Health System in Cuba: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
22 September 1999
HEALTH SYSTEM IN CUBA: BRIEFING

SUMMARY
A Cuban delegation briefed the Committee on the health system in Cuba. Issues being addressed ranged from community health, HIV/AIDS related issues, education, budget and maintenance of the various health initiatives.

MINUTES
The Chairperson welcomed and introduced the Cuban delegation on their return visit to South Africa. Ms Nabaret (Member of Cuban Parliament) who was accompanied by the Cuban ambassador and others, gave the presentation.

Structure of Cuban Parliament:
Cuba has fourteen provinces, represented by 601deputies in the Parliament of Cuba, of which 27.6% are women. Parliament has 10 permanent Commissions (our equivalent of Committees). One Commission deals with Health, Cultural, Sports and Environment issues.

Health system in Cuba
The Ministry of Health greatest achievement has been free education and health for all after the success of the revolution. As a matter of interest Ms Nabaret noted that Cuba has 65 000 doctors and more than 10 000 dentists. Apart from clinics and hospitals, there a system of family doctors where in each community there is one doctor per 106 inhabitants. This doctor has one nurse and a house provided for by the government. The duties of this doctor include fieldwork outside his practice. This initiative was an important guarantee in the area of preventative medicine.

Furthermore Ms Nabaret hoped that everybody was aware of the two situations that Cuba has had to deal with in recent years. The fall of socialism and the blockade of US to Cuba. Due to these actions Cuba had great difficulty in obtaining medicines. The solution was to work hard at prevention, therefore this department had to introduce green medicine commonly known as herbal medicine in the country. Because of this the country has achieved a major breakthrough since the introduction of such vaccines and injections that many other countries use around the world. Secondly, the country had to do a lot of collaborative work with countries such as South Africa and Latin America. Examples are the 415 doctors that are currently working in South Africa and the scholarship scheme which allows many Latin American students to study medicine.

Fundamentally, however, the main objective of this department was to guarantee the health of people and this is believed to have been achieved. These achievements are visible from the following facts:
98% of Cuban population can attend and consult medical centres at all
levels,
98% of births happen in public institutions recognised by Government,
Infant death rate is 7.2%, in some provinces the rate is 0%
- Deaths of women giving birth is 2.6% in every 20 000 cases.
These indicators, Ms Nabaret believed, are similar to those of developed countries.

Questions from members
Ms Nqodi (ANC) asked for information regarding HIV/AIDS in Cuba and how do they deal with it.

The response was that currently, records indicate that Cuba has 500 cases of HIV/AIDS. Thus it is not such a big problem since Cuba has more than 1 million inhabitants. As far as treatment is concerned, doctors deal with this issue in centres that exist solely for that purpose. There is one clinic for every two provinces, thus seven clinics in the country. However this is very costly. Ms Nabaret noted that it is + 10 000 US$ for treatment per patient since special food and psychological attention is provided.

A member asked what methods does Cuba use to bring the mortality rate down, especially the maternal death rate.

Response: With regard to the maternal death rate, pregnant women are considered a very important and serious issue in Cuba. Therefore as soon as a woman is identified as being pregnant, follow-ups are conducted up until birth. She has to consult with her doctor on a regular basis (once a month). Free feeding, treatment and supplements (vitamins, etc) are provided. And if any pregnancy risks are indicated, these women are attended to. In addition to this, brigades of health are also appointed. They are women who visit pregnant women to ensure that they consult with their doctors and take the necessary supplements

Dr R. Rabinowitz (IFP) asked whether HIV/AIDS testing is perfomed routinely on women at clinics, prisoners, rapists and others. Also whether any treatment is given to people who are living with HIV. The response was that Cuban citizens are obliged to test themselves.

A committee member commented that is seems as though Cuba places great emphasis on community health, what about specialised treatment? And what is it the country does to have so many qualified doctors?

Response : Cuba has managed to have so many doctors because the education system established that all children should go to school, especially since education is free. However in order to study medicine all students have to write an entrance exam, these are evaluated and based on results. From there these students are placed in a certain specialised area of study. All the faculties of medicine are a priority since government has decided that the country must never lose doctors and teachers. For doctors do not only execute health issues in their respective communities but they are also teachers and instructors in their areas. They have to give community talks with pregnant women and the aged. Thus they are leaders in the community.
Regarding a follow-up of special treatment, given any sickness or treatment, the same consultation room is used but depending on the period of treatment different slots to attend are given to patients.

Another committee member noted that before the revolution Cuba was in the same position as many other underdeveloped countries. Could an inference be made that the revolution enabled Cuba to address the problems?

Response : The revolution has definitely enabled Cuba to achieve what it has achieved. For the revolution has eliminated various diseases associated with third world countries. Poliomyelitis and gastro-enteritis does not exist in Cuba. As for the infant death rate before the revolution, it was 140 per 1000 cases. Moreover before the revolution doctors often left the country and today Cuba has 60 000 doctors.

Ms Njobe (ANC), who has visited Cuba, commented that she was very impressed with all levels of the system of health. She was wondering what percentage of the budget is allocated to health. Secondly, since the breakdown of socialism as well as the US blockade, how were the initiatives to provide and develop its own medicine and do research sustained with no medical aid from other countries? Lastly, have the Cuban delegates met any Cuban doctors while visiting South Africa?

Response : The Government allocates as much funds as necessary to achieve their objective and most doctors are committed. She elaborated by informing the committee that people donate money spontaneously to the health fund, workers feel they need to give money for health and research centres do generate an income and have been able to sustain their projects.

About the budget, + 1, 6 million (Ed. Note: unverified figure) dollars is budgeted for health. This is because Cuba does not have private health, all is public.

As far as the development of the local industry and herbal medicine is concerned , the US blockade had a major influence on the shortage of medicine. For Cuba was not able to buy in US or anywhere else in the world. Fortunately talented scientists were able to produce and guarantee medicine for Cuba. And from there developed an interest in traditional medicine. Ms Nabaret claimed that this type of medicine is healthier.

The Cuban delegates will meet with some Cuban doctors in Mmpumalanga on Sunday.

A committee member just wanted to confirm whether the allegations are true that Cuba segregate people living with HIV/AIDS.
Response : AIDS patients, once detected, they are obliged to go to a clinic for sanitary and start their treatment. They are allowed to visit their family and families are allowed to visit them. Thus they are not isolated. Mr Costa, ambassador for Cuba, raised another important issue, institutional care for people living with HIV/AIDS. The reason why these clinics had been established is purely because of economical problems. Provinces do not have enough resources to provide services to all people living with HIV/AIDS. Therefore the government has decided to have all treatment needed at hand in one centre where HIV positive people can receive all the care they need. And if those that are HIV positive decide to visit their families they have to take their medication along.

Ms Nqodi (ANC) was wondering whether Cuba has any special school programmes. And as far as herbal medicine is concerned , she requested that Mrs Nabaret give a follow up.
Response : Yes ,most schools have a permanent doctor on the premises to attend to all matters concerned. Each province, which has a small piece of land, grow their own medicine. And for first aid skills everybody has to know what herb they can use.

Unfortunately due to time constraints the Cuban delegates could not be informed about the South African health issues.

Mrs Njobe (ANC) who was part of the South African delegates to visit Cuba commended Cuban government on their achievements and expressed how they have set an example and has been an inspiration for South Africa who is currently faced with equity in health. She then bid them a safe and happy trip.

The chairperson adjourned the meeting.