R2HR2Hin Cubain Cuba

Pol De VosPol De Vospdevos@itg.bepdevos@itg.be

From 1959 onwards

Cold War • continued USA aggression• long term USSR support

Comprehensive revolutionary changes• Housing• Working conditions (radical land reform)• Redistribution of income• Health• Education• Culture and sports• Defense

Consequences

– All Cubans: decent wage, improved nutrition, housing

– Electricity and tap water over the whole country

– Inhuman working conditions disappear (landlordism)

– Industrialization • Embargo and agressivity of USA

• Support of Soviet Union

– Alphabetization

– Education• development of all educational levels

• adult education: combination work & study

– Expansion of culture, art, science and sports

Human and social

Development

Production and

distribution of wealth

Socio-political Economic

CUBAN REVOLUTIONPolitical will

Health as a human right and as a state policy

Investment In social

development

Development of health

system and services

Management of human and social capital

ParticipationSocial

networksEmpowerment

Production and

distribution of wealth

Inter-sectorial action promoted by state and directed by health sector

ENVIRONMENT

LIFESTYLES

HUMAN BIOLOGY

Health and well-being

Cuba: health (care) for all

1960s – Ensure access to medical services for all

1970s – Community medicine

1980s – Family medicine

Since 1990s – Reforms and

adjustments

Development of Cuban health system

1990s: Coping with economic crisis

Economic and social measures : a participatory process• Taken step by step

• After a broad consensus process (over > 3 years)– Discussions in neighborhoods and working places

– Only broadly accepted proposals were put in practice

• Implemented:– Legalization of US-Dollar

– Selected joint-ventures (tourism, mining,…)

– Peasant markets

– Higher payments for telephone, gas, electricity

• Not implemented– Introduction of tax-payment

1989 20101995 2002

GDP – 35% Imports – 70 %

27 169 FDrs 96.2% coverage

8 965 FDrs 46.9 % coverage

30 726 FDrs 99.2% coverage

37 645 FDrs INT COOP +++

Cuba from 1990 onwards

Torricelli act

Breakdown Soviet Union Helms-Burton

Law

Unified public national health system maintained+ Integrated system - Stability of F.Dr. in community + Free access - Lack of resources+ Comprehensive care - Availability of drugs

+ Continuous care - Technology

+ Adequate health outcomes

Results of crisis management 1990s

>< Venezuela (1989) – Ecuador (1997,2000,2005) – Argentina (2001)

• Structural determinants remained priority, but eroded…– severe decline in living standards – deterioration of nutritional status – (limited) resurgence of (almost) eliminated diseases (tb)– vitamin deficiency -> epidemic neuropathy

• Health system – Remains state priority

• exclusively public (no privatizations)• Accessible, holistic, and integrated services of good quality• Free at the point of delivery

– Central in limiting consequences of declining living standards

After 2000

• Continued economic strain– US enmity and embargo remains– Alliance with Bolivarian Venezuela

• Intensive collaboration in health• Oil • Industrial collaboration

• 2011: new economic measures– Decreasing role of de state– Increasing disparities in income (dual currency) – Health system maintained but under strain

Health system today

• Cuban national health system – exclusively public

– free at point of delivery

• FLHS: Family Dr = entry point– well-defined population of

responsibility

– holistic and integrated approach

Health Area (30.000 inh)

Family Doctor1000-1500 inh

policlinic

referral hospital

13

International Cooperation in health

• 40.000 Cuban professionals are working in 105 countries• 80% (+ 30 000) work in the health sector in 68 different

countries• Cuba trains medical students from many of the

poorest regions to serve their communities– Actually 35 out of 54 African countries have medical students

being trained in Cuba

• Important support in health care delivery in many countries– limitations to overcome (integration)

14

Emergency Aid: Brigade Henry Reeve Katrina – 2005 – New Orleans

15

International health policy debate

• Cuba = one of the few important international health players that actively oppose neo-liberal privatization and profit in health services

• Defends development of accessible, qualitative and responsive public health services – counterexample of idea that “public services can’t function”– important example to defend “public rationale” in other contexts

DL1 14.30-17.00 hrsEmpowerment

Centro Habana, Cuba:

“Empowerment through multisectorial action”