Cooperation for Health:
The Cuban Experience
Gail A. Reed
International Director, MEDICC
April 25, 2007
“An evaluation of 25 countries in
the Americas measuring relative
inequalities in health revealed that
Cuba is the country with the best
health situation in Latin America
and the Caribbean. It is also the
country which has achieved the
most effective impact with
resources, though scarce, invested
in the health sector”
(Study on Human Development and
Equity in Cuba, UNDP, 1999)
CUBA
Cuba:
Key Health Indicators - 2003
Region
Infant Mortality*
Under 5 Mortality*
World
56
81
Most developed
8
10
Developing
61
89
Least developed
97
161
Latin America & Caribbean
32
41
Cuba
5.8
7.7
Source: United Nations, 2003 and Anuario Estadístico de Salud
*per 1,000 live births
Human Resources for Health
Fortify the system’s scientific and ethical vitality among new leaders
• Outstanding Graduates program
Train more health care professionals (2005)
• Total health workers: 447 023
• Total physicians: 70 594 (1x159 inh.)
• Nurses x 10.000 inh.: 79.5
2006 – 2007 (January 2007)
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•
•
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Medical school enrollment: 24 682
University nurse enrollment: 45 319
Allied health enrollment: 73 620
Clinical Psychology: 1445
Share lessons and expertise with other developing countries
Global Cooperation:
Scaling Up to Meet the Crisis
•
•
•
•
•
Research Applied to Prevention
Treating Low-Income Patients in Cuba
Disaster Risk Reduction & Relief
Cuban Medical Teams Abroad
Training Doctors for Global Health
Treating Low-Income Patients in Cuba
•
>500,000 eye surgeries in Cuba (2004-2006)
(including >70,000 Cubans)
•
Patients from 29 countries
•
Vision restoration projected for 6 million in the next decade
Cuban International Disaster Relief
1960-2000
1960 Chile
Earthquake, 5,000 dead
Medical team
1970 Peru
Earthquake, 60,000 dead
Medical team, 6 rural hospitals,
106,000 blood donations
1972 Nicaragua
Earthquake, 5,000 dead
Medical team, food, medicines
1974 Honduras
Hurricane Fifi, 2,000 dead
Medical team
1990 Soviet Union
Chernobyl disaster program
17,733 children treated in Cuba
through October, 2004
1996 Brazil
Radiation poisoning
52 patients treated in Cuba
1998 Central
America
Hurricane Mitch,
30,000 dead and disappeared
Medical teams
1998 Haiti
Hurricane Georges
Medical team
1999 Venezuela
Torrential rains, mudslides,
9,000 dead
Medical team
2000 El Salvador
Dengue epidemic,
10,000 cases over 16 wks.
Medical team, advisors
and equipment
Disaster Risk Reduction & Relief
• Katrina sparks Henry Reeve Contingent:
5,000 specially trained medical personnel
• UN Designates Cuba as Regional Disaster
Preparedness Hub
The Henry Reeve Contingent
2005-2006
October 2005
Pakistan
Earthquake, 75,000
dead. 3.3 million
homeless.
2.465 medical team
32 field hospitals
(7 months)
October 2005
Guatemala
Hurricane Stan, 670
dead. 300.000
homeless.
600 medical team and
medicines
(3 months)
February 2006
Bolivia
Flooding
140 medical team
20 field hospitals and medicines
June 2006
Indonesia
Earthquake, 6000
dead.
135 medical team
2 field hospitals
Continuous Care Medical Teams
Began with newly independent
Algeria,1963
Cuban International Medical Cooperation
1963-2006
100,000 Cuban health professionals
in 101 countries
Region
Countries
Africa
38
Americas
37
Europe
8
Asia/Mideast
18
TOTAL
101
February, 2007: 29,809 Cuban health
professionals in 69 countries
Source: International Cooperation Unit, Ministry of Public Health, Havana
Cuban Medical Teams Abroad
“We were particularly attracted to the Cuban
doctors because we knew of the type of health
system that they’d built in Cuba with limited
resources; and the underlying philosophy of
primary health care was the same we’re aspiring
to introduce for our own health system. The
Cubans became in fact very good role models.”
Ayanda Ntsaluba, MD, MPH,
Director General Foreign Affairs, South Africa
Turning the Corner:
Cuba’s Family Doctor Program
Family medicine put to the test:
Healthy people in a resource-scarce
environment
Evolution of community-based
models:
Maximizing lessons for other
developing countries
Turning the Corner:
From Cooperation to Sustainable Assistance
1998:
Hundreds of health professionals sent
to Central America and Haiti
in the wake of Hurricanes
Georges and Mitch.
Cuba’s Comprehensive Health Program:
Confronting the Real Disaster
• Direct long-term medical care
• Applying lessons from Cuban experience
• On-the-ground training 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)
Direct Medical Services:
Strengthening Health Systems
• Bilateral government accords,
identify needs
• Bolster public health infrastructure,
capabilities
• Shared financial responsibility
• Mainly remote, rural postings
• Individual commitment/institutional
commitment
• Numbers of professionals enough
to make a difference
Challenges and Opportunities:
Bolstering Local Public Health Systems
Opportunities
Challenges
____________________________________________________________________
Sustainability
Frustration with local infrastructure
Increase understanding locally
Bend to local opinions
Long-range perspective, understanding
Vulnerable to govt changes, political will
Horizontal model, broad presence
Integrate vertical programs
Increase staffing for health system
Create felt need in population
Broad skill set
Mismatched, narrow skill set
Direct Medical Services:
Professionals Only
• Mainly family doctors
at primary care level
• Other specialists at primary,
secondary levels
• Other disciplines:
biostatistics, epidemiology,
electromedicine
Lessons from the Cuban Health Care Experience:
Patient-Based and Population-Based
• “Guardians of health”
in geographic area
• Marrying clinical medicine
and public health practice
• Risk factor diagnosis/health
situation diagnosis
• Measure outcomes
Training Local Health System Personnel
• Midwives
• Continuing medical education
for nurses, others
• Biomedical Engineering
• Health statisticians and systems
managers
• Health promoters
Research:
Development and Sharing
• Disease-specific: cholera, malaria, genetically-based
• General epidemiological
• Scientific forums
• Advice in specific fields
Cuban Academic
Training at
International Sites:
Outstanding
Graduates Program
Trilateral Cooperation
• Haiti
• Honduras
• South Africa
• HIV/AIDS offer
Scaling up:
The Latin American Medical School (1998)
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29 countries
•
10,000 students,
3,000 first graduates (05-06)
•
100 indigenous populations
•
51% women
•
Low-income students
•
Commitment to serve
•
Sustainability
Different from Previous Scholarships:
Aiming for Sustainability
• Student selection:
poor, indigenous, marginalized
• Bridging program
• Training geared to country of origin
• Looking for commitment to underserved
• Eventually replace Cuban doctors
in-country
Training Doctors for Global Health
“I think the Cuban system of training could serve
as an example to the rest of the world if we wish
to have functioning health systems in the future.
The Cuban system trains doctors for
communities, willing to sacrifice for the welfare
of others. I think there is a need for such a
paradigm shift.”
Nestor Shivute, MD,
WHO Country Representative, Gambia
Training Professionals for Global Health
Profession
International Enrollment 2006-2007
Medicine
23,567*
Dentistry
80
Nursing
128
Allied Health
383
Residencies
704
TOTAL
24,862
Source: Minsap, March 2007
* Includes 12,600 medical and pre-med in new program.
Training Professionals for Global Health
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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
Human Resources for Health:
The Africa Program
• Medical Schools in Africa
• The South Africa model
Scaling up:
Esmeralda, University in the Amazon
Health Equity & Cooperation:
Challenges We Face
$$ Resources
Lacking
Wise use (still lacking…)
Goals
Disease driven
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
Band aids
Change
“We are still challenged to be dissatisfied.
Let us be dissatisfied until every man can have food and material
necessities for his body, culture and education for his mind, freedom
and human dignity for his spirit.…
Let us be dissatisfied until the empty stomachs of Mississippi are
filled, and the idol industries of Appalachia are revitalized.
Let us be dissatisfied until our brother of the Third World—Asia,
Africa, Latin America—(is) lifted from the long night of poverty,
illiteracy and disease.
Let us be dissatisfied until brotherhood is no longer a meaningless
word at the end of a prayer, but the first order of business on every
legislative agenda.”
Dr. Martin Luther King, Jr
February 23, 1968