Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Professor Patrick Pietroni (PH 97)



  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 Care

  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 sites"

  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 care

  The smaller sizes of the communities has allowed for a vertical integration of Primary and Secondary care—but 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 inter-agency collaboration

  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 supported.

(7)   Managerial system without professional managers

  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 support—political and economic

  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 Union—the health and education budgets were protected from the general reduction in GNP.

(10)   Features that caused concern

    —  Low pay of doctors.

    —  Poor facilities—buildings 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 to Cuba.

  (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 countries.


  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 for Peace.

  3.  Update—Cuba: on the road to a family medicine nation. Journal of Public Health Policy. 12(1):83-103, 1991 Spring.

  4.  Healing the Masses: Cuban Health politics at home and abroad. University of California Press; Feinsilver J M, Apter D E. Paperback—328 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.

previous page contents

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 28 March 2001