Cuba's 30-Year Track Record in Community-Based Health Care

Under the Cuban Constitution, health care is a right of citizens and a responsibility of government. In addition, Cuba's Public Health Law outlines the principles of the National Healthcare System as follows:

· Socialized medicine, organized by government.
· Services accessible to the whole population, free of charge (universal
  coverage).
· Preventive medicine as the hallmark of the system.
· An adequate application of scientific and technical advances to the practice
  of medicine.
· Public participation in healthcare.
· International cooperation.
· A comprehensive approach to planned development of the system.

Over the last four decades, these principles have prompted Cuban health authorities to move ever more rapidly towards solid models of community-based, preventive health care, which could effectively reach the entire population. (See From Community Polyclinics to Family Doctor-and-Nurse Teams this issue).

In the 1960s, this meant sending scarce human resources (3,000 of Cuba's 6,000 physicians left the country after the 1959 revolution) to offer services where none had existed. As a result, the Rural Health Service was created, dispatching health professionals to the 50 rural hospitals and dozens of medical posts hastily constructed to offer health care in the remotest regions of the country, where until then, just 8% of the population had access to health care facilities.

In the 1970s, the polyclinic model of local healthcare centers was put into practice throughout the country, for the first time
taking medical services to patients in their communities. The polyclinics took on health education, prevention, and environmental monitoring as well as clinical patient care.

In these years, the Public Health Ministry also began to develop national programs to give more specific attention to certain sectors and at-risk populations. The first of these-which still gets top billing today-was the Maternal-Child Program.

By the 1980's, the Cuban healthcare system was consolidated nationwide, and 54 fields of medicine were practiced in the country, with specialized institutes acting as national reference centers for a number of them. Schools of medicine multiplied, and medical research opportunities were enhanced with the decision to move full speed ahead into biotechnology.

In 1984, the country introduced a model that revolutionized Cuban medicine and the healthcare system: the family doctor and nurse team. As summarized in the UNDP-sponsored study Human Development and Equity in Cuba, 1999, "This has been the most important reform carried out in the National Healthcare System, and it has become the pillar of primary care. The objective of this model has been to improve the health situation of the population through comprehensive actions involving individuals, families, communities and the environment." (Human Development and Equity in Cuba, 1999, UNDP, p. 99) (See Health News from Cuba, this issue.)

Today, 16 years after the model was first introduced in the Lawton neighborhood in Havana, and 14 years after it began traveling to other parts of the country, those responsible for the program are making a thorough assessment of its qualitative as well as quantitative results (See Challenges for Cuba's Family Doctor-and-Nurse Program, in Spotlight this issue). The quality and efficiency of care itself has been an object of study for some time already, and led to numerous innovations and improvements (See Primary Care Services: A Methodology for Quality Assessment and A Practical Approach to Linking Hospitals and Community Health Services).

The potential of the Cuban family medicine model has also begun to crop up in medical literature developed by the family physicians themselves and polyclinic specialists on their teams (see Quality of Life for Diabetic Patients and Family Loss: Characteristics of a Family Crisis). This body of medical literature is still small. Yet the wealth of experience generated by the family doctor-and-nurse program, and the scientific level of the health professionals involved, lead us to believe that we will have ample opportunity to publish more than one issue of MEDICC Review on the subject.

For now, we invite you to become acquainted with a primary care model unique in the world, which carries with it unquestionable social commitment on the part of government, and which has accomplished rather stunning results in its debut.

Gail A. Reed
Editor

Michele Frank, MD
Associate Editor