Cuba best for healthcare

Friday January 19, 2007

Georgina Kenyon

The world sneaked a glance through the window of Cuba's health system recently as the nation's octogenarian revolutionary leader Fidel Castro was treated for a stroke.

While the global media?s focus on the Caribbean islands usually rests on Cuba's often poor human rights record, its lens does not reflect the fact that Cuba's health system is praised by British and American healthcare managers alike as one of the world's best. Indeed it is the envy of public health officials in many developed countries, both for its effectiveness and cost efficiency.

Little freedoms

With its free access to care, health indicators that are similar to those in the west and one doctor provided for every 150 people, at relatively low cost, compared to Britain's one for every 1000, medical experts in the UK who have studied Cuba say that the Cuban health system is one of the best in the world. Even the World Bank cites Cuba?s social performance as exemplary, especially in light of the country?s economic hardships.

Cuba?s consultorios ? a system of three storey buildings with a practice surgery on the ground floor, the doctor with a flat on the second, and the nurse on the top floor ? also allows Cubans to receive treatment quickly. It?s also cheap, at an average £7 per person compared to £750 in Britain.

According to a spokesperson for the US Medical Education Cooperation with Cuba (MEDICC), ?the level of integration between the consultorios and their local communities around health promotion and healthcare delivery is one of the main indicators for its success." MEDICC arranges for healthworkers working in deprived areas of Los Angeles ? where there is a high rate of poverty, unemployment and chronic disease ? to go to Cuba to study, visiting clinics and meeting Cuban doctors.

Teams of doctors from the UK have also travelled to Cuba to study its cheap public healthcare. They analyse health statistics, such as those from the World Health Organisation, to find out how Cuba has managed to turn around life expectancy and child mortality figures in the past decade.

Cuban men currently have a life expectancy of 74, the same as in Britain. The life expectancy of women in Cuba is 76, compared to 79 in Britain.

In the public interest

Good public health services are not necessarily directly proportional to a country's financial resources, as a 2006 report from Oxfam proves. Middle-income countries, such as Peru, have also been lauded by international organisations, including the WHO, for good quality public medical care.

Oxfam has devised an Essential Services Index, which compares the various public health and education systems in the developing world. The index was published in Oxfam's report, In the Public Interest, focusing on both developing and developed country's healthcare systems. The report includes analyses of rich and poor countries' provision of public services.

It is clear from the index that Cuba is not an anomaly, at least not in its combination of good healthcare provision with scarcity of resources. The system in Sri Lanka also has its fans.

According to Oxfam?s UK spokesperson, Nicky Wimble, "Sri Lanka is one of the world's poorest countries yet its maternal mortality rates are among the lowest in the world.

"When a woman gives birth, there is a 96% chance she will be attended by a qualified midwife. If she or her family need medical treatment, it is available free of charge from a public clinic within walking distance of her home, staffed by a qualified nurse."

The index ranks countries by four social criteria: child survival rates, schooling, access to safe water and access to sanitation. Then it judges the country?s performance against its national income per capita.

Although it is accepted among international health officials that countries do not have to be wealthy to have comprehensive and effective public healthcare systems, this index quantifies such findings to the public.

Public or private

Oxfam's report stresses the need for private companies to be properly regulated and integrated into strong public systems, and not seen as substitutes for them. "Only governments can effectively deliver services like health and education to the poorest," it states. When government services fail, many look to the private sector for answers.

In the case of South Korea and Chile, private sector involvement did not have a negative impact. And opinion polls in the UK support mixed public-private healthcare provision. A MORI Social Research Institute poll for the British Medical Association in 2002 found that more than half (51%) of respondents believed that involving the private sector would improve the provision of NHS healthcare.

"Building strong public services for all is hardly a new idea. It is the foundation upon which today's rich country societies are built," according to the Oxfam report. "More recently, developing countries have followed suit, with impressive results. Sri Lanka, Malaysia and Kerala state in India, for example, have, within a generation, made advances in health and education that took industrialised countries 200 years to achieve."

The MORI poll also found that more than 42% of patients would be willing to travel outside the UK for treatment.

 

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