Healthcare System in Cuba

8)Sources 16 )HISTORY innovative horse opera medicinal drug has been practiced in Cuba by mouldally expertdoctorssince at least the beginning of the 19th century and the first surgical clinic was completed in 1823. Cuba has had many world class doctors, includingCarlos Finlay, whose mosquito-based theory of yellowish fevertransmission was given its final proof under the commissioning ofWalter Reed,James Carroll, andAristides Agramonte. During the period of U. S presence (18981902) yellow fever was fundamentally eliminated overdue to the efforts ofClara Maassand surgeon Jesse W. Lazear.In 1976, Cubas wellnessc ar syllabus was enshrined in Article 50 of the revisedCuban constitutionwhich republics E reallyone has the right to wellness protection and c atomic number 18. The call down guarantees this right by providing free medical and hospital tending by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized i ntercession c interjects by providing free dental mete out by promoting the wellness promotion campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the extravasation of indisposition.All the population coope aims in these activities and plans through the social and mass organizations. Cubas doctor to enduring ratio grew significantly 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 administration implemented a program of al retributive just ab out universalvaccinations. This helped eradicate many transmitted diseases including infantile paralysisandrubella, though slightly diseases increased during the period of economic disappointment of the nineties, such astuberculosis,hepatitisandchicken pox.Other campaigns included a program to disregard the infant fatality treasure roll in 1970 directed at enatic and prenatal care. 1. POST-SOVIET UNION The loss of Soviet subsidies brought famine to Cuba in the earlier 1990s. In 2007, Cuba announced that it has underinterpreted computerizing and creating national networks in Blood Banks, Nephrology and medical Images. Cuba is the aid country in the world with such a crossway, only preceded by France.Cuba is preparing a Computerized wellness Register, Hospital Management System, Primary health Care, pedantic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban slew, increase exchange among experts and boost research-development projects. An significant link in wiring process is to guarantee access to Cubas information Transmission Network and health Website (INFOMED) to all units and workers of the national health ystem. 2) give WHOhealth statistics for Cuba SourceWHO country page on Cuba Life presentiment at birth m/f 76. 0/80. ( grades) sanguine bread and bu tter expectancy at birth m/f 67. 1/69. 5 ( divisions) fry mortality m/f 8/7 (per 1000) Adult mortality m/f 131/85 (per 1000) thorough health expenditure per capita $251 Total health expenditure as% of GDP 7. 3 Rank Countries Statistic exit of surveyed Information 125 167 HIV/AIDS adult 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 bang births) 2006. 129 224 Death 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 pabulum rationing program in 1962 to guarantee all citizens a low-cost basket of basic foods.As of 2007, the government was spending about $1 zillion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, nevertheless the Cuban citizen pays only $1. 20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small inwardness of meat. It provides about 30 to 70 percent of the 3,300 ki topical anaestheticories 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 bear gardens, and the black market. fit to the locomote the Statesn wellness brass, daily caloric dream 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 elude under shows the relative seriousness of communicable diseases, non-communicable diseases (e. g. , heart disease and cancer) and injuries, in various parts of the world. Data is fro m the populace wellness Organisation and is for year 2004. Distribution of years of life alienated by cause (%) Place Communicable Non-communicable Injuries Cuba 9 75 16 initiation 51 34 14 High income countries 8 77 15 United States 9 73 18 Low income countries 68 21 10 Source macrocosm Health Organisation. World Health Statistics 2009, Table 2, Cause-specific mortality and morbidity. Like the rest of theCuban sparing, legion(predicate) handles come shown that Cuban medical care has long suffered from severe bodily shortages caused by theUS ban. The ending of Soviet subsidies in the early 1990s has in addition affected it. Whilepreventive medical care,diagnostic testsand musicfor hospitalized long-sufferings are free, some aspects of healthcare are paid 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 i tems at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. 2. SEXUAL HEALTH According to theUNAIDS underwrite of 2003 there were an estimated 3,300 Cubans living withHIV/AIDS(approx 0. 05% of the population). In the mid-1980s, when small was known about the virus, Cuba compulsorily tested thousands of its citizens forHIV. Those who tested absolute were taken toLos Cocos and were not allowed to leave. The policy drew criticism from the United Nationsand was stop in the 1990s. Since 1996 Cuba began the production of genericanti-retroviraldrugs reducing the cost to well below that of developing countries. This has been make 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 describe that HIV contagious disease rates for Cuba were 0. 1%, and for other countries in the Car ibbean mingled with 1 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by theCuban matter Center for conjure up Education. According toAvert, an internationalAIDScharity, Cubas epidemic trunk by far the smallest in the Caribbean. They add however that new HIV infections are on the rise, and Cubas preventive measures appear not to be retentivity pace with conditions that favour the spread of HIV, including widening income inequalities and a growing fire industry. At the aforementioned(prenominal) time, Cubas prevention of mother-to-child transmission programme remains highly effective. All pregnant women are tested for HIV, and those testing positive dupe antiretroviral drugs. In recent years because of the rise in prostitutiondue totourism,STDs put one across 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 em bargo was made more stringent with the passage of theCuban Democracy Actresulting in all U. S. subsidiary trade, including trade in food and medicines, being proscribed. The mandate did not state that Cuba cannot purchase medicines from U. S. companies or their foreign subsidiaries however, such demonstrate 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 integrity and has requested that the U. S. ake immediate steps to exempt medicine from the embargo. The Lancetand theBritish Medical Journal as well as 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 limited resources on medical imports, two because equipment and drugs from foreign s ubsidiaries 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 dock 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 mo highest doctor to patient ratio in the world after Italy. Medical professionals are not paid high salaries by international standards. In 2002 the mean periodic 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, s ome take to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher. TheSan Francisco Chronicle, theWashington Post, andNational 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 case in Cubas burgeoningblack marketeconomy, sometimes termed sociolismo. According to former leash 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 sub-rosa payments reportedly date back to the 1970s, when Cubans used gifts and tips in order to take away health benefits. The harsh economic downturn known as the particular(prenominal) Period in the 1990s aggravated these payments. The advent of the dollar economy, a fugi tive 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 service that would 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 Agriculture Organization(FAO), theUnited Nations Population strain(UNFPA), and theUnited Nations Development Fund (UNDP). Since 1989, this collaboration has played a very historic office 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 service and personnel to Venezuela in exchan ge for subsidizedoil. Cuban doctors play a primary role in theMission Barrio Adentro (Spanish Mission Into the Neighborhood) social welfare program established in Venezuela under current Venezuelan presidentHugo Chavez.The program, which is touristy 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 exclude citizens engaged in authorized excursion from taking their children with them abroad, essentially retentivity 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 backbreaking defectors and silencing critics. Doctors are reported to be monitored by minders and subject to curfew.The C uban 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 assist 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. hostile p atients travel to Cuba for a wide range of treatments includingeye-surgery,neurologicaldisorders such asmultiple sclerosisandParkinsons disease,cosmetic surgery, addictions treatment,retinitis pigmentosaand orthopaedics. 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 asvaccines. By 1998, correspond to the Economic Commission for Latin America and the Caribbean, the Cuban health orbit had risen to occupy around two percent of total tourism. few of these revenues are in turn transferred to health care for ordinary Cubans, although the sizing and importance of these transfers is both unknown and controversial. At one nationally striking hospital/research institute, hard currency payments by foreigners have financed the plait of a new bathroom in the splanic surgery wing anecdotic evidence suggests that this pattern is common in Cuban hospitals. 5)ALTERNATIVE HEAL THCAREEconomic constraints and restrictions on medicines have forced the Cuban health system to incorporate secondaryandherbalsolutions to healthcare issues, which can be more accessible and cheap to a broader population. In the 1990s, the Cuban Ministry of Public Health officially accept natural andtraditional medicineand began its integration into the already well established Western medicine model. Examples of alternating(a) techniques used by the clinics and hospitals include acme essence, neural and hydromineral therapies,homeopathy,traditional Chinese medicine(i. e. acupuncturalanesthesia for surgery), natural dietary supplements,yoga, electromagnetic and laser 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 cholesterol and LDL levels, and Vimang a natural product derived from the bark ofmango trees. 6)MEDICAL RESEARCH IN CUBA The Cuba n Ministry of Health produces a number ofmedical journalsincluding theACIMED, theCuban Journal of Surgeryand theCuban Journal of Tropical Medicine. Because the U. S. government restricts investments 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 inoculate children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kouri Institute, U. S. Centers for distemper 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 us ing 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 switch 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. by and by outbreaks of meningitis B in the United States, the U. S. Treasury 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) compend In 2006,BBCflagship news programmeNewsnightfeatured Cubas Healthcare system as part of a series identifying the worlds best public services.The report noted th at Thanks chiefly to the American economic blockade, but partially also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess national income per head is minuscule, and resources are astonishingly 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 military commissiontravelled to Cuba and issued a report that paid tribute to the success of the Cuban healthcare system, based on its strong emphasis on disease prevention and commitment to the practice of medicine in a community. CUBAS COMPREHENSIVE HEALTH PROGRAM 1. Confronting the Real contingency Direct long-term medical care Applying lessons from Cuban experience On-the-ground grooming of local personnel Development and sharing of research Academic bringing up for Cubans at international sites Trilateral cooperation Scholarships for medical education 29 countries twisty (21 in Africa) 2. 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 3. Challenges and Opportunities Bolstering local anaesthetic Public Health Systems OpportunitiesChallenges ___________________________________________________________________ SustainabilityFrustration with local infrastructure adjoin 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 attainment 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 Equity & Cooperation Challenges They wait $$ Resources Lacking Wise use (still lacking) Goals Disease operate Healthy people driven Programs Silos Blankets Models Stand-alone Building health systems Priorities Donor driven Effective local leadership Investme nts In buildings In people seduce Pilot programs Scaling Up Way Independent Real cooperation motility Band aids Change 8)SOURCES The World Health Organisation, and its regional branch, the Pan American Health Organization, publish regular reports as well as making data 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. Table 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 sec tion is reports on individual countries, including Cuba.