A number of hospitals and clinics in Cuba have been remodelled. Credits: Jorge Luis Baños/IPS

By Patricia Grogg
HAVANA, Sep 7 2013 (IPS)

One challenge faced by the Cuban government, and a high priority for citizens, is improving the efficiency and sustainability of public health services, a constitutional right that the state is supposed to ensure for all.

The quality of healthcare services was a target of criticism during mass debates that were promoted by President Raúl Castro in a key Jul. 26, 2007 speech.

Many suggestions for improving the public health system also emerged from discussions on the draft social and economic policy guidelines that were later approved for the current process of “updating” the country’s development model.

The evident deterioration of hospitals, inadequate professional care, and a shortage of medical personnel were among the complaints most frequently expressed at that time.

“Since the early 2000s, the public has been dissatisfied with a large number of things,” Emilio Delgado, head of the Primary Health Care Department, admitted to IPS in an interview.

The official said that given the need to meet international medical “commitments,” the healthcare system was reorganised, resulting in a reduction of family doctor’s offices, which are the basic foundation of primary health care in Cuba.

Remedying that situation involved a restructuring that began in 2010 as part of a number of changes aimed at modernising Cuba’s socioeconomic model and building what the government describes as “prosperous and sustainable socialism.”

The ongoing restructuring process includes reducing payrolls across the entire public health system.

In 2009 the system had 582,538 workers, 69 percent of whom were women. By 2012 that number had been reduced to 490,245, with a similar proportion of women, according to Public Health Ministry records.

Delgado said the cuts have continued, to 486,000 health workers in July. These staff reductions involve offering other jobs to redundant workers described euphemistically in Cuba as “available”.

As a “very important” result of the ongoing changes, 11,550 family doctor’s offices are now operating nationwide, “almost double” the number before 2010, Delgado said. This system brings doctors closer to Cuban families and prevents unnecessary trips to the hospital, among other benefits.

Measures were also taken to rationally employ high technology and other resources, and investments continue to be made to rebuild hospitals.

“My husband had an emergency operation last week and I have no complaints. Even the hospital food has really improved,” Consuelo Aguilar, a teacher, told IPS.

Delgado said: “These changes had three main goals: to be more efficient and sustainable, that is, to provide the same services but with better quality and at a lower cost; to maintain our health indicators; and to achieve greater satisfaction among the population.”

He estimated that since 2010, more than two million pesos have been saved in healthcare spending.

According to other official sources, the healthcare system had grown in recent years, both in the number of workers and in the acquisition of costlier equipment. This translated into higher spending, which rose from 5.5 percent of GDP in 2004 to 9.6 percent in 2009.

After reorganising its healthcare facilities, Cuba now has 152 hospitals with a total of 40,318 beds; one doctor for every 133 inhabitants; one dentist for every 774; and one nurse for every 117. Life expectancy at birth is 77.9 years, and the infant mortality rate is 4.3 per 1,000 live births.

In parallel, health authorities hope the system will begin generating revenue of its own by marketing services to foreigners both inside and outside of Cuba, including teaching services.

“A large number of doctors from other countries want to and can self-finance training in their specialties here,” Delgado said.

Along with the challenge of sustainability, Cuba’s health system must also respond to the problems presented by the low birth rate, which now stands at 11.3 per 1,000; an aging population; and associated problems, such as cancer, the leading cause of death.

“We are preparing for all of these things, and in some cases, we have already taken precautions,” Delgado said.

Measures are being studied for encouraging women to have more children and to go in for more gynecological checkups. Likewise, treatment for female and male infertility is being expanded in order to offer “the possibility of pregnancy for thousands of couples who can’t have children,” he said.

Cancer, meanwhile, is a disease that requires specialised treatment and medicine and poses a different set of challenges, for which Cuba is preparing with the introduction of new diagnostic technologies and treatments. “There is a whole investment process underway in that sense,” Delgado said.

In his opinion, the greatest challenge in terms of healthcare services that are provided to all of Cuba’s citizens free of cost is achieving greater satisfaction among the population. “If people are dissatisfied, we have to keep finding out why,” he said. Hygiene and epidemiology are other areas that require more attention, he added.

More than 100 non-farming cooperatives this month joined the independent sector of the Cuban economy, which includes self-employed workers and farmers granted public land to work, as part of the policy outlined by the government for modernising the management of state property.

The authorities have defended “social ownership of the basic means of production” as an essential aspect of the new economic model being built on the basis of reforms outlined by the “economic and social policy guidelines” of the governing Communist Party of Cuba, considered a roadmap for “updating” the socialist system promoted by President Raúl Castro.

In recent legislative debates that touched on this issue, the vice president of the Council of Ministers, Marino Murillo, said the changes underway were aimed at building “prosperous and sustainable socialism, in which the main protagonist is the public enterprise, strengthened with greater autonomy in its management and the distribution of its results.”

“Socialism presupposes social ownership over the basic means of production; prosperous signifies a state of well-being; and sustainable is synonymous with development, because without it, nothing is sustained,” said Murillo, who is also chair of the government commission charged with implementing the economic and social policy guidelines, the highest responsibility in the economic modernisation process officially launched in 2011.

Analysts consulted by IPS said that the creation of 124 non-agricultural cooperatives was one of the “boldest” steps taken by the Castro administration, given that 112 of these new entities are former state companies, and they are being called upon to be more efficient than their predecessors. Until now, cooperatives were only allowed in the field of agriculture.

By sector, 99 of the new cooperatives are involved in the agricultural market; 12 will operate as construction brigades; five are for passenger transport, including school transport; six are for transport repair, bodywork and other services; and the remaining two will collect and recycle raw materials. An additional 71 coops are expected to join their ranks shortly.

In a speech that was broadcast after the legislative debates, Castro said his government would resolutely support the creation of non-agricultural cooperatives, which together with the expansion of self-employment “will make it easier to free up the state from non-essential production and service activities so that it can concentrate on long-term development.”

However, this process is being carried out with precaution, which is why these first non-agricultural coops will initially operate only in the provinces of Havana and neighbouring Artemisa and Mayabeque. According to how things go, the experience could be extended to the rest of the country.

Cooperatives in Cuba have their own legal status, and they use, enjoy and dispose of their own assets, although they can also employ any other resource leased to them by the state. The coop’s highest governing body is the general assembly, in which each member has a vote.

Murillo said the number of registered self-employed workers had climbed from 157,037 in September 2010 to 429,458 today. In 2008, the government began distributing idle public land to farmers. The construction of housing on the land was later authorised. Nevertheless, the new farms continue to report low levels of production.

According to recent estimates, a total of 176,000 people were granted land to farm, and Decree-Law 300, passed in December 2012, increased the maximum amount of land they are allowed to possess from 40 to 67 hectares.

The Land Control Centre (Centro de Control de la Tierra) reports that 1.5 million hectares of idle state farmland have been distributed so far, and another 975,000 are available for distribution. The aim is to boost agricultural yields and food production.

Despite these and other measures, the agriculture sector has not obtained sufficient yields to meet the country’s needs. By the end of this year, Cuba will have spent an estimated two billion dollars on food imports.

“Production must be freed up even more,” one expert on agriculture, who did not want to be identified, told IPS.

According to that source, agriculture in Cuba absorbs 20 percent of the workforce but accounts for less than five percent of GDP, because it is the sector with the lowest productivity. “There is still a long road ahead, because the efforts made so far have not produced the expected results,” the expert said.

Food is the biggest expense for the average Cuban family, for whom the 2.3 percent GDP growth in the first half of the year went unnoticed, President Castro admitted during closing remarks at the parliamentary session. Growth is expected to range from 2.5 to 3 percent by the end of the year.

The president said that an atmosphere of order and discipline in Cuban society is an “essential premise for consolidating the progress of the updating of the economic model and for not accepting counterproductive setbacks.”

In that respect, he urged citizens to join the struggle against “the atmosphere of indiscipline that has become entrenched” in Cuban society and that is “causing considerable moral and material harm.” In his opinion, this battle should not be just another campaign, but a “permanent movement.”

“We have painfully perceived, throughout more than 20 years of the ‘special period’ (a euphemism for the crisis), the increased deterioration of moral and civic values, such as honesty, decency, shame, decorum and sensitivity to the problems of others,” he said, in extensive remarks on the subject.

Leonardo Padura. Credit: Courtesy of the author

By Leonardo Padura
HAVANA, Mar 28 2013 (IPS)

The reform process launched in Cuba by the government of President Raúl Castro has made several changes to the country’s rigid social and economic structure, with the ultimate aim of bringing this island nation out of its economic lethargy and making production, which is sinking under the weight of restrictions, controls and contradictions, more efficient.

After the announcement of the government’s intention to introduce “structural and conceptual changes” to “update” the model, the 2011 Sixth Congress of the Communist Party of Cuba – the sole legal party, which governs the country – approved the Guidelines for Economic and Social Policy which set forth the transformations to be carried out.

The programme laid out in the document, which is precise on some issues but vaguer on others, sets out guidelines and commitments for the proposed changes, small and large.

In response to demands or criticism that the pace of change is too slow for a country plagued with social and economic problems that range from the highest structural and macroeconomic level to the complicated daily life of the average citizen, Raúl Castro has stated on several occasions that the transformations will keep pace with well-thought out plans, in order to avoid new errors. He calls this tempo “slow but sure.”

Recently the vice president of the Council of State and Council of Ministers, Miguel Díaz-Canel, confirmed to the press announcements already made by the president.

While economic and social changes have so far brought about slight (or not so slight) shifts in the relations of production, property and citizen rights, such as the revitalisation of private enterprise, creation of agricultural and worker cooperatives, distribution of land for farming, or the important migration reform that allows a majority of the population to travel, changes in the years to come will have a more radical effect on the basic structures of the system.

As Díaz-Canel said: “We have made progress on what was easiest, in the solutions that required less depth of decision and less work to implement, and now we are left with the more important aspects, which will be more decisive in the future development of the country, as well as more complex.”

What is intriguing is that neither leader has specified what the changes will consist of, or what their sphere or scope will be. They merely respond that everything is laid out in the Guidelines.

But an event of international importance has made a big difference to the balance of decision-making in Cuba.

The death of Venezuelan President Hugo Chávez, Cuba’s main political supporter and trading partner through bilateral and regional agreements, such as the Bolivarian Alliance for the Peoples of Our America (ALBA), is definitely a factor that Havana cannot take lightly.

If, as analysts expect, Nicolás Maduro, Chávez’s political heir, wins the presidency in the upcoming elections in Venezuela, Cuba will be able to breathe more easily, given Maduro’s promises with respect to the island and the loyalty he has pledged to Chávez’s thought and commitments.

But what no one doubts is that, with the passing of Chávez, the internal situation in Venezuela could become complicated in many ways, and its close relations with this Caribbean island nation, at least in economic terms, could change because of those unpredictable complications in Venezuela’s domestic reality.

This new turn of events will doubtless have been studied by the Cuban government, independently of political declarations or even silence. And the development will probably have an effect on the pace of internal change.

The fragile state of this country’s economy calls for efficiency, investment (including, of course, foreign capital), the redefinition of production relations, and the updating of state and private sector use of new technologies.

Meanwhile, the complex social fabric, that is so different today than in the early 1990s (when a severe crisis was triggered by the break-up of Cuba’s main political and trading partner, the Soviet Union) requires more realism and dynamism in the process of change, given that a large percentage of the Cuban population is made up of young people with different ideas and points of view, and also that many people have spent more than 20 years struggling to survive on low wages and facing concrete problems of all kinds.

Has the time come to cut short the pauses and accelerate the pace? And is it time for citizens to begin to learn what future is in store for them with those deeper and more complex transformations, that could define the destiny of the country and, certainly, of their own lives? In all likelihood, yes.

Excerpt:

Goats like the ones raised on the Carolina farm are becoming an increasingly frequent source of income and food in Cuba. Credit: Jorge Luis Baños/IPS

By Ivet González
CIENFUEGOS, Cuba, Mar 20 2013 (IPS)

Goat farming is becoming popular among farmers given land to use as part of the economic reforms implemented in Cuba since 2008. The increase in goat rearing, in provinces like Cienfuegos on the southern coast, could help expand the limited range of basic food products available to Cubans.

“The goat is an animal that requires abundant food and care, but its meat and milk are highly nutritious,” Dayamí León, a veterinarian who looks after 512 goats on the 26-hectare Carolina farm near the city of Cienfuegos, 230 km southeast of Havana, told IPS.

León left her job in a state company to work on the farm, which was created in 2008 when her husband applied for some of the unproductive land being redistributed as part of the government’s strategy to increase domestic food production.

The farm now gives work to 12 people, including 10 family members, and it produces some 51,000 litres of goat milk annually. León and her husband also have cows, bulls and pigs, and they grow a few crops as well.

León is responsible for the health of the animals, the births, and the slaughtering.

Small livestock rearing is the third most popular activity for which people in Cienfuegos are applying for land under the redistribution programme.

In this province, some 78,000 hectares were distributed as of February to 8,200 people since the approval of decree-laws 259 and 282 in 2008, which stipulated that idle state land was to be distributed under usufruct to people who would farm it. In June 2012, 975,000 hectares, out of a total agricultural area of 6.6 million hectares, were still available for redistribution, down from 1.8 million hectares when the strategy went into effect.

Decree-law 300 replaced the two previous laws in December, expanding the amount of land granted to each beneficiary from 40 to 67 hectares. It also included fruit production and forestry on the list of permitted activities and allows beneficiaries to build housing and other production-related infrastructure on the land. In addition, the usufruct rights can be renewed after 10 years.

In 2010, the government announced massive lay-offs of public employees, which were to potentially affect one million people by the end of 2011. But the government has slowed down the pace of the reforms, to make them less traumatic. Prior to the slashing of the public payroll, the government employed more than 80 percent of the workforce in Cuba.

Thousands of the people who have lost their jobs in the public workforce have applied for land under the redistribution programme.

“Small livestock rearing has become popular among the people granted usufruct rights,”
Jorge Antonio Rodríguez, provincial director of land control in Cienfuegos, told foreign correspondents. The sector has grown 60 percent in the province since the redistribution began. There is still land available for redistribution in Cienfuegos.

León said the success of small livestock farms depends on good design and planning. After receiving advice from an agronomist, her family farm began to grow white mulberry (Morus alba) bushes for animal feed. The berries are also a tasty addition to the family diet.

“The bushes make the animals grow faster, due to their high protein level,” she said.

The Carolina farm, considered the best producer of goat milk in the country, has milking machines and produces hay with a recently acquired hay-making machine.

The farm also uses animal manure as compost on the plants grown for animal forage, including white mulberry, king grass (Pennisetum purpureum) and the moringa tree (Moringa oleifera).

The aim now is to maximise production. Of the 380 adult goats on the farm, only 30 are milked twice a day. “We have to make more stands to be able to milk the rest of the goats. The ones that are only being milked once a day are being underused,” said Regino Rodríguez, León’s husband.

Rodríguez, who used to work as a technician at the Camilo Cienfuegos oil refinery, is grateful for the new family business, which brings them a higher income.

He also said it feels good to provide goat’s milk for local children who are intolerant of cow´s milk.

“Our city is small. We generally provide milk for around seven kids,” he said. In Cuba, children up to the age of seven are guaranteed a daily ration of milk at subsidised prices. Youngsters who can’t drink cow’s milk are given a substitute, like goat’s milk.

Carolina and other farms must sell most of their output to state-owned companies at pre-established prices. But thanks to the reforms, they can sell the surplus production to businesses catering to tourists, or can take it directly to farmers markets, where prices are set by supply and demand.

But the changes in agriculture, which were given priority in the economic reforms adopted by the government of Raúl Castro, have so far fallen short of the hoped-for results.

Cuba continues to import 1.8 billion dollars annually in food. Nor have there been significant improvements in the cost of food.

Local officials in Cienfuegos acknowledged that food prices have not been brought down far enough.

The government especially wants to reduce imports of milk, due to the high international prices.

Goat milk production rose between 2006 and 2011, particularly thanks to non-state production, according to the national statistics office. But it went down by 0.2 million litres, or 8.3 percent, in the period January-September 2012, with respect to the same period in 2011.

The fall was partly offset by an increase in cow milk production in the same period.

The man behind the counter at a state-run shop in Havana told IPS: “The bags of goat’s milk assigned to the children who need it are always available, but it’s been a long time since I have received enough for temporary diets (for people with special health needs). Nor is it a product that’s easy to get, especially in the cities.”

Pablo, a two-year-old boy with a cow’s milk protein allergy, has been drinking goat’s milk since he was seven months old. His mother, Lilian García, told IPS that the amount of milk she receives for her son from the ration card is sufficient.

But García, who lives in the Havana neighbourhood of Cerro, said the goat’s milk is harder to find than other products. “A farmer sells it to me, along with the meat, but not everyone has someone nearby who they can buy from.”

She also said many people in Cuba don’t consume products from goats because they are not familiar with them.