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Maternal and Child Health Care in Cuba: Achievements and Challenges*

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Maternal and Child Health Care in Cuba: Achievements and Challenges* Pan American Journal Special Report of Public Health Maternal and child health care in Cuba: achievements and challenges* María Cecilia Santana Espinosa,1 Mercedes Esquivel Lauzurique,2 Violeta Regla Herrera Alcázar,1 Berta Lidia Castro Pacheco,3 María del Carmen Machado Lubián,4 Duniesky Cintra Cala,5 Roberto Tomás Álvarez Fumero6 y Beatriz Marcheco Teruel7 Suggested citation (original manuscript) Santana Espinosa MC, Esquivel Lauzurique M, Herrera Alcázar VR, Castro Pacheco BL, Machado Lubián MC, Cintra Cala D, et al. Atención a la salud maternoinfantil en Cuba: logros y desafíos. Rev Panam Salud Publica. 2018;42:e27. https://doi.org/10.26633/RPSP.2018.27 ABSTRACT In Cuba, maternal and child health care is based on the priority granted by the State, the imple- mentation of the National Maternal–Child Health Program and the guarantee of equitable access to health services. This article describes the Cuban experience in this field, as well as its main achievements, challenges, and lessons learned. Among the most relevant results up to 2015 are the reduction of infant mortality rate and under-five mortality rate to 4.3 and 5.7 deaths per 1000 live births, respectively; 5-year survival of 99.4%; more than 10 prenatal check-ups per delivery; 5.3% of low birth weight; 99.9% of institutional births; and being the first country to validate the elimination of mother-to-child transmission of HIV/AIDS and congenital syphilis. The main challenges are to increase the rate of exclusive breastfeeding; to reduce anemia due to iron deficiency in children and pregnant women; to reduce overweight in children; to prevent accidents; and to reduce maternal mortality, adolescent fertility rate, and voluntary abortion. Among the lessons learned are the priority given by the State to health, the programmatic management of maternal and child care, the guarantee of universal coverage, the systematic collection of information for decision-making, the integration of sectors and social participation in health. Sustaining and improving the results achieved will contribute to the fulfillment of the Sustainable Development Agenda for 2030. Keywords Maternal health; child health; maternal mortality; infant mortality; Millennium Development Goals; Sustainable Development Goals; Cuba. When the Cuban Revolution tri- and maternal mortality (70 and 138 per illiteracy rates, scarce health infrastruc- umphed in 1959, health in Cuba was 100 000 live births, respectively) due to ture, and racial and gender discrimina- characterized by high rates of infant limited access to health services, high tion, among other social determinants (1–3). Acute diarrheal and respiratory * Non-official English translation from the original 3 Hospital Pediátrico Universitario Juan Manuel diseases, malnutrition and perinatal Spanish manuscript. In case of discrepancy, the Márquez, Havana, Cuba. conditions were the main causes of in- 4 original version (Spanish) shall prevail. Instituto Nacional de Higiene, Epidemiología y fant death, while mothers died from 1 Escuela Nacional de Salud Pública, Havana, Cuba. Microbiología, Havana, Cuba. Send correspondence to María Cecilia Santana 5 Organización Panamericana de la Salud, repre- lack of medical care for complications Espinosa, [email protected] sentative in Cuba, Havana, Cuba. of childbirth and abortion, and preg- 2 Facultad de Ciencias Médicas Julio Trigo López, 6 Departamento de Atención Materno Infantil, Universidad de Ciencias Médicas de La Habana, Ministerio de Salud Pública, Havana, Cuba. nancy-induced hypertension. Only 10% Cuba. 7 Centro Nacional de Genética Médica, Havana, Cuba. of children received pediatric care, and This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL. Rev Panam Salud Publica 42, 2018 1 Special Report Santana Espinosa et al. • Maternal and child health care in Cuba less than 60% of births took place in near a hospital that take in pregnant children and adolescents by developing health institutions (1–4). women from isolated areas. These insti- a system of care that guarantees planned Changing that situation required State tutions later multiplied and over time ex- doctor visits beginning with newborns intervention in the form of new social panded their role to include care of at-risk and continuing through adolescence (20, policies and government funding. With women at any stage of pregnancy. Inter- 21). More than 3 000 000 well child visits establishment of the National Health sectoral practice and community support are conducted annually with children System (SNS), Article 50 of the Constitu- are key to maternity home operations aged 1–14 years (8), along with actions tion of the Republic stipulating the civil with contributions coming from various promoting early childhood development right to health and the State’s obligation sectors, including agriculture, sports, cul- provided by the Ministry of Education’s to guarantee it was fulfilled. The SNS is ture and education, as well as civil society comprehensive Educate Your Child pro- single system providing free, universal organizations such as the Federation of gram. These examples of good intersec- care oriented by a primary health care Cuban Women (10–12). In 2015, mater- toral practices have been recognized by (PHC) strategy emphasizing prevention. nity homes reported 52.5 admissions per the United Nations Children’s Fund It has developed through constantly 100 live births (8). (UNICEF) (22). evolving infrastructure, and human and During the 1960s, the number of clan- In pediatric care, protocols for moni- technological capital, as well as active in- destine abortions performed in inade- toring communicable childhood dis- tersectoral and citizen participation that quate conditions and by unskilled eases are adapted in primary and intensifies during crisis situations, such personnel was high. In 1968, in response secondary care settings in the form of as hurricanes and epidemics (3, 5, 6). to the demand for women’s reproduc- guidelines for managing acute diarrheal A fundamental strategy to achieve tive rights and to help reduce mortality, and respiratory diseases, infectious neu- satisfactory maternal and child health access to abortion services in authorized rological disorders and arboviruses, outcomes was implementation of the hospitals was institutionalized (11). among others (2, 3). National Maternal–Child Health Pro- These and other actions have substan- Specific strategies for chronic disease gram (PAMI) in 1983. PAMI is a central- tially modified the health situation of management are promoted and carried ized programmatic platform directed by women and newborns. Take, for exam- out by interdisciplinary teams organized the Ministry of Public Health (MINSAP) ple, the 2015 indicators for the country’s by territory and advised by experts at to plan, organize, apply and manage all mountainous areas, which are its most the national level. The main strategies actions and regulations related to repro- remote: 91% early capture of pregnant involve care for children suffering from ductive, child and adolescent health women, low birth weight index of 4.7%, diabetes, asthma, heart disease, neuro- throughout the country, in accordance and an infant mortality rate of 3.8 per logical disorders, chronic renal failure, with a health situation analysis at the 1 000 live births, all figures below the na- hematologic cancer and conditions re- local level and emphasizing guaranteed tional average (8). quiring highly complex surgeries, such equitable access to health care (7). This article discusses Cuba’s experi- as organ transplants. The primary objec- PAMI adopted best practices devel- ence in maternal and child health care, tive is survival of such patients and oped during the 1960s and 1970s, in- shows outcomes obtained up to 2015, providing them with a better quality of cluding the gastroenteritis program identifies challenges to meeting the 2030 life (3). (1962) (4) that removed that disease Sustainable Development Goals, and Incidence of low birth weight has from the registry of main causes of pedi- presents principal lessons learned over steadily declined since the program to atric deaths; the first polio vaccination more than five decades. lower it was implemented in 1988 campaign (1962), which eliminated po- ( Figure 1). In the 1990s, this indicator lio and laid the foundations of the Na- MATERNAL AND CHILD rose as a result of the country’s worsen- tional Immunization Program (1962); HEALTH CARE ing economic difficulties (23), and the and the mass vaccination campaign, program was updated as a result. De- also in 1962, against diphtheria, tetanus In recent years, with respect to mater- spite current low rates, special attention and whooping cough. The vaccination nal and child health, there has been inter- is given to developing perinatology (12), campaign against measles (1971) was national appeal to build resilient health as birth weights under 1 000 grams affect followed by other child health actions systems that guarantee universal
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