The Cuban Health Care System

By A/Prof Gawaine Powell Davies

Fidel Castro is dead, and people are assessing his legacy: dictatorship and oppression on the one hand, the hero of Cuban independence and the creator of one of the most remarkable health and education systems on the other.

We saw this at first hand when I went to Havana with Unconventional Conventions, with a talk about primary health care reform. Not always the most popular topic with GPs, but as we visited a consultario (general practice) and a polyclinico (specialist health centre) and heard from a senior doctor in the Department of Health, we saw what a good primary health care system can achieve.

All Cubans are registered with a GP, a practice serves a defined community, a group of practices is supported by a Polyclinico with a wide range of specialist services, and a group of these refer to a single hospital.  There is a strong focus on preventive care and public health. All health care is free. Cuba provides medical training and personnel to other poor countries as a form of foreign aid.

Does it work? 
Despite low expenditure on health, Cuba ranks higher than its WHO region (and often higher than its nemesis, the USA) on most major health indicators, and the list of diseases eradicated from the country is impressive. Access to services is universal, choice of provider limited. Doctors are paid the same as taxi drivers, but among those that we met morale and a sense of public contribution was high.

With Castro dead and change on the horizon, this is a good time to see a very different health system which may or may not survive coming political changes.

A/Prof Gawaine Powell Davies from The Centre for Primary Health Care and Equity, UNSW Australia, spoke at the Unconventional Conventions Cuba 2010 Medical Conference. 


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