Cuban Health Policy: outreach abroad

1
Cuban Health Policy outreach abroad

• Margaret Blunden
• International Institute for the Study of Cuba
• 9 January 2008
•  

2
Cuban medical education as a development model

• Has the Cuban style medical school the potential
  to contribute seriously to medical capacity
  building worldwide?
• Is the Cuban style medical school more
  appropriate than western ones for developing
  countries?
• Are Cuban trained doctors better equipped to
  achieve a synthesis between western and
  traditional medicine?
• Does Cuba challenge the conventional wisdom that
  generating wealth is a precondition for improving
  health?
• Is it a culturally based alternative to western
  individualism and to neo-liberalism?

3
Cuban medical outreach

• Cuba had more than 25,000 medical aid personnel
  working overseas in 2006. More than those
  deployed by the World Health Organisation

4
Types of Outreach

• Disaster relief 
• Bringing overseas patients for treatment in Cuba
  e.g. from Chernobyl
• Long-term medical aid programmes under bilateral
  or trilateral country agreements
• Capacity building cooperation in developing
  medical schools

5
Medical schools

• Yemen 1976
• Guyana 1984
• Ethiopia 1984
• Uganda 1986
• Ghana 1991
• The Gambia 2000
• Equatorial Guinea 2000
• Haiti 2001
• Guinea Bissau 2004
• Source Vice-Ministry for Education and Research,
  Cuban Ministry of Public Health, 2005

6
Sub-Saharan Africa (6 schools)

• Sub-Saharan Africa has 10 of worlds population
  but only 1 of doctors and 4 of medical
  schools
• Medical education rarely customized to local
  needs
• Doctors concentrated in urban and more prosperous
  areas
• Leakage from public to private practice and to
  NGOs
• Extensive migration within the region and
  internationally

7
Selection
Claimed attributes of the Cuban model 1

• Recruitment from marginalised communities and
  from women
• Widening access
• Extensive use of psychological testing
• Commitment to serve in most deprived areas as a
  selection criterion

8
Abba Hydara, medical student in the Gambia

• From the start it was clear that they (the Cuban
  professors) were teaching to prepare us, to make
  sure we understood we had a responsibility to our
  people, to help them come out of the cycle of
  disease and poverty and ignorance. They never
  minced words about that. And so, from the
  beginning, we visited communities and families to
  get a sense of their problems and to lay the
  foundations for ourselves.
•  
• Source Gail A Reed, University of the Gambia
  Medicine seemed the place to start, Medicc
  Review, 2005

9
Content
Claimed attributes of the Cuban model 2

• Emphasis on primary care and preventive medicine
• Attention to social and demographic and
  environmental determinants of health
• Training designed to match the local and national
  health profiles
• Training to take a detailed clinical history,
  without reliance on sophisticated diagnostic
  equipment
• Holistic approach, combining western
  science-based medicine and traditional and
  non-conventional therapies
• Pedagogy based on co-operation rather than
  competition

10
Issues and questions

• How reliably can schools identify those committed
  to community service?
• Can sufficient numbers be recruited to buck the
  trend of medical migration?
• Have host governments the political resolve to
  face down opposition from medical establishments?
• How sustainable for recipient countries, and for
  Cuba itself?
• How effectively does this model build on
  non-western, pre-colonial cultures?
• What are the implications for local empowerment
  and the sovereignty of small states?
• Is it an alternative to neo-liberalism and the
  global marketisation of medicine?