DOCSLIB.ORG

Cuba's Latin American Medical School: Can Socially-Accountable

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cuba's Latin American Medical School: Can Socially-Accountable Feature Cuba’s Latin American Medical School: Can Socially-Accountable Medical Education Make a Difference? Conner Gorry MA After graduating more than 12,000 doctors since its founding in acterized by curricula that transfer learning from the classroom to 1999, Cuba’s Latin American Medical School (ELAM, the Spanish the community while emphasizing equity, they formed a consor- acronym) is tackling one of its greatest challenges to date: how to tium in 2008 to begin strengthening their evidence base, voice track graduates from over 65 countries and measure their impact and infl uence. on health outcomes and policy in their local contexts? This Training for Health Equity Network (THEnet) provides a ELAM, with its main campus at a former naval academy on the framework for such socially-accountable medical schools to outskirts of Havana, extends scholarships to young people from share tools, data, and experience in an effort to promote the around the world—most of whom otherwise would not have the innovations needed to confront the global crisis in human means to become doctors. The ELAM curriculum is a six-year resources for health. The fi rst step to begin evaluating impact course of study designed to graduate physicians who will provide across such diverse contexts and cultures—THEnet schools relevant, quality care while fostering equity and improving indi- are found in Australia, Africa, Asia, Europe and the Americas— vidual and population health outcomes.[1] ELAM’s framework for is learning where, how and with whom graduates from these recruiting, educating, and retaining students is intended to rein- schools are working. force these goals by: Social accountability in medical education is defi ned as an • Recruiting students from rural, remote, resource-scarce and institutional responsibility to orient teaching, research, and other disadvantaged communities with the greatest health service activities to address priority health needs with a needs; particular focus on the medically underserved. • Providing full, six-year scholarships to all students; – THEnet’s Social Accountability Evaluation Framework[3] • Encouraging students to commit to practice as primary care physicians in underserved areas upon graduation; • Integrating concepts of prevention, social determinants of health, and active community partnering into curriculum design; Tracking ELAM Students and Grads Unlike the rest of the schools in THEnet, ELAM is both big and • Using a community-based, service-learning methodology, pre- diverse. Indeed, it is the world’s largest and most diverse medical paring students to resolve local health problems; and school. Rector Juan Carrizo says such heterogeneity represents • Providing post-graduate clinical, research, and continuing edu- the institution’s biggest challenge, dealing with “different cus- cation opportunities. toms and culture, language and habits.” Yet, he says the school’s strength also lies in diversity, as students live and work amongst This strategy responds directly to what The Lancet characterizes peers from many different cultures, and lifelong relationships are as the failure of medical education “to overcome dysfunctional built across borders.[4] and inequitable health systems because of curricula rigidities, professional silos, static pedagogy, insuffi cient adaptation to local contexts, and commercialism in the professions. Breakdown is For once, if you’re poor, female or from an indigenous popu- especially noteworthy within primary care, in both poor and rich lation, you have a distinct advantage. countries.”[2] Whereas the global debate once focused on the –Dr Margaret Chan, WHO Director-General, on a visit to the number and distribution of health workers, this shift towards the Latin American Medical School type of training signifi es deeper consideration of the relationship between medical education, population health and health sys- Such size and diversity obliges ELAM administrators to system- tems as a whole. Furthermore, it recognizes that new solutions atically evaluate their own policies and outcomes—from student are needed as the global health picture becomes more complex intake and curricular content, to job placement and career con- due to the international transfer of pathogens and people; con- tinuum—in order to remain effective and relevant to the school’s tinuing brain drain from the Global South to developed countries; mission. Through information technologies, and by adapting emerging and re-emerging diseases; and widening health dispari- and contributing to a social accountability evaluation framework ties. Complicating this scenario even further is inequitable access developed by THEnet in partnership with fl agship schools, ELAM to care— primary care in particular—both within and among is striving to better gauge its impact by tracking its graduates’ countries. In short, fresh thinking must be applied to health pro- trajectories. fessionals’ education if there is to be any hope of achieving health for all and global health security. The cornerstone of this effort is an interactive, student and gradu- ate project called the Observatory. Built by Cuban software devel- In this vein, ELAM and a handful of other medical schools world- opers using open access technology, the Observatory is a virtual wide have adopted the central mandate of social accountability, infrastructure providing school administrators a detailed picture of developing problem- and service-based learning, participatory where, how and with whom ELAM doctors work. Comprehensive action research, and other linkages between medical education, and fl exible, the database is supported by a dynamic analysis health systems development and population health equity. Char- package through which variables are parsed to track graduates MEDICC Review, July 2012, Vol 14, No 3 5 Feature and assess their impact on health and health policies. “Right now Haiti, marking this the fi rst time foreign medical graduates served we’re training the people necessary to make the Observatory alongside their Cuban colleagues in a disaster relief effort. as effective as possible,” Observatory director Dr Kenia Monjes explained, “since data reliability and analysis depend fi rst and “The overwhelming response by graduates to volunteer in Haiti foremost on relevant, accurate data collection.” showed that these doctors were ready to put into practice the principles of social accountability that underpin their training,” Students are entered into the Observatory database immedi- said Dr Monjes. The Haiti experience kick-started aggressive net- ately upon matriculation to begin capturing relevant information working efforts by the Observatory, resulting in identifi cation of an and facilitate networking among ELAM stakeholders throughout array of projects, organizations and experiences led by ELAM- their education in Cuba, upon graduation, and beyond. Dr Monjes trained doctors, some of which are described below. The Obser- stressed that tracking students from the beginning provides an vatory, together with THEnet’s evaluation framework, will allow important tool for decision-making. For example, assessing attri- such programs to be documented and assessed with appropriate tion and other diffi culties offers a guide to improving processes for methodology to determine their outcomes, replicability and social selecting scholarship candidates, while feedback from graduates impact—going beyond anecdotal material to provide a sound evi- helps hone the relevance of course content. dence base. In addition to standard fi elds such as graduating class and con- From Argentina to California: Fulfilling the Mission tact information, variables include: whether doctors are unem- Two pillars of Cuban medical education, which ELAM students ployed or working in the public or private health sector; if they are apply in service-learning rotations in the country’s primary care involved in social service projects; if they practice or are enrolled system, are the neighborhood health diagnosis and the Continu- in postgraduate studies in their country of origin, Cuba, or a third ous Assessment and Risk Evaluation (CARE; known as dispen- country; what specialty they are pursuing; and their availability for sarización in Spanish). Both tools are used to assess the health postings with Cuban disaster relief teams. picture and needs of the local population to better tailor services and design strategies to improve outcomes. The fi rst is a com- The Observatory’s Challenges plete health diagnosis carried out annually by community-based “The infrastructure and technology are in place and we already health professionals; the second, conducted more often, classi- have over 22,000 students and graduates from 95 countries fi es residents by chronic disease and risk factors.[8] In many of entered into the database,” Dr Monjes told MEDICC Review. “But the contexts where ELAM graduates work, such needs assess- we are still struggling to fi nd where many of these graduates are ments revealed a stark reality: health services were either non working once they leave Cuba.” existent, insuffi cient, or inconsistent. In response, the ELAM doc- tors profi led below—what The Lancet refers to as “enlightened The chart below illustrates some fi rst results for neighboring Haiti, change agents”[2]—set out to put their problem-based, socially- where ELAM has become the main source of newly-trained physi- accountable training to the test. cians. El Salvador: A member of ELAM’s fi rst graduating class in 2005, Dr
Load more

Recommended publications
  • For Immediate Release Contact: Rasheedah Ali (404) 574-6724 [email protected]
    For Immediate Release Contact: Rasheedah Ali (404) 574-6724 [email protected] On the Road with ¡SALUD! Los Angeles, May 16: Actor Danny Glover and Dr Linda Rosenstock, Dean of UCLA’s School of Public Health, welcomed a full house on May 14th at the new Billy Wilder Theater in Los Angeles for the city’s premiere of ¡SALUD! The award-winning feature documentary exploring Cuba’s contribution to global health is distributed by MEDICC (Medical Education Cooperation with Cuba). In her engaging opening remarks, Dr Rosenstock spoke of the film’s importance and presented the evening’s hosts, who in addition to Glover included Gore Vidal, Oliver Stone, Sarah Pillsbury, Andy Spahn, Stephen Rivers, Marjorie Tabankin, and California Assemblywoman Karen Bass. “¡SALUD!”, noted Glover, “calls up the power of imagination to change our lives ourselves, and it speaks to what Dr (Martin Luther) King called the need for a new moral imperative, a set of values to guide us.” Assemblywoman Bass, the film’s Director Connie Field, and Executive Producer Gail Reed joined in a lively post-screening exchange with the audience. Bass, also a MEDICC board member, noted that 15 Californians are among the 90 US medical students now training in Cuba, who have pledged to practice in underserved communities after graduation. “Our job,” she said, “is to help them make good on that promise.” On to DC, New Orleans, and Atlanta… Dr Mirta Roses, Director of the Pan American Health Organization (PAHO), presented ¡SALUD! at PAHO headquarters in Washington, DC on April 26th. According to Dr Roses: “¡SALUD! brings us the story of what one country—a poor one in terms of GDP—has launched in primary health care and the massive training of human resources for health, a program of solidarity and technical cooperation among countries.” She called human resources central to the strategy of strengthening health systems and meeting the Millennium Development Goals.
    [Show full text]
  • Cuba & Global Health
    Cuba & Global Health Cuba & the Global Health Workforce: Health Professionals Abroad Cuba’s contribution to the developing world’s health workforce has been essentially a practical one, focusing on health care delivery and medical education: since 1960, over 100,000 Cuban health professionals have served in 101 countries, staffing public health infrastructures; and over 21,000 students from Africa, Latin America, Asia and the Caribbean are currently enrolled in Cuban medical schools, not counting those in nursing and allied health professions (1)(2). This collaboration has evolved over time. The first Cuban medical team was sent to earthquake- devastated Chile in 1960, when the two governments had no formal relations. Such disaster relief missions were dispatched to another 16 countries over the next decades, but were soon overtaken by a more long-term modality: by virtue of government-to-government agreements, Cuban health professionals (the vast majority physicians) began providing health care to underserved populations and regions in Africa, Latin America, the Caribbean and Asia (3). Since the 1963 request from the Algerian government of Prime Minister Ahmed Ben Bella (bereft of physicians at the end of French occupation) another 100 governments have initiated pacts with Cuba for a sustained presence of Cuban health professionals in their countries’ health care delivery programs: six in the 1960s; 22 in the 70s; 11 in the 80s; 47 in the 90s; and 15 since 2000 (1)(4)(5). The fact that half this cooperation began in the nineties speaks to developments during that time in Cuba’s own health system, which made larger numbers of physicians available for international service and also reinforced Cuban health authorities’ commitment to primary care as key to improving health status.
    [Show full text]
  • “Exploring Health, Wellness & Culture in Cuba” a MEDICC Gateways
    “Exploring Health, Wellness & Culture in Cuba” A MEDICC Gateways Professional Research Opportunity February 16-22, 2020 Join MEDICC for an insider’s look at intersections between health and culture in Cuba’s unique and historic capital! MEDICC welcomes all whose area of expertise and/or profession is medicine, health or wellness; as well as artists, photographers, actors, musicians and other cultural workers whose professional life includes culture as a component of health, contributing to improved social determinants of health or individual/population wellbeing. An extraordinary itinerary is in the works on the tail end of Havana’s 500th Anniversary year, including learning from participatory community projects, natural/traditional medical therapies, artists’ cooperatives, mental health centers, neighborhood family doctor-and-nurse offices, children’s theater ….and finally, the HistArtMed program that brings together Cuban health professionals and the country’s vibrant culture, past and present. Draft Program in Cuba (Subject to change) Sunday, February 16 Morning / Afternoon ARRIVAL Check-in Hotel Sevilla Morning / Afternoon Orientation Meeting: Background on Cuban social development and your program, Hotel Sevilla Afternoon / Evening Welcome Lunch or Dinner Monday, February 17 Morning Primary care in Cuba’s National Health System Visit a community-based multispecialty polyclinic and a family doctor-and-nurse office nearby. Both are accredited for teaching medical and other health professionals. Take time to talk with patients, too.
    [Show full text]
  • Socioeconomic Status and Perceived Health-Related Quality of Life in Chile
    Original Research Socioeconomic Status and Perceived Health-related Quality of Life in Chile Isabel Matute MPH, Soledad Burgos PhD, Tania Alfaro MD MPH ABSTRACT RESULTS The sample comprised 4473 respondents, 51.6% women, INTRODUCTION Changes in the conceptualization of health and ill- median age 47.8 years. The probability of poor quality of life was ness have led to development of theory and methods to study health- higher in persons with only primary school education, those not in related quality of life. One instrument used frequently to measure this the workforce and those whose monthly income was below 100,815 concept is the SF-12 survey, included in the Second National Health Chilean pesos (US$140); the effect was stronger for physical health- Survey carried out in Chile between 2009 and 2010. related quality of life (OR 2.8, 95% CI 1.8–4.2; OR 1.7, 95% CI 1.2–2.3 and OR 2.2, 95% CI 1.3–3.8, respectively) than for mental health- OBJECTIVE Estimate the association between socioeconomic status related quality of life (OR 1.4, 95% CI 1.1–1.8; OR 1.6, 95% CI 1.2–2.2 stratifi ers and health-related quality of life in the adult population resid- and OR 1.9, 95% CI 1.1–3.0, respectively). ing in Chile. CONCLUSIONS The probability of poor health-related quality of life is METHODS We conducted a cross-sectional study of a subsample of higher in the worst socioeconomic status strata, and the effect is most the National Health Survey, in the population aged ≥25 years.
    [Show full text]
  • Letters to the Editor
    Letters to the Editor To the Editors of MEDICC Review: Of particular interest is the ed States for all but their first year of edu- University Polyclinic Medical cation. Their educational and clinical home The fall 2008 issue of MEDICC Review will be the community health center (simi- (Teaching for Health Equity: Changing Training Program (UPMTP) lar to a polyclinic), and they will spend time Paradigms of Medical Education) treats in Cuba, which moves the “back-rotating” to hospitals for limited pe- the rarely discussed topic of “teaching for principle site of medical riods and specialty exposure. The school health equity”. Within medical education, education out of the hospital has yet to have any graduates or any em- there is discussion of medical ethics, pro- and into the polyclinic ulators, so it is hard to speak definitively fessionalism, and, sometimes, services about how it will fare in the US medical to the underserved. The broad issue an outpatient base for medical education educational and practice environment, but of equity—health equity—receives little would greatly increase the capacity of any it does represent the boldest effort in the attention, either in the design of medi- institution or country. Secondly, the focus United States to depart from the traditional cal education programs or their con- of education in ambulatory facilities is far Flexnerian medical center-based model of tent. Medical education systems in most more congruent with the population’s ex- medical education and, like Cuba’s Univer- countries are wedded to traditional so- perience with health, the vast majority of sity Polyclinic Medical Training Program, it cial and economic structures that usually which does not occur in hospitals.
    [Show full text]
  • Cuban Health Care: a Work in Progress
    MEDICC Medical Education Cooperation with Cuba Cuban Health Care: A Work in Progress Since 1959, Cuba has pursued a health strategy founded Did You Know? on universal access, prevention, and community-based medicine. Launched with the Rural Health Service in Cuba is among the top 20 countries in progress towards the 1960 when doctors fresh from medical school fanned UN Millennium Development Goals out to remote regions, providing medical care to many rural people for the first time this strategy evolved into Cuba has the lowest HIV rate in the Americas a single public health system featuring services free to The leading causes of death are the same for the USA and patients, with particular focus on the most vulnerable Cuba (heart disease, cancer, chronic lower respiratory populations. diseases, stroke, and unintentional injury) Early and dramatic improvements eliminated many Doctor-to-patient ratio in Cuba is among the world s highest; vaccine-preventable diseases altogether, and meant that 59% of physicians are women diarrheal and other infectious diseases, malnutrition, A woman born in Maryland has the same life expectancy as a and parasites were no longer major health problems. woman born in Matanzas province in central Cuba Those gains prompted Cuba s health system to develop further: today, a family doctor-nurse program and Cuba has the lowest infant mortality rate in the hemisphere: a nearly 500 clinics locate primary care in communities child born in the eastern mountains of Cuba has a better nationwide. This is coupled with a
    [Show full text]
  • Place, Race, and the Politics of Identity in the Geography of Garinagu Baündada Doris Garcia Louisiana State University and Agricultural and Mechanical College
    Louisiana State University LSU Digital Commons LSU Doctoral Dissertations Graduate School 2014 Place, Race, and the Politics of Identity in the Geography of Garinagu Baündada Doris Garcia Louisiana State University and Agricultural and Mechanical College Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_dissertations Part of the Social and Behavioral Sciences Commons Recommended Citation Garcia, Doris, "Place, Race, and the Politics of Identity in the Geography of Garinagu Baündada" (2014). LSU Doctoral Dissertations. 3744. https://digitalcommons.lsu.edu/gradschool_dissertations/3744 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Doctoral Dissertations by an authorized graduate school editor of LSU Digital Commons. For more information, please [email protected]. PLACE, RACE, AND THE POLITICS OF IDENTITY IN THE GEOGRAPHY OF GARINAGU BAÜNDADA A Dissertation Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Doctor of Philosophy in The Department of Geography & Anthropology by Doris Garcia B.A., City College of New York, 2002 M.S., Central Connecticut State University, 2006 December 2014 Belize Caribbean Sea Islas de la Bahía Colón Atlántida Guatemala Cortés Yoro Gracias a Dios Santa Bárbara Copán Olancho Comayagua Lempira Ocotepeque Francisco Morazán Intibucá La Paz El Paraíso El Salvador Valle Nicaragua Choluteca P a c i f i c O c e a n Miles 0 50 100 Map of Honduras in Central America Prepared by: Paul Karolczyk and Doris Garcia ii ACKNOWLEDGMENTS I extend my most profound gratitude to several people who contributed to the completion of this dissertation and my evolution as a scholar.
    [Show full text]
  • MEDICC Review Author Guidelines March 2018
    MEDICC Review — Author Guidelines (available online) Version: January 2018 MEDICC Review Author Guidelines March 2018 Contents General Instructions ................................................................................ 2 Checklist for Manuscript Submission ................................................... 3 Definitions of Author & Contributor ................................................... 5 Policy on Conflict of Interest ................................................................. 6 Author Instructions: Original Research Article ................................... 7 Author Instructions: Review Article ..................................................... 9 Author Instructions: Lessons from the Field .................................... 10 Author Instructions: Lessons in International Cooperation ........... 11 Author Instructions: Perspective ......................................................... 12 Author Instructions: Viewpoint ........................................................... 12 Author Instructions: Letters to the Editor ......................................... 12 Page 1 of 12 MEDICC Review — Author Guidelines (available online) Version: January 2018 Author Guidelines MEDICC Review (MR) is an open-access quarterly journal, founded in 1999 and peer-reviewed since 2007. MR is indexed in PubMed; SciELO; Latindex; Thomson-Reuters; SCOPUS and Embase (Elsevier); CABI Global Health; Tropical Diseases Bulletin; Latindex and Redalyc. Available in EBSCO Host, ISI Web of Knowledge, and HINARI. MR publishes experiences
    [Show full text]
  • Download Full Book (PDF)
    Cuba The Atlantic Philanthropies 10 Rockefeller Plaza, 16th floor New York, NY 10020 United States atlanticphilanthropies.org The Atlantic Philanthropies Cuba 3 Dr. Rodriguez providesThe primary care to Shexley BenentAtlantic at walk-in clinic Number Philanthropies 14, Lo Santa Fe, Isle of Youth. Foreword 7 Preface 13 ‘It Was Something Like an Unrealized Dream’ 17 Summary 21 Why African-American Doctors Are Choosing to Study Medicine in Cuba 39 Cuba 45 Investments in Health Care 59 An Untold Story: Atlantic’s Support for Reconciliation Between the U.S. and Cuba 97 Grantee Profiles 119 William Soler Pediatric Hospital 121 INFOMED and the National Medical Sciences Information Center 130 Latin American Medical School — ELAM 136 Community Partnerships for Health Equity 142 Cuban Neurosciences Center 148 Center for Democracy in the Americas 151 Lessons 155 Acknowledgements 172 All references to currency are in U.S. dollars. The Atlantic Philanthropies Cuba BY JULIE FEINSILVER Chuck Feeney, founding chairman of The Atlantic Philanthropies, and Christopher G. Oechsli, president and CEO of Atlantic and first country director for Viet Nam, Australia and Cuba. DEDICATION Charles Francis Feeney, whose generosity and vision have improved the lives of millions in Cuba and across the globe The Atlantic Philanthropies comprise The Atlantic Trust and the Atlantic Foundation, the Mangrove Foundation (each based in Bermuda), and the Atlantic Advocacy Fund (AAF), a 501(c)(4) social welfare organization based in the United States, and other entities. One of these is the Atlantic Charitable Trust (ACT) of the United Kingdom, which is registered with the Charity Commission for England and Wales and is not subject to the same U.S.
    [Show full text]
  • CPHE Newsletter, May, 2019 COMMUNITY PARTNERSHIPS for HEALTH EQUITY US-Cuba Policy Changes Have Been in the News Lately
    CPHE Newsletter, May, 2019 COMMUNITY PARTNERSHIPS FOR HEALTH EQUITY US-Cuba policy changes have been in the news lately. nities have been able to creatively adapt Cuba’s working Yet we don’t hear about how the harsh restrictions on models and approaches to improve health and health equi- family remittances have created even more economic ty at home. This is the kind of news that is worth sharing hardships for the Cuban people. And we rarely, if ever, – especially with our existing health care system in con- read about Cuba’s educated and healthy population, who stant crisis. We are grateful to our CPHE participants for can do so much with so little – or of Cuban pride in their their staying power and their successful efforts to make history and culture. CPHE participants have seen differ- their voices heard at local, state and national levels. We ent faces of Cuba, and strongly identify with the spirit and are also grateful for the long-term support of our funders assets of Cuban neighborhoods – poor in material re- who recognize how CPHE is contributing to the national sources, but rich in spirit, like their own US neighbor- movement for health equity and social justice. Onward! hoods. We at MEDICC admire the ways CPHE commu- - the CPHE team CPHE’s First Cuba Youth Exchange “In the after-school program we observed at a middle school in Havana, all the kids went to their clubs and were excited! None of them left!” “I liken it to an All-Star that shoots 100 jump shots after prac- tice… these children were sharp… and wanted to be sharper! I thought it was SUPER dope that the STD club at the school partnered with the staff of Carrito por la Vida (the HIV/AIDs prevention center we had visited earlier) on some community outreach programs! I believe these kids’ enthusiasm was fueled by the confidence of knowing their place in the uni- Students in a middle school in Havana verse and having connection to their roots.
    [Show full text]
  • Your Primary Care Doctor May Have an MD from Cuba: Experiences from the Latin American Medical School
    Roundtable Your Primary Care Doctor May Have an MD from Cuba: Experiences from the Latin American Medical School Conner Gorry MA On the 40th anniversary of the Alma Ata Declaration that Data Snapshot: US Students and Graduates of ELAM af rmed health for all a right and primary health care the route Indicator Value to guar antee that right, WHO and PAHO have issued a call Students currently enrolled 72 to action to convert universal health into reality for the nearly Graduates 172 four billion people worldwide lacking full coverage of essential Graduates in residency or post residency 84 health services. There is some urgency to this movement: WHO Graduates working in designated Health 73% estimates the health workforce shortage of nearly 8 million could Professional Shortage Area (HPSA) and/or reach almost 13 million by 2035. And the USA is not exempt: Medically Underserved Area (MUA)* medical associations and special commissions set up to Specialty Graduates n (%) investigate the shortage of primary care physicians, especially Family medicine 49 (58) “under-represented minority” doctors, have issued report after report on this growing health care emergency. The biggest Internal medicine 21 (25) question looming is: where will the health care providers come Surgery 5 (6) from, especially well-trained primary care doctors who want to Pediatrics 4 (5) work for those who need them most? Emergency medicine 2 (2) Neurology 1 (1) Part of the answer may be found in Cuba and its Latin American Psychiatry 1 (1) School of Medicine (ELAM), which has graduated some 28,500 Triple board 1 (1) MDs from 103 countries since its rst class of 2005 —including *Those not working in an HPSA or MUA are working in the public sector with nearly 200 from the USA.
    [Show full text]
  • CHAPTER Two CUBAN HEALTH CARE in the NINETIES
    CHAPTER Two CUBAN HEALTH CARE IN THE NINETIES CUBAN HEALTH CARE IN THE NINETIES 33 Background The Cuban Constitution makes health care a right of citizens and the responsibility of government. The public health system, which emerged in the early 1960s, is based on universal coverage and comprehensive care, offered essentially free to the popu1ation.12 Over the past three decades, the following major developments have made their mark on the system: In the 1960s: The former Health -Department was given -ministerial ranking and reorganized to take up the task of providing universal health care. Pharmaceutical production and private health facilities were nationalized, with few exceptions. A Rural Medical Service recruited physicians who were dispatched to care for patients in remote areas, and 50 local hospitals and dozens of medical posts were hastily constructed in the countryside. By 1962, 161 neighborhood polyclinics were in operation in urban areas. The National Immunization Program was initiated, relying heavily on community participation, as were programs to control such diseases as tuberculosis, leprosy and the diarrheas. During this decade, approximately half the physicians in Cuba emigrated to the United States and elsewhere, leaving the country with 3,000 doctors and 16 full professors at the medical school. Training of new doctors became a priority. Margaret Gilpin comments in the Journal of Public Health Policy, "By the end of the first decade, a unified Cuban national health care system had been created and was firmly in place. The efforts paid off in changes in major health indicators, reductions of infectious diseases, and improved hygienic and environmental conditions.” 3 In the 1970s: In this decade, the polyclinic model of primary care was reinforced and expanded, taking on health education, prevention and environmental monitoring.
    [Show full text]