Memorandum by Professor Patrick Pietroni
CUBAN HEALTH CARE SYSTEMS AND ITS IMPLICATIONS
FOR THE NHS PLAN
Over the last 10-15 years several reports 1-5
and papers in international journals have described the organisation
and benefits of the Cuban Health Care system with special reference
to Primary Care. As a result of the more recent changes to the
organisation of Health and Social care proposed by both this and
the previous Government; one of us (Professor P C Pietroni) undertook
an extensive visit to Cuba hosted by the Ministry of Health, and
undertook an analysis of the health care system. Following this
visit a study tour/conference was held in Havana in March 2000,
attended by over 100 UK doctors including Department of Health
officials, the President of the Royal College of General Practitioners
and several senior academics, including Chairs of Primary Care
Groups. This visit has generated a further series of contacts
and in October 2000 the UK hosted a visit by the Vice-Minister
of Health who was received by our Under Secretary of State for
Health. A further study tour/conference is planned for April/May
2001 and numerous individual exchange visits have been organised
including "twinning" of health centres in the UK and
polyclinics in Cuba.
The purpose of this briefing is to bring to
the attention of the committee the very important developments
that have occurred in the Cuban Health Care system, their impact
on health care statistics and the lessons the UK could learn,
especially at this time of maximum change to the NHS.
(1) Integration of Public Health and Primary
There appears to be little evidence of a divide
between the prevention/proactive response and the disease management/reactive
response and Cubans were surprised to hear of the divide existing
in the UK.
(2) Doctor-Patient ratio
By far the biggest difference:
1 doctor per 175 people;
1 GP per 600 (UK 1:1800)
The GPs are spread throughout the population
and are supplied with housing, as are the nurses.
(3) Generalist emphasis on medical education
The curriculum was altered in the 80's to ensure
that over 90 per cent of all graduates completed three years in
General Practice. There is a commitment to the triple diagnosis
(physical/psychological/social) at all levels. Frequent appraisals
and revalidation has been the norm for two years.
(4) Collection of data at "front-line
Although not equipped with the level of IT found
in the UK, the Cuban Health Care practitioners have a passion
for data and statistics which they use frequently for audit and
clinical governance purposes.
(5) Integration of hospital/community/primary
The smaller sizes of the communities has allowed
for a vertical integration of Primary and Secondary carebut
with a feature as yet sparsely found in the UK. Each Polyclinic
(supporting 10-15 family practices) has a series of community
based specialists (paediatric, gynaecology, dermatology, psychiatry)
which reduce the referral rate to hospitals and lead to an almost
non-existent waiting list.
(6) Multi-professional approach and good
Team-work that works is much more evident both
in the community and the hospital sector and the mental-health
and care of the elderly sites visited were very well staffed and
(7) Managerial system without professional
All sites we visited were managed and led by
professional practitioners (doctors and nurses). This was true
of the Ministry of Health officials as well as the Ministers.
(8) Extensive involvement of "patient"
and the public in decision making at all levels
The context of the Cuban revolution and the
local social structures developed have led to the continuous involvemement
of the public in the health care system. This is seen not as the
"icing on the cake" but very much part of the cake itself.
(9) Central government supportpolitical
Very many of the features identified in 1-8
would not have occurred had there not been an obvious commitment
to health provision by the President Fidel Catro. This is demonstrated
not only in the personal interest he takes, but in the protection
and proportion of the budget given the health care. During the
"special period" following the collapse of the Cuban
economy as a result of the break up of the Soviet Unionthe
health and education budgets were protected from the general reduction
(10) Features that caused concern
Poor facilitiesbuildings in
poor state of repair.
Poor provision of equipment.
Frequent absence of essential drugs.
Concern regarding freedom of choice
both for patient and doctor.
(a) UK Government supports the continuation
of visits between Health-Care Practitioners from both countries
including officials from the Department of Health.
(b) UK Government works towards a Ministerial
visit from the UK to Cuba.
(c) UK Government establishes a fund to
support the provision of technical and pharmaceutical supplies
(d) UK Government brings influence to bear
to repeal the Helm-Burtor act and lift the blockade.
(e) UK Government joins other EC countries
in establishing tri-partite agreements with Cuba and third world
1. Primary Care in Cuba: low and high technology
developments pertinent to family medicine; Waitzkin H, Wald K,
Kee R, Danielson R, Robinson L. Journal of Family Practice.
45(3):250-8, 1999 Sep.
2. Health Care in Cuba: A health care system
dedicated to health and healing in Cuba and in the world. Prepared
by the Interreligious Foundation for Community Organization (IFCO)/Pastors
3. UpdateCuba: on the road to a family
medicine nation. Journal of Public Health Policy. 12(1):83-103,
4. Healing the Masses: Cuban Health politics
at home and abroad. University of California Press; Feinsilver
J M, Apter D E. Paperback328 pages, 1993 Nov. ISBN: 0520082982.
5. Cuba's family doctor programme; Perez
J T, Von Braunmuhl J, Valencia J J, Marquez M A. UNICEF 1991.