HEALTH-CUBA: Government Takes Scalpel to Medical System

By Patricia Grogg Reprint | | Print |

Patricia Grogg

HAVANA, Jan 31 2003 (IPS) - Cuba is reorganising its health system, the pride and joy of its socialist government, in order to return the shine it lost due to years of economic crisis and poor administration.

The complete health coverage provided to all Cubans free of charge, with technological and scientific advances comparable to those seen in the world’s richest countries, has sharply deteriorated in quality.

Shortages of basic medicines, rundown hospitals and health centres, delays in obtaining basic non-emergency services like x- rays, and overburdened, underpaid family doctors who have little time to meet with and examine their patients are some of the problems that Cubans have been complaining about for years.

This Caribbean island nation has one doctor for every 167 inhabitants, compared to one per 358 in the United States; one per 437 in Canada; one per 330 in France; one per 286 in Germany; one per 909 in Chile; and one per 538 in Mexico, according to Granma, the official publication of the governing Communist Party.

z Life expectancy stands at 76.15 years in Cuba, similar to the rates seen in the most developed countries: 78.5 in Canada; 76.5 in the United States; 78.1 in France; 77.2 in Britain; 77.3 in Germany; and 75.9 in Denmark, Granma reported.

But in this country where organ transplants are carried out with no cost whatsoever to the patient, it has become increasingly difficult to schedule an x-ray or get a dentist appointment.

”I can’t complain, because I have a lot of doctor friends who helped me with my problem,” said Fernanda Martínez, a 60-year-old hairdresser who took care of her ailing mother until she died at the age of 90 last November.

But although she praised the ”strides” made by the revolution led by President Fidel Castro, Martínez confessed that she had to wait a long time to get false teeth and to upgrade her eyeglasses.

Now she is hoping that the health clinic and pharmacy in her neighbourhood, which are ”falling apart”, will be repaired, as have others in Havana, and that her family doctor will start to have more time to attend his patients in the local community.

The family doctor and nurse programme was launched in 1984, and became the pillar of Cuba’s primary health system. But the burden of paperwork that was placed on the doctors limited the time they could dedicate to their patients.

Castro himself admitted the problem late last year, when he said that ”unsound decisions, red tape, and absurd work schemes and schedules” had caused considerable damage to the health system.

Although the president did not mention any names, observers interpreted the criticism as being directed at Carlos Dotres, the health minister who was replaced in July 2001 by Damovar Peña.

Closed-door meetings and surveys among health professionals over the past few months have apparently given the government new insight into the array of problems standing in the way of the work of family doctors, such as their small salaries.

Special ”programmes and more programmes, questionnaires and more questionnaires kept raining down, leaving the family doctors without time to attend” their patients, said Castro.

Basically, the reorganisation will mean that neighbourhood health clinics will once again provide a range of services that had gradually stopped being offered in the past 10 years, in order to turn them into ”centres of primary health care of the highest quality.”

The clinics will be furnished with ultrasound, x-ray, optometry, traumatology, ophthalmology, electro-cardiology and physical rehabilitation equipment.

Once the health centres have been upgraded, only the most specialised and complex treatments will be provided by the hospitals, which will also be restructured, until there is not ”one single hospital that is functioning poorly due to administrative or subjective problems,” according to government officials.

At the same time, the lack of medicine and faulty medical treatment have served as a breeding-ground for a black market in pharmaceutical products, and for the illegal charging of fees for services that should be free of charge.

Officials, however, said such cases of corruption were ”isolated” and would be rooted out, although there has been no public announcement of the possibility of adopting measures to combat the problem.

The production of medicines picked up after the pharmaceutical industry was restructured and transferred, two years ago, from the sphere of the Health Ministry to the Ministry of Basic Industry, which also oversees other strategic areas like the oil and nickel industries.

The process of computerising the country’s main pharmacies should be completed this year, which will link them by e-mail to hospitals, health clinics, and the National Centre for Control of Medicines.

Health officials hope the distribution of drugs will substantially improve with the availability of timely, up-to-date information on supply and demand regarding pharmaceutical products around the country.

Cuba’s pharmaceutical industry produces 540 of a list of 809 ”essential” drugs, and imports 90 percent of the raw materials used in manufacturing the medicines.

Cuba, a country of 11 million, has 66,000 physicians, nearly 31,000 of whom form part of the family doctor programme, which attends patients in a total of 15,000 health posts located around the country, even in the most remote mountainous areas.

In addition, the country has a total of 267 hospitals, 444 health clinics, 13 medical research centres, 15 sanatoriums for HIV/AIDS patients, 25 blood banks and around 2,000 pharmacies.