Despite a suffering economy, Cuba boasts a successful health care system

Video by David Morris
Text by Adam Khorasanchi

HAVANA – In listing the failures of the Cuban revolution, some in the country narrow the list down to three things: breakfast, lunch and dinner.

If that light-hearted phrasing causes a bit of pain, there is also an accomplishment of the revolution that elicits praise from supporters of the regime and critics alike: the country’s health care system.

Cuba is classified as a developing country, and it has more than its share of poverty, so its success in its health sector is all the more noteworthy.

Average life expectancy in Cuba is 78.3 years, currently tied for thirty-six with the United States and Denmark, while developing nations like Botswana and South Africa rank considerably lower.

The key to Cuba’s achievements in health care, experts here and abroad say, is its focus on primary care, especially its policy of providing large numbers of doctors in neighborhoods throughout the country.

Dr. Magdalys Campos Pupo is a family doctor who serves as the vice director of medicine at a neighborhood polyclinic in Havana. Her polyclinic serves 7,953 families, with 79 doctors and 69 nurses on staff. It is here that patients in need of more specialized services receive treatment. Such services include oncology, dermatology, minor surgery, opthamology and urgent care.

“If you’re able to detect health issues at an early stage, you don’t end up spending so much money on a patient,” Dr. Campos said.

“We develop more work on education and prevention because healing and rehabilitation are the most expensive things to do.”

For instance, doctors encourage women over age 30 to undergo mammographys to detect breast cancer. Men over age 50 are encouraged by their doctors to undergo a blood test to detect prostate cancer.

“We try to achieve all the best results at a primary care level so that the patients do not need to go to the hospital,” Dr. Campos added. “The last resort would be the hospital.”

Polyclinics work in conjunction with family doctors to make up the primary care system in Cuba. Unlike in the U.S., Cuba’s family doctors are integrated into the communities they serve. Doctors largely work in two-story buildings, in which they attend patients on the first floor and live in apartments on the second floor.

Teams of doctors and nurses provide patient care on a nine-to-five schedule but Dr. Beatriz Caballero Hernandez, a family doctor who also works at the polyclinic, emphasized that these hours are not fixed.

“These are community-based doctors and they are available for any emergency. They are there twenty-four hours,” Dr. Caballero said.

Another feature of the Cuban healthcare system is that doctors make regular home visits. During these visits, the doctors will assess the health of all persons living in the house, as well as inspect the physical conditions of the house. Each person is then placed into one of four categories: those who are apparently healthy; those who are at risk, for example with communicable diseases; those with non-communicable disease; and those with disabilities.

Dr. Caballero said doctors play active roles in trying to get more people into the “apparently healthy” category. This is achieved by promoting healthy habits, she said.

“Promotion is education. If the person smokes, you let them know the damage they are producing.”

While such efforts have not had much success in changing smoking habits, Dr. Caballero said that progress has been made in other areas.

“Due to the promotional work we do, we have been able to control the AIDS rate, so that in Cuba it is very low,” she said.

Currently, Cuba’s health markers are on par with so-called first world nations. These markers include average life expectancy, infant mortality rate and maternal morbidity rate. This is an impressive feat considering how little the country spends per person.

As of 2010, the cost of health care per person in Cuba was less than $400 a year, while the per capita figure in the United States was twenty times higher.

While doctors like Dr. Campos and Dr. Caballero have been able to achieve much, there do remain challenges. For example, largely as a result of the embargo, Cuba has not been able to obtain medications it needs.

“There have been cases of either children or an adult with cancer and we haven’t had certain medications to assist the patient,” Dr. Campos said. “Cuba has tried to find alternatives, but we have to spend more money on certain medications and medical equipment than we may need to because of this blockade.”

Dr. Campos and Dr. Caballero said they hope the embargo will come to an end in the near future.