Overview of Cuban Health Sector

The Cuban healthcare system is free for citizens and prioritizes primary care. In 1959, after the revolution, the government set up a public health system focused on preventative medicine. Today, the country’s health is surpassing that of the U.S. according to several key indicators. In 2014, life expectancy in Cuba was measured at 79 years compared to 78 years in the U.S. and the infant mortality rate is 4.2 per 1000 births compared to 6.2 in the U.S. Cuba is not only one of the healthiest countries in the world, but is also a leader in the field of medical research and development (R&D). In recent news, Cuba became the first country in the world to eliminate mother-to-child transmission of HIV and developed a vaccine for lung cancer that many developed countries are hoping to access.

The government places incredible value on their health system, particularly on primary care. In fact, all Cubans are required to visit a doctor at least once annually. In most cases, employers (i.e. the government) require that employees bring a certificate from their doctors after their annual check-up in order to keep their job. This emphasis on primary and preventative care is reflected in the way that the Cuban healthcare system is set up.

Cuba tackles preventative care on two fronts, through consultorios (doctors offices that serve a particular neighborhood) and policlinicos (small hospitals that serve several neighborhoods). Consultorios reach a community of approximately 1100 people. Neighborhood doctors know their patients intimately, having lived and worked amongst many of them since birth. This intimacy results in an extremely in-depth knowledge of patients’ medical histories, as well as a strong understanding of environmental and social factors that influence their health. This also leads doctors to take a holistic approach to healthcare - knowing their patients intimately means that they can intervene on various levels, sending psychologists or pediatricians to people’s homes if necessary.

In addition, consultorios are seen as a focal point for many communities. Walking around a neighborhood in Havana, nearly every stranger can point to the nearest consultorio and tell you the name of the doctor who works there. Elderly neighbors come to clinics quite frequently for minor scratches and bruises, simply because medical services are readily available and accessible to them. Doctors reported that many elderly patients use the consultorios as a community gathering place and frequent them on a regular basis to socialize with one another in the waiting room. Doctors take the time to talk to each patient and provide the necessary care, regardless of why they visit.

Photo by Chiara Bercu

After the consultorio, the second front of primary care in Cuba is the policlinico, which is a larger medical center equipped for minor emergencies and surgeries that is open 24 hours a day. On average, 23 consultorios feed into a single polyclinic which serves a population of about 22,000 people. Polyclinics are generally equipped with ultrasounds, and some have CAT scans and other more advanced medical technology as well. They are staffed by two doctors at all times, and serve as primary emergency facilities for the communities they support. While patients technically are expected to access their local consultorio before visiting a policlinico, many go straight to the polyclinic level for their healthcare needs, according to one doctor staffing a polyclinic in Havana. Both consultorios and polyclinics are structured as primary health care facilities for Cubans, helping to alleviate pressure on hospitals and offer conveniently located access points for Cubans to seek care.

Lastly, Cubans visit hospitals for major surgeries and specialized medical attention. Hospitals have more advanced medical equipment in addition to medical specialists. Hospitals are located throughout the country, with a larger concentration in Havana. In the case of extremely complicated medical procedures, patients in rural areas occasionally have to travel to Havana to receive necessary care. Additionally, medical facilities in Havana --including consultorios and policlinicos--tend to be better equipped than many medical facilities in rural parts of the country. Cubans reported that they were often unable to find specific medications or access equipment like CAT Scans in rural areas of the country.

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Diagnosis in Cuba - Classifications of Risk

Doctors in Cuba classify all patients into “categories of risk” on a scale from one to four, with one being the least risky and four being the most. The classifications are as follows:
  1. Patient is completely healthy as far as the doctor can tell
  2. Patient has some risk factor present
  3. Patient is sick (might have an illness, be a smoker or an alcoholic)
  4. Patient has some kind of permanent impairment

Individuals are classified annually and can move between categories from year to year. Each category has different follow-up procedures based on risk levels. Doctors see patients who are classified as riskier more frequently, either by requiring them to come in for more regular check-ups or by visiting them at home. Home visits are extremely common in Cuba. Doctors frequently conduct home visits if patients cannot come to the consultorios due to illness. When patients miss appointments and are not responsive to phone calls, doctors will simply conduct a home visit the following day to see why they have not responded.

Women's Health

The Cuban healthcare system places a huge emphasis on women’s health, especially prenatal health. Sexuality is a comfortable topic of conversation amongst most Cubans, and women generally begin receiving sex education from their primary care doctors at an early age. Doctors reported having open and honest conversations with their patients about their love life and consulting young women on their birth control options when they decide they are ready to have sex. When they reach age 18, women are considered a category 2 on the risk scale, as doctors assume that they are sexually active and are at risk of becoming pregnant. They remain in this risk category until age 36, or until they have consulted their doctors to let them know that they do not plan on having anymore children.

Doctors are extremely forthcoming with their female patients about various forms of birth control, and access to contraceptives is easy and inexpensive. A single condom costs 1 CUP (equivalent to .04 cents in U.S. currency). Doctors spend a great deal of time educating their patients with prenatal health information to ensure that they are in good physical health and receiving proper nutrition in case they do choose to become pregnant. After the age of 18, doctors make a point to talk to women about their sexual and reproductive health during each annual check up. Additionally, because doctors live amongst their patients, they reported hearing whispers from family members and neighbors of women attempting to get pregnant. Doctors diligently follow up on these rumors with phone calls and schedule additional appointments to address the woman’s health. In order to help women create a plan for prenatal health, doctors make a point of keeping track of when female patients hope to conceive. Women who hope to get pregnant schedule several follow-up appointments throughout the year to ensure their health and seek advice if they are having any trouble.

Early Childhood Health

The special attention placed on a prenatal woman carries forward into the first few years of her child’s life. Children under a year old are considered at risk, also falling into category 2. They are required to see their doctors at the consultorio several times throughout their first few months of life. When the child is just 5 to 7 days old, they visit the consultorio for the first time for metabolic tests. If a woman does not bring her baby to the consultario by this date, the doctor will make a home visit to check on mother and child.

Specialists also do rotations through the consultorios so that women can bring their children to their neighborhood clinics once a week to see a pediatric doctor. At one neighborhood consultorio, for example, a pediatrician visits each Thursday and a Psychologist visits each Monday.

Written by: Chiara Bercu
Edited by: Laura Lehman