Cooperation for Health: The Cuban Experience

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Cooperation for Health The Cuban Experience
Gail A. ReedInternational Director, MEDICCApril
25, 2007
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An evaluation of 25 countries in the Americas
measuring relative inequalities in health
revealed that Cuba is the country with the best
health situation in Latin America and the
Caribbean. It is also the country which has
achieved the most effective impact with
resources, though scarce, invested in the health
sector (Study on Human Development and Equity
in Cuba, UNDP, 1999)
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CUBA
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Cuba Key Health Indicators - 2003
Source United Nations, 2003 and Anuario
Estadístico de Salud per 1,000 live births
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Human Resources for Health

• Fortify the systems scientific and ethical
  vitality among new leaders
• Outstanding Graduates program
• Train more health care professionals (2005)
• Total health workers 447 023
• Total physicians 70 594 (1x159 inh.)
• Nurses x 10.000 inh. 79.5
• 2006 2007 (January 2007)
• Medical school enrollment 24 682
• University nurse enrollment 45 319
• Allied health enrollment 73 620
• Clinical Psychology 1445
• Share lessons and expertise with other developing
  countries

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• Global Cooperation
• Scaling Up to Meet the Crisis
• Research Applied to Prevention
• Treating Low-Income Patients in Cuba
• Disaster Risk Reduction Relief
• Cuban Medical Teams Abroad
• Training Doctors for Global Health

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• Treating Low-Income Patients in Cuba
• gt500,000 eye surgeries in Cuba (2004-2006)
  (including gt70,000 Cubans)
• Patients from 29 countries
• Vision restoration projected for 6 million in the
  next decade

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Cuban International Disaster Relief 1960-2000
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• Disaster Risk Reduction Relief
• Katrina sparks Henry Reeve Contingent 5,000
  specially trained medical personnel
• UN Designates Cuba as Regional Disaster
  Preparedness Hub

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The Henry Reeve Contingent2005-2006
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Continuous Care Medical Teams
Began with newly independent Algeria,1963
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Cuban International Medical Cooperation 1963-2006
100,000 Cuban health professionals in 101
countries February, 2007 29,809
Cuban healthprofessionals in 69 countries
Source International Cooperation Unit, Ministry
of Public Health, Havana
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• Cuban Medical Teams Abroad
• We were particularly attracted to the Cuban
  doctors because we knew of the type of health
  system that theyd built in Cuba with limited
  resources and the underlying philosophy of
  primary health care was the same were aspiring
  to introduce for our own health system. The
  Cubans became in fact very good role models.
• Ayanda Ntsaluba, MD, MPH, Director General
  Foreign Affairs, South Africa

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Turning the Corner Cubas Family Doctor Program
Family medicine put to the test Healthy people
in a resource-scarce environment Evolution of
community-based modelsMaximizing lessons for
other developing countries
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Turning the Corner From Cooperation to
Sustainable Assistance
1998
Hundreds of health professionals sent to Central
America and Haiti in the wake of Hurricanes
Georges and Mitch.
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Cubas Comprehensive Health ProgramConfronting
the Real Disaster

• Direct long-term medical care
• Applying lessons from Cuban experience
• On-the-ground training of local personnel
• Development and sharing of research
• Academic training for Cubans at international
  sites
• Trilateral cooperation
• Scholarships for medical education
• 29 countries involved (21 in Africa)

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Direct Medical Services Strengthening
Health Systems

• Bilateral government accords, identify needs
• Bolster public health infrastructure,
  capabilities
• Shared financial responsibility
• Mainly remote, rural postings
• Individual commitment/institutional commitment
• Numbers of professionals enough to make a
  difference

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Challenges and Opportunities Bolstering Local
Public Health Systems
Opportunities Challenges ______________________
______________________________________________ Su
stainability Frustration with local
infrastructure Increase understanding
locally Bend to local opinions Long-range
perspective, understanding Vulnerable to govt
changes, political will Horizontal model, broad
presence Integrate vertical programs Increase
staffing for health system Create felt need in
population Broad skill set Mismatched, narrow
skill set
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Direct Medical Services Professionals Only

• Mainly family doctors at primary care level
• Other specialists at primary, secondary
  levels
• Other disciplines biostatistics,
  epidemiology, electromedicine

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Lessons from the Cuban Health Care
Experience Patient-Based and Population-Based

• Guardians of health in geographic area
• Marrying clinical medicine and public health
  practice
• Risk factor diagnosis/health situation
  diagnosis
• Measure outcomes

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Training Local Health System Personnel

• Midwives
• Continuing medical education for nurses,
  others
• Biomedical Engineering
• Health statisticians and systems managers
• Health promoters

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Research Development and Sharing

• Disease-specific cholera, malaria,
  genetically-based
• General epidemiological
• Scientific forums
• Advice in specific fields

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Cuban Academic Training at International Sites
Outstanding Graduates Program
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Trilateral Cooperation

• Haiti
• Honduras
• South Africa
• HIV/AIDS offer

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• Scaling up
• The Latin American Medical School (1998)
• 29 countries
• 10,000 students, 3,000 first graduates (05-06)
• 100 indigenous populations
• 51 women
• Low-income students
• Commitment to serve
• Sustainability

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Different from Previous Scholarships Aiming for
Sustainability

• Student selection poor, indigenous,
  marginalized
• Bridging program
• Training geared to country of origin
• Looking for commitment to underserved
• Eventually replace Cuban doctors
  in-country

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US Medical Students in Cuba

• 93 at the Latin American Medical School
• Mainly from minority communities

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Training Doctors for Global Health I think the
Cuban system of training could serve as an
example to the rest of the world if we wish to
have functioning health systems in the future.
The Cuban system trains doctors for communities,
willing to sacrifice for the welfare of others. I
think there is a need for such a paradigm
shift. Nestor Shivute, MD, WHO Country
Representative, Gambia
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Training Professionals for Global Health
Source Minsap, March 2007 Includes 12,600
medical and pre-med in new program.
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• Training Professionals for Global Health
• At least 100,000 new doctors by 2015
• Second Latin American Medical School
• Cuba has founded 11 medical schools and 2
  nursing schools abroad
• Cuban professors teach in a dozen others

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Human Resources for Health The Africa Program

• Medical Schools in Africa
• The South Africa model

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Scaling up Esmeralda, University in the Amazon
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Health Equity Cooperation Challenges We Face
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We are still challenged to be dissatisfied.
Let us be dissatisfied until every man can have
food and material necessities for his body,
culture and education for his mind, freedom and
human dignity for his spirit. Let us be
dissatisfied until the empty stomachs of
Mississippi are filled, and the idol industries
of Appalachia are revitalized. Let us be
dissatisfied until our brother of the Third
WorldAsia, Africa, Latin America(is) lifted
from the long night of poverty, illiteracy and
disease. Let us be dissatisfied until
brotherhood is no longer a meaningless word at
the end of a prayer, but the first order of
business on every legislative agenda. Dr.
Martin Luther King, Jr February 23, 1968