HEALTH: New Challenges for Cuba, 15 Years after ‘Health for All’

By Dalia Acosta Reprint | | Print |

Dalia Acosta

HAVANA, May 13 1998 (IPS) - Cuba is facing new challenges, such as maintaining the quality of health services and preserving the gains of the past few decades, 15 years after reaching the goal of “health for all” outlined by the international community for the year 2000.

The Caribbean island nation, which met the goal of universal health coverage back in 1983, has had to do a balancing act to keep the crippling economic crisis that has dragged on for eight years from dulling the “jewel” in the crown of the government of Fidel Castro.

The crisis has caused an accumulated 34.8 percent drop in Gross Domestic Product (GDP) since 1990. But although the quality of health services has been hurt, the key health indicators have not been significantly affected.

Meanwhile, the effects of the U.S. economic embargo in force since 1962 have been partially counteracted by the priority treatment accorded to health spending in Cuba and international aid.

Castro is expected to attend the World Health Organisation’s 50th anniversary celebrations in Geneva Thursday, where he will be awarded a prize for his government’s contributions to health.

This week, Public Health Minister Carlos Dotres confirmed the Castro administration’s aim to continue granting top priority to healthcare as “an indispensable element of social justice.”

Health ministers and delegations from 191 nations have been participating in the 51st annual World Health Assembly, which opened Monday in Geneva.

“Life in the 21st century, prospects for all” is the central theme of the report to the Assembly, which will discuss the overwhelming failure of UN member countries in meeting the objective of universal health coverage by the turn-of-the-century.

Dotres said that while WHO is facing the challenge of change, he underlined that “change in and of itself will not resolve anything” if not accompanied by efforts “to overcome, rather than further complicate, the major health problems in the world today.”

The report “Human Development in Cuba, 1996” presented this month in Havana stresses that “the country’s material limitations have not prevented a rise in spending in the local currency in the health sector.” The study was conducted by the Research Centre on the World Economy, a non-profit, Havana-based group sponsored by the United Nations Development Programme (UNDP).

The study reports that public health spending in 1994 – at the peak of the crisis – totalled 1.061 billion pesos (on par with the dollar at the official rate), 17 percent higher than the 1989 figure. That increase in absolute terms was accompanied by a rise in public health’s relative share of GDP and public spending.

But although spending on primary care rose 80 million pesos from 1990 to 1994, hospital care expenses dropped more than seven million pesos in that period, and the public health sector accounted for a mere 3.1 percent of the government’s new investments in 1994.

“The most serious problem is the availability of freely convertible currency,” which fell from 230 million dollars in 1989 to 75 million in 1994 and “seriously hurt supplies,” especially of medication, the study adds.

Authorities say the effects of the economic crisis on the health sector came on top of the losses caused by the U.S. blockade, estimated at more than 60 billion dollars for the economy as a whole.

At this week’s World Health Assembly, the Cuban delegation can boast of the universal, gratuitous health coverage enjoyed by the population and the low infant and maternal mortality rates, as well as a broad vaccination programme covering 12 diseases.

The latest Public Health Ministry figures indicate that infant mortality was a low 7.2 of every 1,000 live births in 1997 – compared to six per 1,000 in Germany (1994) and eight per 1,000 in the United States (1994) – while 9.3 per 1,000 children die before the age of five.

And only 6.9 percent of the 152,547 babies born last year in Cuba – a country of slightly more than 11 million – were of low birth-weight, down from 1993’s nine percent, and only just below Sweden’s 1990 rate of five percent.

Maternal mortality, meanwhile, one of the indicators that suffered worst at the peak of the crisis, dropped to 22 deaths per 100,000 live births in 1997. After maternal mortality was reduced in Cuba from 145 per 100,000 live births in 1953 to 30.8 in 1985, it rose to 31.6 in 1990 and shot up to 36.2 in 1991.

Poliomyelitis was eradicated in Cuba in 1962, tuberculous meningitis in 1971, neonatal tetanus in 1972, diphtheria in 1979, congenital rubella syndrome and meningoencephalitis arising from parotitis (mumps) in 1989 and measles in 1993.

“Whooping cough, German measles, tetanus and mumps are no longer health problems, because the rates are lower than 0.1 per 100,000 inhabitants,” says the study on human development in Cuba.