Healthcare in Cuba

Overview of the health care system in Cuba

The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. although challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. There are no private hospitals or clinics as all health services are government run. The current public health minister of Cuba is José Angel Portal Miranda. Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991. The United States embargo against Cuba also has an effect. Cuba has had many world class doctors, including Carlos Finlay, whose mosquito based theory of yellow fever transmission was given its final proof under the direction of Walter Reed, James Carroll, and Aristides Agramonte. In the 1950s the number of doctors per thousand of the population ranked above Britain, France and the Netherlands. In Latin America it ranked in third place after Uruguay and Argentina. The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America. These aims were hampered almost immediately by an exodus of almost half of Cuba's physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana’s medical college. In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "Everybody has the right to health protection and care. The State guarantees this right:

by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals and preventive and specialist treatment centers;
by providing free dental care;
by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All of the population cooperates in these activities and plans through the social and mass organizations." Privatization of healthcare in Cuba is illegal and unnecessary as high quality, equal, care covered by the state is available to everyone as made necessary by Cuba's constitution. Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. Some experts have said that these statistics may reflect heavy handed treatment of pregnant patients. Tassie Katherine Hirschfeld, an associate professor at the department of anthropology of the University of Oklahoma, said that doctors have incentives to falsify statistics, as a spike in infant mortality may cost them their jobs. She also said pregnant women may be pressured to undergo abortions if fetal abnormalities are detected or forcibly placed under monitoring if complications arise. In 1992 the US embargo was made more stringent with the passage of the Cuban Democracy Act resulting in all U. S. subsidiary trade, including trade in food and medicines, being prohibited. The Lancet and the British Medical Journal also condemned the embargo in the 90s. The embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U. S. firms or from non U. S. sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba's medical system. It prohibited foreign subsidiaries of U. S. corporations from selling to Cuba, thus further limiting Cuba's access to medicine and equipment, and raising prices. In addition, the act forbid ships that dock in Cuban ports from docking in U. S. ports for six months. This drastically restricted shipping, and increased shipping costs some 30%. In 1997, the American Association for World Health stated that the embargo contributed to malnutrition, poor water access, lack of access to medicine and other medical supplies and concluded that "a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventative medicine to all its citizens." In 2000, the Trade Sanctions Reform and Export Enhancement Act was passed. The US became Cuba's single largest source for imported food. The Cuban American National Foundation (CANF) states that should Cuba choose not to purchase from the U. S., it can purchase any medicine or medical equipment it needs from other countries. In a 2006 report to the U. N. Secretary General, Cuba acknowledged the authorization of medicines, though stated that they were subject to severe restrictions and complicated procedures. Cuba is obliged to make payments in cash and in advance, and is precluded from obtaining credit funding, even from private sources. The sale and transportation of the goods require licenses to be obtained for each transaction. Cuba cannot use its own merchant fleet for transporting these goods, but has to make use of vessels from third countries, primarily the United States. Payments are made through banks in third countries, since direct banking relationships are prohibited. The Cuban delegation concluded that restrictions on importing medical products were "so extensive that they make such imports virtually impossible". The World Health organization/PAHO and UNFPA concurred that it was impossible for Cuba to purchase equipment, medicines and laboratory materials produced by the United States or covered by United States patents, even though those products were purchased through multilateral cooperation. Cuba was not able to purchase the isotope I 125 that is used to treat eye cancer in children. The companies manufacturing reagents and equipment are 70 per cent United States owned, which makes it difficult to purchase necessary medical equipment and other items. One effect of the embargo has been to make it necessary for Cuba to create its own biotech industry to produce drugs which it is unable to access. One of its innovations is the drug CimaVax, which is used to treat lung cancer. While the embargo forbids US citizens from seeking medical treatment in Cuba, some cancer patients from the US have defied the embargo and travelled to Cuba for treatment with CimaVax.|| 33.2 || 35.3 || 37.4 || 41.5 || 47.5 || 55.8 || 63.9 || 69.8 || 73.8 || 74.6 || 76.6 || 78.9
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| Increase per decade || || 2.1 || 2.1 || 4.1 || 6.0 || 8.3 || 8.1 || 5.9 || 4.0 || 0.8 || 2.0 || 2.3
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| Latin America|| || || || || || || 56.0 || 60.4 || 64.2 || 67.7 || 71.5 || 74.0
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| Difference with L. A. || || || || || || || 7.9 || 9.4 || 9.6 || 6.9 || 5.1 || 4.9
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Cuba's national health system is made up of multiple tiers: 1) the community containing individuals and families, 2) family doctor and nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes. Cuba's Family Physician and Nurse program is made up of physician and nurse teams that serve individuals, families, and their communities. They live above their government built family medicine offices, living directly in the communities they serve and available 24 hours a day. Polyclinics are community based clinics that house primary care specialists. They exist in every Cuban community and are well acquainted with the people and the communities they serve. They can see the social determinants and environment that affect the community's health, bettering their ability to serve their patients. The Cuban health system has been promoted for decades by the government as an international role model due to its free access and broad coverage. However, in practice, there are reports indicating issues such as the deterioration of hospital facilities and the need for patients to provide basic supplies. Challenges for healthcare in Cuba include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. As at 2024, Cuba spends 11.4 per cent of its GDP on healthcare, which is more than twice as much as most Latin American countries, and has nine doctors per thousand residents. Child mortality in 2023 was four per thousand, which is similar to that of rich industrialised countries.

Indicators Statistic Date of information Life expectancy at birth 79 (years) 2012Life expectancy at age 6022 (years)2012 Fertility rate 1.4 (children born/woman) 2013 Number of live births 107.1 (thousands) 2013Maternal mortality ratio 80 (per 100,000 live births)2013 Under five mortality rate 6 (deaths/1,000 live births) 2013 Number of deaths 95.9 (thousands) 2013 Deaths due to HIV/AIDS 2.6 (per 100,000 population) 2012Total health expenditure per capita2,475 (Intl $)2014Total health expenditure as % of GDP11.12014
All statistics from World Health Organization figures. Cuba had 128 physicians and dentists per 100,000 people in 1957. This was comparable to the levels in many European countries and allegedly the highest in Latin America. In 2005, Cuba had 627 physicians and 94 dentists per 100,000 population. That year the United States had 225 physicians and 54 dentists per 100,000 population; the Central American isthmus had 123 physicians and 30 dentists per 100,000. As of 2005, Cuba became the world leader in the ratio of doctors to population with 67 doctors per 10,000 population as compared with 43 in the Russian Federation and 24 in the United States. Abortion rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near 1970s levels of 32.0 per 1000 pregnancies. The rate is still among the highest in Latin America.

Following the successful 2022 Family Code referendum, surrogacy is legal in Cuba as long as money is not exchanged.

Cuba's healthcare system survives, in part, due to its medical education system. In Cuba, the medical university is not a separate entity from health services, but it exists within the system, a model common in the rest of the developing world. In Cuba, this may include more community based centers than large hospitals. Medical and nursing students mentor and intern within the national system from the first years of their training, specifically within primary care facilities rather than hospitals. This is supposed to create a community based teaching method rather than a typical hospital based teaching method. Primary care, being the first level of contact to a patient, is ideally located close to the patient's home and work. At primary care facilities, the Cuban government's ethics and values are mandatorily taught as a key part of the Cuban healthcare system, followed by the science and technology. One of the largest medical universities in the world exists in Cuba, the Latin American School of Medicine. In the 1970s, the Cuban state initiated bilateral service contracts and various money making strategies. Cuba's missions in 68 countries are staffed by 25,000 Cuban doctors. Medical teams have worked in crisis such as the South Asian tsunami and the 2005 Kashmir earthquake. Nearly 2,000 Cuban doctors are currently working in Africa in countries including South Africa, Gambia, Guinea Bissau and Mali. Since the Chernobyl nuclear plant exploded in 1986, more than 20,000 children from Ukraine, Belarus and Russia have traveled to Cuba for treatment of radiation sickness and psychologically based problems associated with the radiation disaster. In response to the 2005 Hurricane Katrina disaster, Castro offered to send a "brigade" of 1,500 doctors to the U. S. to provide humanitarian aid, but the U. S. did not accept. Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized oil. Around 30,000 medical professionals were sent to the country in exchange for more than 100,000 barrels of oil per day. Through Operación Milagro (in English, “Operation Miracle”), Cuba began in 2004 to pay for Venezuelans with reversible blindness to travel to Cuba for free operations to restore their sight. Over 200,000 Venezuelans received this free surgery.

Cuba attracts about 20,000 paying health tourists, generating revenues of around $40 million a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments including eye surgery, neurological disorders such as multiple sclerosis and Parkinson's disease, cosmetic surgery, addictions treatment, retinitis pigmentosa and orthopaedics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming. By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around 2 percent of total tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splenic surgery wing; anecdotal evidence suggests that this pattern is common in Cuban hospitals.

President George W. Bush in 2006 initiated a program called the "Cuban Medical Professional Parole Program", this program allowed for any Cuban doctor serving outside of Cuba to be granted political asylum and permanent resident status in the United States, if only the Cuban national was able to make it to a U. S. embassy anywhere in the world. The program was ended by the Obama administration as part of an effort to warm relations between the United States and the Cuban government. 7,117 applications by Cuban doctors working abroad have been approved since 2006.

The Cuban healthcare system, renowned for the quality of its medical services, has largely strategized its approach around the export of health professionals through international medical missions. These missions have enabled Cuba to establish a medical presence across various regions of the world, especially in areas with healthcare deficiencies. During the COVID 19 pandemic, medical brigades were deployed to 41 territories, spanning nations in Latin America, the Caribbean, Africa, and Europe. Historically, these professionals have conducted millions of operations and have had a substantial impact on global health. Sánchez wrote that nearly 7,000–8,000 doctors since 2006 have gone into hiding or failed to return to Cuba after having gone on abroad as part of the Cuban government's "volunteering" them to provide healthcare to foreign nationals without remuneration. While Cuban doctors are sent abroad to assist in medical missions, domestically, although wages in the health sector have increased in recent years, they are still considered low compared to the prices of basic goods in Cuba. Because the U. S. government restricts investments in Cuba by U. S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs. In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U. S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U. S. and elsewhere. The Center of molecular immunology (CIM) developed nimotuzumab, a monoclonal antibody used to treat cancer. Nimotuzumab is an inhibitor of epidermal growth factor receptor (EGFR), which is over expressed in many cancers. Nimotuzumab is now being developed with international partners. In April 2007, the Cuba IPV Study Collaborative Group reported in the New England Journal of Medicine that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kourí Institute, U. S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics. Cuba has been free of polio since 1963, but continues with mass immunization campaigns. During the COVID 19 pandemic, Cuba developed two COVID 19 vaccines. Soberana 02 is produced by the Pasteur Institute of Iran and the Finlay Institute, a Cuban epidemiological research institute. Abdala was developed by the Center for Genetic Engineering and Biotechnology in Cuba.

In reviewing five books about Cuba's medical system for Family Medicine magazine, William Ventres concluded that Cuba's state run medical system has been quite successful, due largely to its family medicine model. In 2006, BBC flagship news programme Newsnight featured Cuba's healthcare system as part of a series identifying "the world's best public services". The report alleged that "Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are nearly the same as the USA's. Its doctor to patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power. A 2006 poll carried out by the Gallup Organization's Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three quarters of urban Cubans responded positively to the question "do you have confidence to your country's health care system". In 2000, Secretary General of the United Nations Kofi Annan stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy." The Kaiser Family Foundation, a non governmental organization that evaluated Cuba's healthcare system in 2000 1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources" President of the World Bank James Wolfensohn also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health", at the annual meeting of the Bank and the International Monetary Fund. Wayne Smith, former head of the US Interests Section in Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated". Robert N. Butler, who was president of the International Longevity Center in New York and a Pulitzer Prize winning author on aging, traveled to Cuba to see firsthand how doctors were trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. Furthermore, London's The Guardian newspaper lauded Cuba's public healthcare system for what it viewed as its high quality in a September 12, 2007 article. In 2001, members of the UK House of Commons Health Select committee travelled to Cuba and issued a report that paid tribute to "the success of the Cuban healthcare system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community". Margaret Chan, former director of the World Health Organization, recommended other countries follow Cuba's example in health care.

The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning black market economy, sometimes termed "sociolismo". According to former leading Cuban neurosurgeon and dissident Dr Hilda Molina, "The doctors in the hospitals are charging patients under the table for better or quicker service." Prices for out of surgery X rays have been quoted at $50 to $60. Such "under the table payments" reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the "Special Period" in the 1990s aggravated these payments. The advent of the "dollar economy", a legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise.