COMPLETE DOCUMENT: Foro Cubano – Indicadores
Coordinador: Pavel Vidal Alejandro
The island’s medical system is envied throughout the region and is a major foreign revenue earner
Original Article: Cuba’s Medical System
Cuba’s healthcare system is a source of pride for its communist government. The country has well-trained, capable doctors, the sector has become an important export earner and gives Cuba valuable soft power – yet the real picture is less rosy. A lot of health infrastructure is deteriorating and there is a de facto two-tier system that favors those with money.
Cuba’s child mortality rate is on par with some of the world’s richest countries. With six deaths for every 1,000 births, according to World Bank data from 2015, Cuba is level with New Zealand. In 2015, the global average was 42.5 deaths for every 1,000 births. Despite more than half a century of a US economic embargo, Cuba’s average life expectancy matches that in the US: 79.1 years, just a few months shorter than Americans who, on average, live to 79.3 years, according to 2015 data from the World Health Organization (WHO).
Much of Cuba’s success in these areas is due to its primary healthcare system, which is one of the most proactive in the world. Cuba’s population of 11.27 million has 452 out-patient clinics and the government gives priority to disease prevention, universal coverage and access to treatment.
Cuba has also produced innovations in medical research. In 1985 the country pioneered the first and only vaccine against meningitis B. The country’s scientists developed new treatments for hepatitis B, diabetic foot, vitiligo and psoriasis. They also developed a lung cancer vaccine that is currently being tested in the United States. Cuba was also the first country on earth to eliminate the transmission of HIV and syphilis from mother to child, a feat recognized by the WHO in 2015.
In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than the global average. According to the World Bank in 2014, the European average spending GDP spending was 10%, compared to 17.1% in the United States.
A lesser-known characteristic of Cuba’s healthcare system is the existence of special clinics, reserved for tourists, politicians and VIPs. The state reserves the best hospitals and doctors for the national elite and foreigners, while ordinary Cubans sometimes must turn to the black market or ask expatriate friends or family to send medicine.
“Cuba’s health service is divided in two: one for Cubans and the other for foreigners, who receive better quality care, while the national population has to be satisfied with dilapidated facilities and a lack of medicines and specialists, who are sent abroad to make money for Cuba,” says Dr. Julio César Alfonzo, a Cuban exile in Miami and director of the NGO Solidaridad Sin Fronteras.
In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than the global average
In 1959, the country had only 6,000 doctors, half of whom emigrated after the Cuban revolution. By 2014, Cuba had 67.2 doctors for every 10,000 inhabitants, with only Qatar and Monaco ahead of it.
However, despite these impressive statistics, the quality of primary healthcare, which has been fundamental to Cuba’s success, has been declining in recent years. Between 2009 and 2014 there was a 62% fall in the number of family doctors, from 34,261 to 12,842, according to Cuba’s National Statistics Office (ONEI).
AN ARMY OF WHITE COATS
In the words of Fidel Castro, Cuba’s “army of white coats” was formed in 1960, when a medical brigade was sent to Chile after an earthquake left thousands dead. Since then, Cuba has sent more than 300,000 healthcare workers to 158 countries in Latin America, Africa and Asia, according to Cuba’s state news agency. Today, around 50,000 Cuban medical workers are present in 67 countries.
“Cuban doctors are rooted in solidarity and in the Hippocratic Oath. Our job would be unthinkable without foreign missions,” says Salvador Silva, a doctor specializing in infectious diseases who has worked in Haiti and Liberia. “Yes, our salary is low and maybe that pushes us to go abroad, but it also makes us proud when we see our work recognized throughout the world, on top of just helping in our own country,” he adds.
Doctors are arguably Cuba’s most profitable resource and the country’s medical missions have proved to be a lucrative diplomatic tool. The healthcare industry is also one of the country’s main sources of income. In 2014, Cuban authorities estimated overseas healthcare services would bring in $8.2 billion, putting it ahead of tourism.
Cuba has a different deal with each country it works with. For example, in exchange for sending 3,500 health care workers to work in and provide training in Venezuela, a close Cuban ally, Venezuela sends oil.
With such a high demand for personnel, some suspect that the Cuban government has been reducing educational requirements to hasten students’ entry into the work force. “They are giving doctors licenses in record time to meet the need to export them, and this has been detrimental to the quality of training and medicine, which used to be the best. This has been happening since they started the program in Venezuela, between 2003 and 2004,” says Dr Alfonzo.
Doctors are also eager to be sent abroad, not only to help the less fortunate, but also for money. Salaries are higher – depending on the location, with doctors abroad reportedly making up to $1,000 per month (minus taxes), whereas those in Cuba make around $50. On the island, it isn’t rare to find taxi drivers, shopkeepers or construction workers with medical degrees.
Juan drives a 1950s Chevrolet he bought with his brother and he uses it as a taxi from 6pm to midnight. He’s also a doctor in the clinic Hermanos Ameijeiras. “The wage is a pittance. We find ourselves obligated to make a living doing other things. I have coworkers who sell prescriptions to pharmacies, who work in unlicensed clinics or help their families in shops. It’s frustrating,” he says. “It’s like they’re pushing us to enlist in international missions, the business of Cuba.”
The country’s medical missions abroad have been an important escape route for Cubans looking to defect. Before migratory reforms were passed in January 2013 allowing Cubans with passports and visas to travel abroad, the preferred way to abandon Cuba was via Venezuela. In 2013 and 2014, more than 3,000 doctors deserted the island to go to the United States through a special visa program called Cuban Medical Professional Parole, a program started by George W. Bush to help healthcare workers who had escaped while working abroad.
Lucia Newman, a former CNN correspondent in Habana, said Cuban doctors complain that travel restrictions prevent them from attending conferences or keeping abreast of the latest medical advances. The US trade embargo on Cuba includes some textbooks, but the major problem is that Cuban doctors cannot buy medical equipment from the United States or from any US subsidiaries.
For Odalys, a young patient waiting at the Hospital Salvador Allende, “the situation is becoming unsustainable in this country and it’s not because of a lack of specialists, it’s because we have to bring everything ourselves. I just bought a light bulb for the hospital room. I’ve called home so that they can bring me bedding, towels and even toilet paper. There aren’t even stretchers, I saw a family carrying their sick son into a room. Free and universal health care, yes, but it’s a bit of a mess and very informal,” she says.
English version: Alyssa McMurtry.
Artisanal charcoal will become the first legal Cuban export to the United States in decades under a deal announced Thursday between Cuba’s government and the former lawyer for imprisoned U.S. government contractor Alan Gross.
Attorney Scott Gilbert, who has sought to build economic ties between the two countries since Gross’ release, said a company that he founded will buy 40 tons of charcoal made from the invasive woody plant marabu. The charcoal is produced by hundreds of worker-owned cooperatives across Cuba and has become an increasingly profitable export, valued for its clean-burning properties and often used in pizza and bread ovens.
Gilbert’s company will pay $420 a ton, which is significantly above the wholesale market price of about $360. The first delivery is scheduled for Jan. 18, two days before the inauguration of Donald Trump as U.S. president.
Products of privately run or cooperative farms in Cuba can be exported to the United States under measures introduced by President Barack Obama after the Dec. 17, 2014, declaration of detente with Cuba. The measures loosen a 55-year-old trade embargo on Cuba.
The charcoal is sold by cooperatives to a local packager, which sells it on to state-run export firm CubaExport. Each middleman takes a 1 percent or 2 percent commission, CubaExport general director Isabel O’Reilly said. CubaExport said the charcoal would be the first legal export to the United States in more than five decades, and it hoped to expand the deal to include honey and coffee.
The charcoal will be sold to restaurants and online to consumers in 33-pound bags under the brand name Fogo, Gilbert said.
Cuba sells about 40,000 to 80,000 tons of marabu charcoal annually to buyers in Italy, Germany and about a half dozen other countries, O’Reilly said.
“I think that once they have examined this situation and looked at all the facts, that they will be supportive of increased engagement and the economic changes that it will bring,” Gilbert said.
Under Obama’s changes, American visitors to Cuba can return with unlimited rum and cigars, but state-run companies cannot export those products to the U.S.
A man prepares artisanal charcoal at a farm on the outskirts of Havana, Cuba, on Jan. 5, 2017. Artisanal charcoal will become the first Cuban export to the U.S. this month under a new deal between the Cuban government and the former lawyer for imprisoned U.S. government contractor Alan Gross.
(Ramon Espinosa / AP)
From the Cuba Study Group, Desde la Isla, 5 de Noviembre de 2012
Antonio Romero, Universidad de la Habana
From the Island, Issue 13, November 5, 2012
I. Economic Growth and Development in Cuba: some conceptual challenge s.
The set of economic and social guidelines adopted at the Sixth Congress of the PCC (Havana, April 2011) cover a wide range of policies, sectors and areas of action. The application of these guidelines will determine substantive changes for the country’s economic, social and political life. However, it is convenient to think of an analysis that defines strategic foresight—from the experience gained and the economic and social problems currently facing Cuba, which are the basis of the transformation process—a medium and long term vision for the country that is wanted and can be built. It should consider the restrictions on existing national political space, and the basic political consensus, economic and social rights of the Cuban nation.
Such a medium and long term view would necessarily have to include in economic terms, the requirement to achieve high and sustainable growth rates in Cuba. This is key to guarantee expanded reproduction, increased living standards and the welfare of the population, a necessary condition, although not exclusive, for development.
Considering the growth rate of gross domestic product as an indicator of little relevance in economic terms—as it was believed by some in recent periods in Cuba’s economic history—reveals serious limitations in understanding the processes that lead to the development of a country. The development is always a path of sustained growth in the context of the dynamic interaction of capital investment, the accumulation of knowledge applied to production, structural change and institutional development. Key in this strategic vision—in economic terms—would be the discussion and definition of the spaces needed in that process of change:
i) the non-government property sector and within it, the private sector;
ii) monetary-commercial relationships and their link to national economic development;
iii) decentralization of the management and direction of the national economy, and what degree of autonomy derived from it would be allowed to economic agents;
iv) the role of economic stimulus to encourage production and reward the efforts and social contributions of people and the institutions in which they work; and
v) the degree of acceptable distributive inequity—and buffer policies—under such a scenario in the medium and long term.
Obviously, such a strategic vision would include other elements, but the five dimensions outlined above would be central to the understanding and to consistency of the process of transformation of the development model for the country.
Progress in terms of development, also involves in the case of small economies like Cuba, the adoption and implementation of a strategy of specialization relatively concentrated in a limited number of export activities that will ensure the country international insertion and that would be beneficial to sustained expanded reproduction.
This is so because small island economies are not able to establish a “closed loop” for operation, since they cannot internally guarantee all conditions that are required for economic growth.
The limited size of the domestic market, the requirements of economies of scale that characterize contemporary technology, and the limitations on labor and financial and productive resources, determine a relatively narrow specialization in the case of small economies like Cuba.
The complete essay: Antonio Romero, Cuba, Reformulation of the Economic Model and External Insertion