A Global Village
Issue 2

Cuban Healthcare Revolution

The Future of International Healthcare?

Rahma Elmahdi, Imperial College London

The Cuban healthcare system is renowned for being one of the most effective healthcare systems in the world today with life expectancies equal to those of some of the world’s leading economies. Cubans have for some time been making a push to reach out far beyond their small island borders in order to export their methods of disease prevention and treatment worldwide, particularly in the developing world where their influence is greatest. Should we be advocating the expansion of health programs implemented by a country with such a long history of tyranny and authoritarian control? 

A leader medical philanthropy, Cuba has long led the way in healthcare schemes both at home and abroad. Despite fears of a Cuban disrespect for both patient and worker rights, such schemes have proved immensely successful in both short-term crisis management and long-term healthcare in some of the most impoverished countries in the world. Cuban standards may not live up to those of some developed countries, but should we stand in the way of a new approach to international healthcare, one that has been so successful in practice?

In 1991 Cuba was a country in ruins. The collapse of the Soviet Union meant the end of the subsidies upon which the country had relied for so long to provide food, fuel and healthcare for its citizens. This was further compounded by the crippling embargo imposed upon the country by the United States who, at the time, was attempting to make a clear stand against the fallen communist colossus and all who were associated with it. This period was devastating for Cuba and many of its supporters as the Cubans were already at this time well recognised in the Caribbean, Latin America and Africa for health and humanitarian programmes which were specifically targeted at the most deprived communities in the world. All such international assistance provided by Cuba came to a halt and this time became known as Cuba’s ‘Special Period’.

Cuban standards may not
live up to those of some
developed countries, but
should we stand in the way
of a new approach to
international healthcare?

Since the 1990s, however, Cuba has been able to foster a strong economic recovery, despite the ongoing US embargo, through opening its borders to foreign visitors and allowing limited free-market trade. This has enabled the Cubans to finance the rebuilding of their own healthcare system, training a greater number of doctors and nurses and providing a ratio of one doctor to every 175 people, one of the best doctor to population ratios in the world. Today Cuba is again a force in healthcare both at home and around the world.

“Cuba should be the envy of many other nations … Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy.”
Kofi Annan, Secretary General of the United Nations, 2000

Doctor Diplomacy
Cuban medical internationalism, otherwise known as ‘doctor diplomacy’, was a Cuban programme founded after the Cuban Revolution in 1959 that is aimed at exporting Cuban health practices and practitioners to developing nations. Rooted both in foreign policy objectives, including Cuba’s policy of supporting anti-colonial struggles of the 1960s, and humanitarianism, the programme today sees 50,000 healthcare personnel working globally each year.

One of the first countries active in medical crisis operations, in 1960, 1972 and 1990 Cuba dispatched emergency assistance teams and medical professionals to provide support to struggling national governments after major earthquakes in Chile, Nicaragua and Iran, arriving on the scene well before developed world parties. In 1963 Cuba was again one of the only countries to send a medical brigade to Algeria where the country was suffering hugely in the wake of a long war for independence.

Following the dramatic events of the early 1990’s, Cuba has gradually returned to its former international healthcare provision. In 2004 medical teams were sent to Sri Lanka after the Asian tsunami. In 2005 Cuba prepared to send a ‘brigade’ of 1,500 doctors to New Orleans in the wake Hurricane Katrina; this offer was declined however by the former US president George Bush. After the recent earthquake in Haiti the Cubans were one of the first to set up medical facilities to assist the injured. These efforts would be considered uniquely philanthropic if carried out by any of the world’s developed nations but what makes it exceptional in this case is that Cuba has a minute fraction of the GDP of a developed nation such as the UK.

Cuba to the Rescue
Humanitarian crises, although devastating when they occur, are few and far between. That is why, since 1998, the Cuban Comprehensive Health (CPH) programme has formed the cornerstone of Cuban international health cooperation. This programme has allowed the Cubans to move towards the establishment of durable international healthcare provisions and runs alongside its international relief programme. The CHP aims to promote international solidarity and bolster the public health infrastructure of a country through staffing local clinics and hospitals with Cuban medical teams.

The programme runs in 27 countries in Latin America, Africa and Asia and as a result there are now health workers providing medical care and assistance for some of the most isolated and deprived populations in the world. Indeed, in several countries such as Honduras, Guatemala and Mali, Cubans have been the first bearers of local physician services to rural, indigenous and other marginalized communities.

Workers providing medical care
and assistance for some of the
most isolated and deprived
populations in the world

The Cuban approach combines population based public health principles and preventative programmes with clinical medicine, formulating long-term healthcare initiatives and taking these directly to the populations where it’s needed. Since its foundation, the CHP is estimated to have sent 3,446 health professionals to participating countries. These personnel have carried out over 96 million patient visits, saved 1.8 million lives in the poorest parts of the world and greatly improved the quality of life of many more.

Patient Matters
This seemingly harmonious solution to the world’s health needs is not without its critics. A case which is often cited as an example of the dangers of exporting Cuban style healthcare was the Cuban government’s use of so-called sanatoria during the early years of the AIDS epidemic. In these health resorts HIV positive individuals experienced mandatory quarantine, kept out of contact with the general population. This raised many questions surrounding individual rights, specifically Cuba’s historically documented disregard of these. Although the Cuban press is keen to point out that the country has the lowest level of HIV prevalence in Latin American at 0.1%, with the regional average being 2.5%, many Cubans still complain privately about patent rights in choice of medical treatment and more general healthcare decision-making. There is no right to privacy or refuse treatment, including for religious or ethical reasons. Accusations of malpractice are also outlawed. A certain disregard for what are considered basic civil liberties in most of the developed world has led many to speak out against the spread of Cuban-style healthcare.

There have also been claims that Cuban doctors sent abroad are ill treated, subject to very low wages, tight supervision and curfews. They are actively discouraged from remaining abroad, their family and children restricted to Cuban soil.

“(The Cuban government) bars citizens engaged in authorized travel 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.”
Human Rights Watch

Availability of funding and resources also presents an obstacle to the CHP. These programmes are implemented in the most deprived countries in the world and consequently the facilities available to Cuban healthcare professionals are often poor with frequent absences of essential drugs and of clinical equipment. These problems have been tackled to a large extent with increased efficiency, improved logistics and human resource management.

The Future of International Healthcare
For many, however grave external concerns are, the programme produces excellent results. An extensive list of countries that have benefited from the CPH and Cuba’s other relief programmes. Indeed, many argue that this is the future of international healthcare for the poorest countries in the world; they contend that a Cuban approach achieves great results despite extremely limited resources.

The Cuban programmes are unlike the usual aid and development programmes implemented by developed countries and large NGOs that require significant investment and are very often limited by political considerations. Cuba instead works in cooperation with the poorest countries embracing the ideas of international fraternity and philanthropy. This concept would once have been regarded as naïve and impracticable but the Cuban’s have made it a reality for so many. The question is now: can they convince the rest of the world of this?

Rahma Elmahdi is a third year undergraduate medical student at Imperial College with an interest in global health.

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