Tag Archives: Health

Al Jazeera on “The Truths and Tales of Cuban Healthcare”

The full article is available here:The Truths and Tales of Cuban Healthcare  and here;  http://www.aljazeera.com/indepth/features/2012/06/201265115527622647.html. The Introduction and an excerpt are reproduced below.

The state-run system has been praised, but many specialists now fear they are falling behind international standards.

Lucia Newman  Last Modified: 18 Jun 2012 08:30

If there is one thing for which Cuba has received praise over the years, it is the Communist government’s state-run healthcare system. Much of this praise is well-deserved. Despite its scarce resources, Cuba has one of the world’s lowest infant mortality rates – just slightly lower than that of the US. Life expectancy is 77.5 years, one of the world’s highest. And until not so long ago, there was one doctor for every 170 citizens – the highest patient-per-doctor ratio in the world.

Of course, the government can afford so many doctors because they are paid extremely low salaries by international standards. The average is between $30 and $50 per month.

And the benefits of this healthcare have not only been felt by Cubans.

Under Fidel Castro, the former Cuban president, hundreds of child victims of the Chernobyl nuclear disaster, left without proper medical attention after the collapse of the Soviet Union, were invited to Cuba. A hospital was constructed to treat them while they and their families set up temporary residence in Tarara, a beautiful seaside neighborhood near Havana. Many remain there today.

Decline

By the time I moved to Cuba in 1997, there were serious shortages of medicine – from simple aspirin to more badly needed drugs.

Ironically, many medicines that cannot be found at a pharmacy are easily bought on the black market. Some doctors, nurses and cleaning staff smuggle the medicine out of the hospitals in a bid to make extra cash.

Although medical attention remains free, many patients did and still do bring their doctors food, money or other gifts to get to the front of the queue or to guarantee an appointment for an X-ray, blood test or operation.  If you do not have a contact or money to pay under the table, the waiting time for all but emergency procedures can be ridiculously long.

Many Cubans complain that top-level government and Communist Party officials have access to VIP health treatment, while ordinary people must queue from dawn for a routine test, with no guarantee that the allotted numbers will not run out before it is their turn. And while the preventative healthcare system works well for children, women over the age of 40 are being shortchanged because yearly mammograms are not offered to the population at large.

I saw many hospitals where there was often no running water, the toilets did not flush, and the risk of infections – by the hospital’s own admission – was extremely high.

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Centro de Estudios de la Economía Cubana (CEEC)

By Arch Ritter

Centro de Estudios de la Economía Cubana (CEEC)

The University of Havana’s Centro de Estudios de la Economia Cubana has made itself the foremost research institution on the Cuban economy since its establishment in 1989.  Its faculty includes many of the best-known analysts on the Cuban economy, including both senior and newer faculty members. The work of the Cuban Economy Team is especially impressive and is certainly worth careful study by anyone interested in Cuba. I have often thought that Cuba would benefit immensely if some of the members of CEEC were in key Cabinet positions in the Government of Cuba responsible for the management of the economy.  I expect that this in fact will happen before too long! Cuban Economy Team: Dr. Juan Triana Cordoví, Dr. Omar Everleny Pérez (Director), Dr. Armando Nova González, Dr. Hiram Marquetti Nodarse, Dr. Jorge Mario Sánchez Egozcue, Dr. Pavel Vidal Alejandro, Ms. Betsy Anaya, Ms. CamilaPiñeiro Harnecker, Ms. Ricardo Torres Pérez and Lic. Saira Pons Pérez Enterprise Management Team: Dr. Orlando W. Gutierréz Castillo, Dr. Humberto Blanco Rosales, Dr. Rosendo Morales González, Dr. Jorge Ricardo Ramírez, Dra. Aleida Gonzalez-Cueto, Dra. Dayma Echevarría León, Dra. Ileana Díaz Fernández, Ms. Mercedes González Sánchez, Ms. Maria Isabel Suárez González,  Lic. Dayrelis Ojeda Suris and Lic. Mariuska Cancio  Fonseca The CEEC publishes a number of “Boletínes” each year that usually include valuable analyses of various aspects of Cuba’s economy and economic policy. Here are the Tables of Contents of the last three issues. The “Boletínes” are hyper-linked to the CEEC Web Site and some of the essays are linked to the PDF files for rapid access.

Boletín Agosto 2011

El sistema de gestion y direccion de la economia hoy. Ileana Diaz,  Dra.Ileana Diaz Experiencias noruegas relevantes para la agricultura cubana, Dr. Anicia Garcia La propiedad en la economia cubana. Armando Nova,  Dr.Armando Nova Los sistemas de direccion  de la economia  1961- 1975,  Dra.Ileana Diaz Turismo de salud en Cuba. David Pajon Dr. David Pajon

Boletín Abril-Agosto 2010

Competitividad e innovacion, donde esta Cuba. Ileana Diaz, Dr. Ileana Díaz El impacto del postgrado en la educacion superior Cuba- Venezuela. Rosendo Morales Dr. Rosendo Morales El mercado y el estado, dos partes que forman un todo. Armando Nova, Dr. Armando Nova González Entre el ajuste fiscal y los cambios estructurales, se extiende el cuentapropismo, Dr. Pavel Vidal y Dr. Omar Everleny Pérez Fuerzas favorables y restrictivas a la dirección estratégica de la empresa. Dayrelis Ojeda y Humberto Blanco Lic. Dayrelis Ojeda y Dr. Humber

Boletin Enero-Mayo 2010

El mercado libre agropecuario en 2009. Armando Nova, Dr. Armando Nova González El sector energetico cubano entre 2005 y 2009. Ricardo Torres_0 Ms. Ricardo Torres Pérez La política fiscal actual. Pavel Vidal_0 Dr. Pavel Vidal Alejandro Estrategia. Mito o realidad. Ileana Diaz y Roberto Cartaya_0 Dr. Ileana Díaz y Dr. Roberto Cartaya La producción agricola y ganadera en 2009. Armando Nova_0 Dr. Armando Nova González La universidad, la economía y el desarrollo. Juan Triana_0 Dr. Juan Triana Cordoví Los cambios estructurales e institucionales. Pavel Vidal_0,  Dr. Pavel Vidal Alejandro

Universidad de la Habana, “Alma Mater”

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CUBA in the UNDP 2011 Human Development Report

By Arch Ritter, November 3   2011

The 2011 United Nations Development Program (UNDP) Human Development Report (HDR) was just published on November 2.

Cuba is back in the main Human Development Index (HDI) and the statistical tables of the 2011 HDR after a complete absence last year mainly due to its unorthodox measurement of Gross Domestic Product (GDP), a central component of the HDI.  Presumably the UNDP now accepts Cuba’s approach and its HDI is recalculated and is presented for the 1985 to 2011 period.

The 2011 Human Development Report is especially interesting this year focusing on Environment and Equity issues and including statistical measures in both of these areas for all countries of the world for which such data is available. The UNDP HDR is the most reliable and comprehensive “Report Card” on most aspects of human development (though with little attention to the political dimension) for all countries of the world).

The full report is available and can be down-loaded here:  Human Development Report 2011, Sustainability and Equity: A Better Future for All; http://hdr.undp.org/en/reports/global/hdr2011/download/

Cuba’s place in the 2011 Human Development Index is summarized in Table 1. The basic methodology used for the HDI measure is described below in the Appendix.  Cuba’s overall ranking in the world is # 51 for 2011 – the same ranking as in 2009 which used a somewhat different methodology. Its rank in Latin America in 2011 was # 5, up from # 6 in 2009. Interestingly enough, Cuba can be seen in Chart 1, as somewhat of an “outlier” in that its Gross National Income per capita is relatively low while its overall HDI is high.

Source: UNDP Human Development Report, 2011

Chart 1. Cuba’s Human Development Index and Gross National Income per capita in Purchasing Power terms in 2011 in Comparative International perspective.

Source: Calculated from UNDP HDR 2011
Of the three components of the HDI, Cuba did poorly in the Gross National Income measure, placing 23rd in Latin America and 103rd in the world. The Life Expectancy component was strong, though Cuba was behind Costa Rica for this indicator and tied with Chile. The “Mean Years of Schooling” measure at 9.9 years is probably not unreasonable.

The big surprise in the HDI calculation is the second element of the education component. The “Expected Years of Schooling” indicator is an amazing 17.5 years, ahead of all other countries in the world with the exception of Iceland, Ireland, and Australia. This is a curious result and presumably is due to a mechanical calculation based on current enrolment at all levels of education and population of official school age for each level of education. The number for this sub-component accounts for about one-sixth of the weight for the whole HDI measure. This number is high perhaps because of the enrolments at Municipal Universities and the retraining of displaced sugar sector workers that seems to still be continuing. The quality of expected years of education is not considered. As a genuine indicator of human development, this measure is weak because, unlike Life Expectancy and GNI per capita, it measures input and effort more so than output and the result.

The trend of Cuba’s HDI from 1985 to 2011 and is illustrated in Chart 2 in comparison with the long-term HDI trends for the other countries of Latin America and the Caribbean. (The measure for Cuba is the light blue line with that includes the HDI numbers. The other countries of the region are in the darker colours, but unfortunately are unmarked.) The decline of the HDI according to this new UNDP measure after about 1989 is apparent, reflecting the 35% reduction in GDP per person from 1990 to 1993. Reasonably steady improvement then occurred right to 2011, as a result of the improvements in GDP per capita and steady improvements in health and education.

Chart 2. Cuba’s Human Development Index Trend, 1985-2011,  in Comparative Latin American Perspective

Source: Calculated from UNDP HDR 2011

Some of the environmental numbers for Cuba are of interest, though the coverage is incomplete. Some other variants of the HDI, namely the ”Inequality-adjusted HDI” and the “Multi-Dimensional Poverty Index” exclude Cuba, presumably for lack of data.

Appendix: Measurement of the 2011 Human Development Index; (from UNDP HPR 2011) See http://hdr.undp.org/en/statistics/hdi/

The education component of the HDI is now measured by mean of years of schooling for adults aged 25 years and expected years of schooling for children of school entering age. Mean years of schooling is estimated based on educational attainment data from censuses and surveys available in the UNESCO Institute for Statistics database and Barro and Lee (2010) methodology). Expected years of schooling estimates are based on enrolment by age at all levels of education and population of official school age for each level of education. Expected years of schooling is capped at 18 years. The indicators are normalized using a minimum value of zero and maximum values are set to the actual observed maximum value of mean years of schooling from the countries in the time series, 1980–2010, that is 13.1 years estimated for Czech Republic in 2005. Expected years of schooling is maximized by its cap at 18 years. The education index is the geometric mean of two indices.
The life expectancy at birth component of the HDI is calculated using a minimum value of 20 years and maximum value of 83.4 years. This is the observed maximum value of the indicators from the countries in the time series, 1980–2010. Thus, the longevity component for a country where life expectancy birth is 55 years would be 0.552.
For the wealth component, the goalpost for minimum income is $100 (PPP) and the maximum is $107,721 (PPP), both estimated during the same period, 1980-2011.
The decent standard of living component is measured by GNI per capita (PPP$) instead of GDP per capita (PPP$) The HDI uses the logarithm of income, to reflect the diminishing importance of income with increasing GNI. The scores for the three HDI dimension indices are then aggregated into a composite index using geometric mean. Refer to the Human Development Report 2011 Technical notes [388 KB] for more details.

 

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CARMELO MESA-LAGO and PAVEL VIDAL-ALEJANDRO, “The Impact of the Global Crisis on Cuba’s Economy and Social Welfare”

Journal of Latin American Studies. 42, 689–717,  Cambridge University Press, 2010

Carmelo Mesa-Lago and Pavel Vidal have teamed up to produce a fine analysis of the impacts of the world recession of 2009-201o on Cuba,  its macro-economy and its social sectors.  It is certainly encouraging to see such cooperation in the economics discipline! The article can be found here: Pavel Vidal and Carmelo Mesa-Lago, Cuba economic social impact crisis-JLAS-11 (2)

Abstract.The mechanisms by which the world economic crisis has been transmitted from developed to developing economies are conditioned by domestic factors that may attenuate or accentuate external economic shocks and their adverse social effects. Cuba is a special case : it is an open economy and hence vulnerable to trade growth transmission mechanisms, but at the same time, it is a socialist economy with universal social services. This article reviews the literature, summarises Cuba’s domestic socio-economic strengths and weaknesses prior to the crisis, evaluates the effects of the crisis on the macro-economic and social services indicators, assesses the government response and suggests alternative socio-economic policies.

Carmelo Mesa-Lago

 

Pavel Vidal

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Carmelo Mesa-Lago: “Cincuenta años de servicios sociales en Cuba”

Carmelo Mesa-Lago. Professor Emeritus, University of Pittsburgh

Hyperlink: Revista TEMAS, no. 64: 45-56, octubre-diciembre de 2010

Revista Temas has published a valuable work by Carmelo Mesa-Lago analysing Cuba’s major social issues, namely health, education, pensions, and housing, and drawing on the work of various analysts from the Centro de Estudios sobre la Economia Cubana. Inclusion of Mesa-Lago’s work in Revista TEMAS is indeed encouraging in my view and contrasts with the situation some 25 years ago when he and other Cuban-American analysts were villified as “Cubanologos.”

Here is the Table of Contents for  followed by its concluding session. Unfortunately an English translation is not available right now.

Introducción

Evolución de los servicios sociales (1959-2000

Costo actual de los servicios sociales en Cuba

Un caso de estudio: el costo creciente de las pensiones

Capacidad económica para sostener los servicios sociales a largo plazo

Cambios necesarios para mejorar y hacer sustentables los servicios sociales

No es posible resolver los problemas que los costosos servicios sociales enfrentan sin un aumento de la producción, la productividad y las exportaciones que permitan, a su vez, reducir las importaciones. Pero para lograrlo, se necesita implementar las reformas estructurales anunciadas por el presidente Raúl Castro y recomendadas por numerosos economistas cubanos.

El tema de la sostenibilidad de los servicios sociales ha sido planteado por varios economistas cubanos. Viviana Togores y Anicia García consideran que

la crisis económica y el proceso de ajuste han mostrado que la preservación de los beneficios sociales debe transitar hacia una nueva etapa donde su sustentabilidad financiera quede asociada al desarrollo de la economía y los cambios estructurales y organizativos [necesarios] […] las decisiones de política social deben tomarse no solo teniendo en cuenta las funciones sociales, sino que debenrespetar los principios de equilibrio económico.34

Por ejemplo, la seguridad y asistencia socials agravan seriamente el déficit fiscal y su carga, hoy solo asumida por el Estado; debe ser compartida por otros contribuyentes (los trabajadores). Mayra Espina agrega:

El primer reto [de la renovación social] es el de la sustentabilidad económica de la política de desarrollo social […] es necesario encontrar fórmulas de reinserción  de la economía cubana en los mercados internacionales que reactiven la producción interna y doten a los programas sociales de los recursos suficientes, sin los cuales siempre estarán enfrentados al déficit.35

Las decisiones cruciales sobre la economía y los servicios sociales competen a los cubanos. Pero a  diferencia de la crisis de los años 90, en que hubo una estrategia para hacerles frente, en la presente esta no se ha definido. El VI Congreso del PCC, anunciado inicialmente para fines de 2008, debe decidir los lineamientos económicos para el próximo quinquenio y también dictar las directrices en materia de servicios sociales. Habiendo dedicado cincuenta años de mi vida al estudio de este tema en toda América Latina, incluida  Cuba, hago unas sugerencias —parte de estas coinciden con las de economistas y académicos cubanos— como aporte para el debate. A mi juicio, sería posible aumentar el ingreso fiscal y reducir el gasto social, mediante mejoras en la asignación y uso de los recursos, con las medidas siguientes:

Educación: En la enseñanza elemental habría que transferir fondos hacia el pago de mejores sueldos a los maestros (en vista de la caída en la fecundidad y de la población en edad primaria) y, en la secundaria,  riorizar la educación vocacional. Respecto a la superior, Juan  Triana propone invertir más en las carreras técnicas y las que contribuyen al conocimiento, aunque son más costosas que las humanidades, la pedagogía y las ciencias sociales.36 Las carreras científicas son esenciales para el desarrollo, incluyendo la administración de negocios y la economía moderna, por lo que habría que transferor recursos de carreras no tan esenciales, imponiéndoles cuotas y estándares de ingreso más estrictos. Ya en 2008-2009 se estaba reduciendo la matrícula en medicina, humanidades y ciencias sociales, pero también en agronomía y ciencias técnicas.37 Además, habría que continuar y expandir las medidas recién iniciadas que  establecen exámenes de ingreso para la educación superior y requisitos más estrictos de admisión, lo cual ayudaría a aumentar la relación de graduados por matriculados; considerar el establecimiento de pago de matrículas en las universidades a los grupos de altos ingresos, y legalizar el trabajo por cuenta propia de los maestros y profesores.

Salud: Sería aconsejable priorizar la infraestructura de agua potable y alcantarillado,38 reasignar los recursos destinados a la continuada reducción de la mortalidad infantil (un problema resuelto hace años) hacia la reparación de la infraestructura deteriorada, la importación de medicinas, la disminución de la mortalidad materna y otras áreas de mayor necesidad; subordinar el número de profesionales de la salud que  trabajan en el extranjero a las necesidades internas, e invertir parte de los ingresos en divisas que generan sus servicios en la mejora de las instalaciones y equipos  internos y el suministro de medicinas; convertir  hospitales de  aternidad y pediatría que tienen bajas tasas de ocupación en hospitales geriátricos y asilos para ancianos; terminar las becas a estudiantes extranjeros y cobrar el costo básico de los servicios que hoy se regalan  a otros países; cargar el costo de cuartos privados al grupo de altos ingresos de la población cubana; autorizar el trabajo por cuenta propia del personal de salud y permitir la organización de cooperativas médicas.

Pensiones de seguridad social: Habría que realizar un studio que determine cuál es la cotización de  quilibrio del sistema; establecer cotizaciones a todos los trabajadores de empresas no estatales con un mínimo de empleados, incorporándolos al sistema; cargar a los trabajadores por cuenta propia y empleados en el sector  rivado el mismo 5% que paga parte de los asalariados (en lugar de 10% y 15%) para promover su afiliación; ajustar las pensiones al costo de la vida, lo que requiere, primero, aumentar la producción y la productividad y, a su vez, avanzar en las reformas estructurales. Medidas más complejas serían cerrar el actual sistema de pensiones, que el Estado se haga responsable de las pensiones en curso de pago, y crear un nuevo sistema público para los asegurados jóvenes y los nuevos trabajadores, con una reserva que se invierta para generar un retorno del capital y ayudar en el financiamiento a largo plazo y mejorar las pensiones.

Vivienda: Rafael Hernández argumenta que la ley originalmente estipuló que la vivienda es propiedad de los ciudadanos, y es lógico que ellos puedan hacer con ella lo que quieran, venderla y también comprarla; además, hay que facilitar que la gente pueda reparar y construir viviendas por medios propios.39 Habría que proporcionar a la población el acceso a materiales de construcción, y otorgar pequeños créditos estatales rembolsables con interés para la construcción y reparación de viviendas; permitir el uso de la casa propia como colateral para obtener  réstamos destinados a su reparación; posibilitar la inversión de remesas externas en esas actividades; eliminar el actual sistema de permutas y autorizar la compraventa con regulaciones adecuadas.

Asistencia social. Para reducir la pobreza, Lía Añé recomienda eliminar la dualidad monetaria,

disminuir la segmentación del mercado, mejorar los salaries más bajos, y consolidar y evaluar la efectividad de los nuevos programas sociales.40 Pedro Campos propone eliminar la libreta de racionamiento, previa concesión de subsidios directos focalizados en las personas de bajos ingresos, y un reajuste salarial para compensar el incremento de precios que ocurriría.41 Alexis Codina agrega que los cuantiosos recursos fiscales asignados a subsidios de precios por la libreta, recibidos por todos, independientemente de sus ingresos, deberían quedar solo para la población más vulnerable y el resto utilizaría el mercado.

En mi opinión, el sistema de racionamiento no debería aliminarse de golpe, pues o bien sería muy  costoso o dejaría parte de los necesitados sin protección. Lo ideal sería hacerlo gradualmente, de manera paralela a los incrementos en la producción y la productividad  que resulten de reformas estructurales, a la par que se focaliza la asistencia social en toda la población pobre y vulnerable, a fin de crear una amplia red mínima de protección. Ello requeriría mecanismos eficientes para determinar el grado de necesidad de la población y una estimación confiable de la incidencia de pobreza. También habría que permitir a iglesias y ONG que establezcan y expandan asilos gratuitos para ancianos pobres con ayuda externa directa.

La Revolución transformó los servicios socials —salvo la vivienda—,  universalizó su cobertura, eliminó desigualdades entre grupos de ingreso y zonas urbanas y rurales, y otorgó servicios gratuitos de calidad. Las crisis de los años 90 y la actual, unidas a deficiencias de las políticas económicas, han afectado severamente esos servicios y agravado su falta de sustentabilidad a largo plazo. Resulta crucial, por tanto, implementar  las reformas estructurales necesarias y los cambios en dichos servicios para restaurar su calidad y garantizarlos a las generaciones futuras.

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Still the “Bestest” and the “Worstest” and Maybe the Most Opaque: Cuba in the 2010 UNDP Human Development Report

By Arch Ritter

The 2010 UNDP Human Development Report , published on November 5, 2010, presents the definitive and much-awaited “Report Card” on the social, economic, political, environmental and security dimensions of development for all countries of the world. In this Report, Cuba fares well in some indices, badly on others, but is also “out-of-the-running” on the major UNDP Human Development Indices due to lack of reliable information.

The whole of the UNDP Human Development Report can be accessed here:   2010http://hdr.undp.org/en/mediacentre/

Here are a few of the interesting comparative insights and results for Cuba.

1.      Main Human Development Indices

Cuba is excluded from the main Human Development Indices that the UNDP presents, namely the Human Development Index (Table 1), the Inequality-adjusted Human development Index (HDI) (Table 2) and the Multidimensional Poverty Index (Table 5)  as well as the HDI Trends from 1980 to 2010 (Table 3). This is unfortunate because it is not possible this year to make a comparison of Cuba with other countries or with itself over time.

Due to the existence of the dual exchange rate system in which there is no reasonable single exchange rate, together with the complexity of the highly segmented markets – underground economy, rationing system, farmer’s markets, non-market allocation of some goods and services, and quasi-dollar stores – it was concluded by the UNDP that it was impossible at this time to construct a measure of GDP per capita in purchasing power terms as is done for some 169 other countries. . The UNDP apparently is working with the Government of Cuba to correct this situation. The UNDP’s explanation of the problem is presented in Appendix 1.

2.      Gender Inequality Index

Cuba comes first in Latin America and 47th in the world for this measure, which includes maternal mortality rates, adolescent fertility rate, share of parliamentary seats held by each sex, attainment at secondary and higher education, labor market participation rates, contraception availability, and births attended by health personnel (Table 4).

3.      “Empowerment”” Measures

In a new dimension of its analysis (Table 6), the UNDP brings together a variety of indicators of human “empowerment.”  Cuba fares uniformly badly, and indeed worst in Latin America for many measures:

  • “Democracy”: worst in Latin America;
  • “Press Freedom”: worst in the world, including China;
  • “Satisfaction with Freedom of Choice”: worst in Latin America, with 26% and 28% satisfaction for males and females respectively;
  • “Journalists Imprisoned”: worst in the world with the exception of  China;
  • “Human Rights Violations”: among the worst.

4.      Education

Cuba fares well in education generally (Table 13). One notable feature of Cuba’s comparative experience is that it has the largest tertiary education enrolment in the Hemisphere and the world at 121.5% compared to an average of 36.5% for all of Latin America.

How can this be? Presumably more people than are in the normal tertiary education age cohort are attending colleges or University. This is the result of increasing the supply of tertiary education, by creating alleged “Universities” in every Municipality, plus an increase in the demand for higher education by those who have been put out of work in various areas including the sugar sector. It is difficult to know without further information if the 121.5% figure represents an achievement or a gross misallocation of resources given that Cuba needs to produce real products in agriculture and industry, and seems to be overproducing university graduates – not unlike some higher income countries .

5.      Health

As is well-known, Cuba also fares well in health measures and has been particularly successful in squeezing strong health outcomes from very scarce resources (Table 14).

One interesting measure is the number of doctors per 10,000 people that stands at 64 for Cuba. This again is the highest ration by far in Latin America and the world. Again, this looks like an over-allocation of resources to the “doctor” category in health. However, given that the 30,000 doctors abroad are now the largest earner of foreign exchange for Cuba, it is likely that this over-abundant resource is now being used effectively.

6.      Access to Information and Communications Technology.

Cuba’s performance is in communications and access information is also the weakest in the Hemisphere. Here are a number of indicators noted by the UNDP (Table 16).

  • The access of Cubans to land-line and mobile telephones stands at 13%. This is by far the lowest in the Hemisphere. Even the lower income countries in the region have much higher access to telephones, with Haiti at 33%, Nicaragua 60%, Guatemala 120%; Grenada 86%, El Salvador 131%, Paraguay 103%m and Honduras 96%.
  • The cost of a mobile telephone connection in Cuba is by far the highest in the world, at $120.00.  Obviously this limits the demand for mobile connections and helps explain Cuba’s 13% access rate.
  • Access to the internet is particularly low at 12.9 per 100 persons, though not the lowest in the Hemisphere.
  • The proportion of the population with personal computers was estimated at 5.6 per 100 persons, again low but not the lowest in the Hemisphere.

This illustration shows the HDI trajectories for all countries of the world from 1980 to 2010, excepting Cuba and a few others.
Appendix !: Purchasing power parity conversions and the HDI: an illustration with the case of Cuba (Source: UNDP,  HDR 2010, p.138).

The HDI uses internationally comparable data on gross national income (GNI) per capita from the World Bank (2010g). These data are expressed using a conversion factor that allows comparisons of prices across countries. This conversion, known as purchasing power parity (PPP), is necessary to take into account differences in the value of a dollar across countries.  Four countries have data on all HDI components except for GNI: Cuba, Iraq, Marshall Islands and Palau. For three of these countries (Cuba, Marshall Islands and Palau) this is due to the fact that they do not participate in the International Comparisons Program. Iraq lacks information about GNI for the last 10 years.
To illustrate the options and problems that arise in attempting to reliably estimate GNI per capita in PPP terms, Cuba is used as an example. One well known approach to estimating GNI—used by the Center for International Comparisons of Production, Income and Prices at the University of Pennsylvania (Heston, Summers and Aten 2009)—is a regression that relies on data from the salaries of international civil servants converted at the official exchange rate. However, because the markets in which foreigners purchase goods and services tend to be separated from the rest of the economy, these data can be a weak guide to the prices citizens face in practice. The Center for International Comparisons of Production, Income and Prices recognizes this problem, rating its own estimate of Cuba’s GDP as a “D” (the lowest grade).
An alternative estimate applies the exchange rate used in Cuba and the PPP conversion of an economy with similar attributes, but this method goes against the principle of using a country’s legally recognized exchange rate and prices to convert its national aggregates to an international currency. Another option is to not apply any PPP correction factor to the official exchange rate for convertible pesos. Both of these options yield far lower estimated income than the PPP correction does. The wide variation in income estimates arising from these different techniques indicates that no single robust method exists in the absence of reliable data.
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Cuba’s Achievements under the Presidency of Fidel Castro: The Top Ten

NOTE: For additional articles on various aspects of Fidel Castro’s presidency, see:

Fidel Castro: The Cowardice of Autocracy

Fidel’s Phenomenal Economic Fiascoes: the Top Ten

Fidel’s No-Good Very Bad Day

The “FIDEL” Models Never Worked; Soviet and Venezuelan Subsidization Did

On September 17, I published and entry on this blog entitled “Fidel’s Phenomenal Economic Fiascoes: the Top Ten” but stated that I would also write a statement on Cuba’s greatest achievements under the leadership of President Fidel Castro. Here it is.

There certainly were economic policy blunders from 1959 to mid-2006 when Fidel Castro stepped aside in favor of his brother Raul. However, as is well known, Cuba made major achievements over these years in socio-economic terms. I will begin with a quick summary of Cuba’s socio-economic performance from 1959 to 1990 and 1990-2010, and then proceed to a listing of the Tip Ten Achievements

I. Socio-Economic Performance, 1959-1990

While the performance of the Cuban economy from 1959 to 1990 period was mixed, major improvements were made in terms of socio-economic well-being. The summary of changes in a few key socio-economic indicators in Table 1 illustrates the absolute and relative improvements achieved in human well-being. Life expectancy and infant and child mortality are summary indications of nutrition, income distribution and poverty and the quality of a nation’s health care system. Literacy and educational attainment are key factors in the investment in human capital and in citizen empowerment in a modern economy.

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Cuba’s rankings for these indicators in 1960 were relatively high in the Latin American context so that it was building on reasonably strong foundations.

However, despite improvements in the rest of Latin America, Cuba raised its relative ranking for all five of the socio-economic indicators vis-à-vis the rest of Latin America (excluding the English-speaking Caribbean.)  However Cuba’s economic ranking – in terms of the purchasing power of GDP per person – fell well down the list in 1990 placing Cuba at the 14th rank. As a result, Cuba placed at #10 in the UNDP Human Development Index.

II.        Socio-Economic Performance 1990-2010

Despite the economic difficulties of the 1990s, Cuba continued to improve its socio-economic performance in relative and absolute terms, at least as these are measured by the indicators in Table 2. Cuba continued to lead the Latin American countries in infant mortality and the education indicators. The improvements in education and health indicators and rankings occurred despite weakening of resource allocations and problems of maintaining quality. Cuba’s success in these areas was due largely to the quality and quantity of the educational systems built up in the previous1960-1990 period and institutional momentum.

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III.             Top Ten Achievements

Here is a listing of the Cuba’s socio-economic and economic achievements under the Presidency of Fidel Castro. They are not presented in order of importance. Some are the result of specific policy decisions or design or negotiations of Fidel Castro, though others are not.

#1        The 1961 Literacy Campaign

#2        Reorganization of the Health Sector

#3        Redesign of the Educational System

#4        Rapid Expansion of the Tourism Sector

#5       Provision of Medical Services to Latin America and Other Countries

#6        Survival in the Face of the 1989-1993 Economic Melt-Down

#7        Winning Economic Support from the Soviet Union, 1961-1990 and Venezuela, 2004-2010

#8        Establishment of the “Polo Cientifico” and the Development of the Bio-Technological Sector

#9        Dedication to their Jobs by Cuban Citizens during the Catastrophic Decline in Real Wages and Incomes after 1990

#10      Fruitful Collaboration with Foreign Enterprises


IV.             Achievements in Detail

#1        The 1961 Literacy Campaign

The 1961 literacy campaign was an inspired approach to improving educational levels among the relatively large proportion of the population that was illiterate in 1959. This was done at relatively low cost with strongly motivated volunteers. It quickly improved literacy rates immensely, though there is some disagreement as to the quality of the literacy that was achieved.

#2       Reorganization of the Health Sector

Cuba succeeded in reorganizing its medical system so as to provide universal access to health services, and managed to obtain excellent results relative to the amounts of resources that it was able to devote to the health sector.  As a result, Cuba’s health indicators improved quickly and remain among the very best in Latin America (See Tables 1 and 2)

#3        Redesign of the Educational System

Cuba’s reorganization and expansion of the educational system in the early 1960s also made education universally accessible and increased investment in people (human capital.) As a result, Cuba moved from 5th place in Latin America in terms of literacy and school enrolment in 1970 to 1st in 2007 – a fine achievement.

#4        Rapid Expansion of the Tourism Sector

As a result of the 1989-1994 economic melt-down, it was decided to earn foreign exchange by expanding the tourist sector. This required massive involved massive investment by both Cuba and foreign enterprises and the rapid shifting of resources to the sector. This was done and by 2008, Cuba was earning almost MN 2.4 billion from tourism.

#5        Provision of Medical Services to Latin America and Other Countries

By the latter 1990s, Cuba had a major surplus of medical personnel, with doctors and nurses posted in small tourist hotels and day care centers. However, this was converted into a major humanitarian asset, with Cuba’s provision of medical assistance to many countries in need, and expanding the Latin American Medical School outside Havana. The services of medical personnel are also exported to other countries – paid mainly by the Government of Venezuela. The foreign exchange earnings from medical (and educational) service exports amounted to MN 6.1 billion, almost half of Cuba’s foreign exchange earnings in 2008, as indicated in the accompanying chart.

#6        Survival in the Face of the 1989-1993 Economic Melt-Down

With the loss of Soviet subsidization and the near 40% decline in income per capita from 1989 to 1994, Cuba reorganized its economy, “depenalizing” the use of the US dollar, legalizing farmers’ markets, liberalizing self-employment and promoting new economic activities and exports etc. With no support from the international financial institutions of which it was not a member, thanks to the embargo with the United States, Cuba survived, at a cost borne almost directly, immediately and totally by its citizens.

#7       Winning Economic Support from the Soviet Union, 1961-1990 and Venezuela, 2004-2010

As noted in an earlier blog, The “FIDEL” Models Never Worked; Soviet and Venezuelan Subsidization Did posted on September 9, 2010 ,  Cuba received generous subsidization from the Soviet Union for a substantial period of time. An estimate of the amount of the subsidization is presented in the accompanying chart.  Presumably President Fidel Castro is responsible for negotiating this support. Similarly, Cuba has received substantial support from President Chavez of Venezuela through export and investment credits, low-cost oil imports and generous payments for Cuba’s exports of medical services.  How beneficial any of this assistance has been is debatable partly because it has been and is unsustainable and it has made possible the continuation of economic policies and institutions that have been counterproductive in the longer term. Fidel Castro can undoubtedly take the credit for these special relationships.

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#8        Establishment of the “Polo Cientifico” and the Development of the Bio-Technological Sector

To my knowledge, there has been no careful analysis of Cuba’s huge investment in the “Polo Cientifico” and the Bio-Technological sector. Indeed, I have not seen any analysis of the investment in the sector so I cannot judge accurately if it has been commercially viable so far or not.

However, Cuba is beginning to achieve major exports of pharmaceutical products amounting to MN 296.8 million pesos vis-à-vis MN 233.4 million for sugar in 2008.  These exports should continue to increase in future and the investment in the sector may be valuable. Moreover, Cuba’s investment in the “Polo Cientifico” has built a professional and institutional foundation for future success in pharmaceutical and other scientific areas.

#9        Dedication to their Jobs by Cuban Citizens despite the Decline in Real Incomes after 1990

I have always been impressed at the professionalism of many Cuban citizens that I have known over the years since 1990. In the face of huge declines in the purchasing power of their incomes, they continued to work seriously and with dedication in medicine, the Universities, the schools, the public service, or other employment. Many professionals and others in effect subsidized their state sector employers by earning other incomes that permitted them to survive in the unofficial economy. We have all heard of the doctors and engineers forced to provide taxi services on the side in order to make ends meet and continue to function in their professional capacities. The dedicated work of countless citizens over the difficult years of the Special Period, 1990-2010, is essentially what has brought about some recovery since the depths of the depression in 1993.

#10      Fruitful Collaboration in Nickel, Oil, Gas and Electric Power Generation with Sherritt International

Cuba opened up to foreign direct investment in joint venture arrangements with state firms. This has paid off handsomely, most notably with Sherritt International (nickel, cobalt, oil, gas, and electric power) and other enterprises as will be argued later in this Blog.

 

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Health and the Medical System

Richard S Cooper, Joan F Kennelly, and Pedro Ordunez-Garcia, “Health in Cuba”, International Journal of Epidemiology, 2006; 35:817–824

Katherine Hirschfeld,”SOCIOLISMO AND THE UNDERGROUND CLINIC: THE INFORMAL ECONOMY AND HEALTH SERVICES IN CUBA”, Cuba in Transition, ASCE 2006

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