R2HR2Hin Cubain Cuba
Pol De VosPol De [email protected]@itg.be
From 1959 onwards
Cold War • continued USA aggression• long term USSR support
Comprehensive revolutionary changes• Housing• Working conditions (radical land reform)• Redistribution of income• Health• Education• Culture and sports• Defense
Consequences
– All Cubans: decent wage, improved nutrition, housing
– Electricity and tap water over the whole country
– Inhuman working conditions disappear (landlordism)
– Industrialization • Embargo and agressivity of USA
• Support of Soviet Union
– Alphabetization
– Education• development of all educational levels
• adult education: combination work & study
– Expansion of culture, art, science and sports
Human and social
Development
Production and
distribution of wealth
Socio-political Economic
CUBAN REVOLUTIONPolitical will
Health as a human right and as a state policy
Investment In social
development
Development of health
system and services
Management of human and social capital
ParticipationSocial
networksEmpowerment
Production and
distribution of wealth
Inter-sectorial action promoted by state and directed by health sector
ENVIRONMENT
LIFESTYLES
HUMAN BIOLOGY
Health and well-being
Cuba: health (care) for all
1960s – Ensure access to medical services for all
1970s – Community medicine
1980s – Family medicine
Since 1990s – Reforms and
adjustments
Development of Cuban health system
1990s: Coping with economic crisis
Economic and social measures : a participatory process• Taken step by step
• After a broad consensus process (over > 3 years)– Discussions in neighborhoods and working places
– Only broadly accepted proposals were put in practice
• Implemented:– Legalization of US-Dollar
– Selected joint-ventures (tourism, mining,…)
– Peasant markets
– Higher payments for telephone, gas, electricity
• Not implemented– Introduction of tax-payment
1989 20101995 2002
GDP – 35% Imports – 70 %
27 169 FDrs 96.2% coverage
8 965 FDrs 46.9 % coverage
30 726 FDrs 99.2% coverage
37 645 FDrs INT COOP +++
Cuba from 1990 onwards
Torricelli act
Breakdown Soviet Union Helms-Burton
Law
Unified public national health system maintained+ Integrated system - Stability of F.Dr. in community + Free access - Lack of resources+ Comprehensive care - Availability of drugs
+ Continuous care - Technology
+ Adequate health outcomes
Results of crisis management 1990s
>< Venezuela (1989) – Ecuador (1997,2000,2005) – Argentina (2001)
• Structural determinants remained priority, but eroded…– severe decline in living standards – deterioration of nutritional status – (limited) resurgence of (almost) eliminated diseases (tb)– vitamin deficiency -> epidemic neuropathy
• Health system – Remains state priority
• exclusively public (no privatizations)• Accessible, holistic, and integrated services of good quality• Free at the point of delivery
– Central in limiting consequences of declining living standards
After 2000
• Continued economic strain– US enmity and embargo remains– Alliance with Bolivarian Venezuela
• Intensive collaboration in health• Oil • Industrial collaboration
• 2011: new economic measures– Decreasing role of de state– Increasing disparities in income (dual currency) – Health system maintained but under strain
Health system today
• Cuban national health system – exclusively public
– free at point of delivery
• FLHS: Family Dr = entry point– well-defined population of
responsibility
– holistic and integrated approach
Health Area (30.000 inh)
Family Doctor1000-1500 inh
policlinic
referral hospital
13
International Cooperation in health
• 40.000 Cuban professionals are working in 105 countries• 80% (+ 30 000) work in the health sector in 68 different
countries• Cuba trains medical students from many of the
poorest regions to serve their communities– Actually 35 out of 54 African countries have medical students
being trained in Cuba
• Important support in health care delivery in many countries– limitations to overcome (integration)
14
Emergency Aid: Brigade Henry Reeve Katrina – 2005 – New Orleans
15
International health policy debate
• Cuba = one of the few important international health players that actively oppose neo-liberal privatization and profit in health services
• Defends development of accessible, qualitative and responsive public health services – counterexample of idea that “public services can’t function”– important example to defend “public rationale” in other contexts
DL1 14.30-17.00 hrsEmpowerment
Centro Habana, Cuba:
“Empowerment through multisectorial action”
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