just over a tenth of the UKs. The report concluded that the populations admirable health is one of the key reasons why Castro is still in power.A 2006 poll carried out bythe Gallup Organizations Costa Rican affiliate Consultoria Interdisciplinaria en Desarrollo (CID) found that about three-quarters of urban Cubans responded positively to the question do you have confidence to your countrys health care system. In 2001, members of theUKHouse of CommonsHealthSelect Committeetravelled to Cuba and issued a report that paid protection to the success of the Cuban healthcare system, based on its strong emphasis on disease prevention and commitment t o the practice of medicine in a community. CUBAS COMPREHENSIVE HEALTH PROGRAM 1. Confronting the Real Disaster Direct long-term medical care Applying lessons from Cuban experience On-the-ground upbringing of local personnel Development and sharing of research Academic training for Cubans at international sites Trilateral cooperation Scholarships for medical education 29 countries involved (21 in Africa) 2. Direct Medical Services Strengthening Health Systems Bilateral government accords, identify needs Bolster public health infrastructure, capabilities Shared financial office Mainly remote, rural postings Individual commitment/institutional commitment Numbers of professionals enough to make a difference 3. Challenges and Opportunities Bolstering Local Public Health Systems OpportunitiesChallenges ___________________________________________________________________ SustainabilityFrustration with local infrastructure Increase understanding locallyBend to local opinions Long-range perspective, understandingVulnerable to govt changes, political will Horizontal model, broad presenceIntegrate vertical programs Increase staffing for health systemCreate felt need in population Broad skill setMismatched, narrow skill set 4. Training Professionals for Global Health At least 100,000 new doctors by 2015 Second Latin American Medical School Cuba has founded 11 medical schools and 2 nursing schools abroad Cuban professors teach in a dozen others 5. Health candor & Cooperation Challenges They Face $$ Resources Lacking Wise use (still lacking) Goals Disease impelled Healthy people driven Programs Silos Blankets Models Stand-alone Building health systems Priorities Donor driven Effective local leadership Investments In buildings In people Reach Pilot programs Scaling Up Way Independent Real cooperation Movement rotary aids Change 8)SOURCES The World Health Organisation, and its regional branch, the Pan American Health Organization, publish regul ar reports as well as making information available on the web. World Health Organisation,World Health Statistics 2009consists mostly of tables (. df format) of health indicators, for most countries, for selected years between 1990 and 2008. World Health Organisation,National Accounts seriesconsists of statistics on the financing of health care in various countries. Cuba tables covers years 1995-2007. Pan American Health Organisation,Health situation in the Americas Basic Indicators 2008. control panel of health indicators for countries, one datum from a recent year (2000-2008) for each indicator. Pan American Health Organisation,Health in the Americas 2007is primarily a text report also contains tables. First section is on the region as a whole, second section is reports on individual countries, including Cuba.