Download presentation - People`s Health Movement

R2H
in Cuba
Pol De Vos
[email protected]
From 1959 onwards
Cold War
• continued USA aggression
• long term USSR support
Comprehensive revolutionary changes
•
•
•
•
•
•
•
Housing
Working conditions (radical land reform)
Redistribution of income
Health
Education
Culture and sports
Defense
Consequences
–
–
–
–
All Cubans: decent wage, improved nutrition, housing
Electricity and tap water over the whole country
Inhuman working conditions disappear (landlordism)
Industrialization
• Embargo and agressivity of USA
• Support of Soviet Union
– Alphabetization
– Education
• development of all educational levels
• adult education: combination work & study
– Expansion of culture, art, science and sports
Production
Production
and and
distribution
distribution
of wealth
of wealth
CUBAN REVOLUTION
Political will
Human
and social
Development
Health as a human right
and as a state policy
Economic
Socio-political
Investment
In social
development
Development
of health
system and
services
Management
of human and
social capital
Participation
Social
networks
Empowerment
Inter-sectorial action promoted by state
and directed by health sector
ENVIRON
MENT
LIFE
STYLES
HUMAN
BIOLOGY
Health and well-being
Cuba: health (care) for all
Development of Cuban health system
1960s – Ensure access to medical services for all
1970s – Community medicine
1980s – Family medicine
Since 1990s – Reforms and
adjustments
1990s: Coping with economic crisis
Economic and social measures : a participatory process
• Taken step by step
• After a broad consensus process (over > 3 years)
– Discussions in neighborhoods and working places
– Only broadly accepted proposals were put in practice
• Implemented:
–
–
–
–
Legalization of US-Dollar
Selected joint-ventures (tourism, mining,…)
Peasant markets
Higher payments for telephone, gas, electricity
• Not implemented
– Introduction of tax-payment
Cuba from 1990 onwards
8 965 FDrs
46.9 % coverage
Breakdown
Soviet Union
1989
Torricelli
act
27 169 FDrs
96.2% coverage
30 726 FDrs
99.2% coverage
37 645 FDrs
INT COOP +++
Helms-Burton
Law
1995
Unified public national health system maintained
+ Integrated system
+ Free access
GDP
+ Comprehensive
care– 35%
Imports – 70 %
+ Continuous care
+ Adequate health outcomes
2002
- Stability of F.Dr. in community
- Lack of resources
- Availability of drugs
- Technology
2010
Results of crisis management 1990s
>< Venezuela (1989) – Ecuador (1997,2000,2005) – Argentina (2001)
• Structural determinants remained priority, but eroded…
–
–
–
–
severe decline in living standards
deterioration of nutritional status
(limited) resurgence of (almost) eliminated diseases (tb)
vitamin deficiency -> epidemic neuropathy
• Health system
– Remains state priority
• exclusively public (no privatizations)
• Accessible, holistic, and integrated services of good quality
• Free at the point of delivery
– Central in limiting consequences of declining living standards
After 2000
• Continued economic strain
– US enmity and embargo remains
– Alliance with Bolivarian Venezuela
• Intensive collaboration in health
• Oil
• Industrial collaboration
• 2011: new economic measures
– Decreasing role of de state
– Increasing disparities in income (dual currency)
– Health system maintained but under strain
Health system today
• Cuban national health system
Health Area (30.000 inh)
– exclusively public
– free at point of delivery
• FLHS: Family Dr = entry point
– well-defined population of
responsibility
– holistic and integrated approach
referral
hospital
policlinic
Family Doctor
1000-1500 inh
International Cooperation in health
• 40.000 Cuban professionals are working in 105 countries
• 80% (+ 30 000) work in the health sector in 68 different
countries
• Cuba trains medical students from many of the
poorest regions to serve their communities
– Actually 35 out of 54 African countries have medical students
being trained in Cuba
• Important support in health care delivery in many
countries
– limitations to overcome (integration)
13
Emergency Aid: Brigade Henry Reeve
Katrina – 2005 – New Orleans
14
International health policy debate
• Cuba = one of the few important international health
players that actively oppose neo-liberal privatization and
profit in health services
• Defends development of accessible, qualitative and
responsive public health services
– counterexample of idea that “public services can’t function”
– important example to defend “public rationale” in other contexts
15
DL1
14.30-17.00 hrs
Empowerment
Centro Habana, Cuba:
“Empowerment through
multisectorial action”