Spotlight on…

The Cuban Maternal-Child Program:
One Province’s Experience

By María O'Farrill Fernández, MD,* María Cecilia Santana Espinosa, MD**, Bárbara del Rosario Hernández Bravo, MD***, and Olga Prats Alvarez, MD****

The development attained by Cuba’s public health system has made it possible to reinforce the Maternal-Child Program—the first steps toward which were taken in 1970. This program has been gradually reviewed and enhanced with the purpose of ensuring and maintaining the country’s main maternal and child health indicators. The enhancement process was complemented by the implementation, in 1984, of the family doctor-and-nurse model of primary care, making the program more community-oriented and ensuring better work. This model establishes that one doctor and one nurse serve only a small number of individuals in one neighborhood, thus increasing the quality of medical assistance.

In 1970, the Maternal-Child Program was put into practice, aiming primarily at decreasing maternal and child morbidity and mortality rates. This program was gradually improved and expanded to include the sexual and reproductive health more generally.

Today’s Maternal-Child Program is directed by a national-level commission, consisting of specialists in obstetrics and gynecology, pediatrics, epidemiology, and psychology, among others. This multi-disciplinary group is also repeated at the provincial and municipal levels.

The Program’s aim is to decrease not only maternal and child morbidity and mortality rates but low birthweight as well. It also aims at achieving high rates of breast feeding, at lowering the incidence of acute diarrheic disorders and acute respiratory infections, at reducing child injury rates, and at implementing programs such as the Responsible Parenthood Program, the Program for the Control of Cervical and Uterine Cancer, Program for the Control of Breast Cancer, the Comprehensive Attention to Adolescent Health Program, the Program for Attention to Non-Communicable Chronic Disorders in Children, the Women’s Obstetrical and Gynecological Health Care Program and the Sex Education Program.

The Maternal-Child Program, as well as the subprograms it includes, undergoes continual assessment, evaluated according to the quality of its application and epidemiological results.

While the Program’s work is carried out at all three levels of the health system, emphasis is placed on its application in primary care settings, since it is at the community level that most of the events affecting the health of individuals, families and the whole community take place and, consequently, it is at this level that health promotion, prevention of disease, early detection and treatment can most effectively occur.

The Maternal-Child commissions at all levels provide the necessary methodology and orientation for the implementation of the program, and assess outcomes. Furthermore, the members of these groups participate in education and research activities.

To achieve all their goals, these groups need to work in collaboration with various departments and institutions throughout the country. These include genetic services, ultrasound services, health education departments, nursing departments, social work services , and statistics departments. They also need the support of governmental and non-governmental community organizations.

In Pinar del Rio Province

In Pinar del Río, Cuba's westernmost province, actions to improve the historically poor health of the population began in 1959. Top priority was given to maternal and child health care. Due to this province’s high infant mortality rate (60 per 1,000 live births—a referential figure, as there are no reliable statistical records available) the Provincial Maternal-Child Commission was created. The structure of this group was not as complete as it is now. It was directed by a specialist in ob-gyn and/or a pediatrician, who also headed the provincial commissions for their respective specialties. This program has been enhanced over the years and health indicators significantly improved.

In 1984, family medicine was introduced in the province, which enhanced the quality of primary care and, accordingly, the results of the maternal-child program.

Currently, there is a group in this province in charge of the methodological orientation and assessment of the program. This group consists of a specialist in comprehensive general medicine, a pediatrician, an ob-gyn, an epidemiologist, and an RN. The group works in collaboration with various departments—statistics, social work, health education, genetics, and ultrasound—and with governmental, political, and mass organizations. This ensures an integral, systematic work that increases the quality of care to children, women, and men. Very special attention is given to prenatal care, as well as to the health of children, adolescents and senior citizens.

The results of the Maternal-Child Program in Pinar del Rio Province over the last ten years can be seen in the indicators recorded below:

Source: Provincial Statistics Division.  Pinar del Río Province

* First-Degree Specialist in Pediatrics. Assistant Professor. Medical School of Pinar del Río. Comprehensive General Medicine. Assistant Pediatrician. Provincial Group for Maternal and Child Care. Chief of the Provincial Pediatrics Group.

** Second-Degree Specialist in Pediatrics. Assistant Professor. Medical School of Pinar del Río. Ex-director of the Pediatric Hospital of Pinar del Río. Provincial Director of Health.

*** First-Degree Specialist in Comprehensive General Medicine. Chief of the Provincial Group for Maternal and Child Care.

**** First-Degree Specialist in Epidemiology. Advising Epidemiologist for the Provincial Maternal and Child Care Group.

All rights reserved (c) 2002 - MEDICC - Medical Education Cooperation with Cuba - ISSN: 1527-3172