Lessons from Cuba's healthcare

A physician drops by your home and enquires about your health from time to time. The doctor notes down blood pressure readings of all your family members and sugar levels of elderly to compare with the past and future data. Dietary guidelines or physical exercises or lifestyle adjustments are suggested to prevent a potential ailment. Medicines are supplied depending on your health condition. If need be, you are asked to visit a designated hospital in the locality for further investigations. If you require an emergency hospitalisation or operation, the system takes care of it. Lo and behold, you need not pay a penny for this.

Now, it is Covid-times. A medico pays a visit to your home every day to keep a tab on the health condition of each and every member of your family. He or she alleviates all your fears, teaches Covid-appropriate behaviour and makes you understand the dos and don'ts of the pandemic. Those who are inflicted with Coronavirus are shifted to a hospital to provide medical support. Oxygen cylinders and intensive care units are kept ready to meet any kind of emergency. Again, free of cost!

What a pleasant contrast to our horrible struggle for doctor appointments, hospital beds, oxygen cylinders and life-saving medicines besides hefty medical bills raised by private and corporate hospitals during the second wave of the dreaded virus!

This is the healthcare system of a small, poor country located at the confluence of the northern Caribbean Sea, Gulf of Mexico and Atlantic Ocean, called the Republic of Cuba, for you. Built by an iconic revolutionary Fidel Alejandro Castro Ruz, an eternal template of socialism and communism for his fans and symbol of dictatorship and repression for his haters, Cuba remains a medical model for the world. Braving the stringent economic sanctions and political coups staged by the arch-enemy, the USA, over decades, and the collapse of the gracious USSR, Castro developed a strong healthcare for his country as the Prime Minister and President for fifty years.

Castro, who dethroned a dictatorial government led by Fulgencio Batista on January 1, 1959, built up a socialist counterexample to the fiercely capitalist USA with limited resources and unlimited commitment. Despite the mass exodus of Cuba's physicians to the neighbouring USA leaving the country with a handful of doctors and medical professors, Cuba built a robust medical system by reducing military spending. Castro dispensed with private medical practice and took over foreign-funded pharmaceutical companies as part of a grand plan to make healthcare absolutely free. Since 1965, every Cuban doctor took an oath against private practice for profit.

Inspired by the revolutionary Argentine physician Che Guevara, who helped Castro's men in their fight against Batista, Cuba always strives to provide public health services for the greatest possible number of persons and to focus on preventive medicine. Castro throughout his life firmly believed that 'health is the basic human right of every citizen' but not a purchasable commodity. All other leaders and health professionals strongly believed the benefits of preventive and community health measures over orthodox curative medicine. The Alma-Ata Declaration of 1978, a major milestone of the twentieth century in the field of public health that identified primary healthcare as the key to the attainment of the goal of Health for All, has been the guiding force for the country. The revised Cuban constitution guarantees universal healthcare through Article 50.

Dr. David Blumenthal, an academic physician and health care policy expert, who served as US National Coordinator for Health Information Technology from 2009-2011, observed: "When it comes to health care, Cuba is a success story with few parallels." After making a visit to Cuba, Dr Blumenthal, president of the Commonwealth Fund, said that since its 1959 revolution, Cuba's infant mortality rate has fallen from 37.3 to 4.3 per 1000 live births—a rate equivalent to Australia's and lower than the United States' (5.8). From 1970 to 2016 life expectancy increased from 70.04 to 78.7 years, approaching expectancy in the United States (79.8).

The beauty of the Cuban healthcare system, which operates at three levels, is the availability of a doctor and a nurse to the community round-the-clock. They live within the community and maintain the health map of each and every member. The second level of service is the island's community hospitals that dispense secondary services while the third level of service consists of a dozen institutes that offer advanced and specialised services besides taking care of medical teaching and research.

Making parallels between Cuba and India may not sound logical given the huge difference in geographical and population size, literacy rate and the nature of the government but the small socialist island nation's health set-up offer some lessons to the market-driven democracies.

Cuba's population is 11,320,046 and the total land area is 106,440 square kms with 78 percent living in urban areas. Cuba spends about 10 percent of its GDP on healthcare compared to India (1.5 percent) and China (3).

Cuba leads the world with the lowest patient to doctor ratio (155:1) while the super power U.S. trails way behind at 396:1 and India is nowhere with 1456:1. This is because of the basic common-sense applied by the Communist regime: free, quality medical education. About dozen institutes offer medicine courses to cater to the health needs of Cubans. Besides, Cuba launched an international medical school, Latin American School of Medicine (LASM), in 1999 to contribute to the training of Primary Health Care physicians in diverse regions of the World. Hundreds of students, mostly from Latin America and the Caribbean, enrol in the residential school every year.

The Indian Prime Minister Narendra Modi's 'One Earth-One Health' proposal at the G-7 summit a couple of days ago was indeed the global health philosophy of the late Castro (international solidarity and brotherhood) for more than 50 years.

Cuba sends surplus physicians and health professionals abroad annually to provide medicare in developing countries. Since 1963, Cuban doctors, called as "Army of white coats" or "Cuban Medical Brigade", have been on international missions. It is estimated that more than 30,000 selfless Cuban doctors are serving patients in more than 50 countries. Ban Ki-moon, the then Secretary General of the United Nations, reported as saying, "Cuban doctors are always the first to arrive and the last to leave. They remain in place after the crises. Cuba can be proud of its healthcare system, a model for many countries."

Established in 2005, Henry Reeve Brigade's health-care professionals are dispatched all over the world to combat disasters and epidemics. Cuban doctors served Haiti (during the cholera outbreak that followed the 2010 earthquake), West Africa (during the 2013–16 Ebola crisis) and South Africa (During the Covid crisis) to name a few. Impressed by the Cuban medical team's assistance in fighting the virus in his country, the South African president Cyril Ramaphosa announced that his country would nominate the Henry Reeve International Contingent of Doctors specialised in disaster situations and serious epidemics for the 2021 Nobel Peace Prize.

Cuba invested substantially in biomedical research to be self-reliant in the face of US sanctions. It focussed on research centres specializing in biotechnology, genetics, and cancer immunology. Cuba's biotechnology industry consists of more than 30 research institutions and manufacturers, under the aegis of the state-owned conglomerate BioCubaFarma. In the late 1980s, Cuba developed the world's first meningococcal B vaccine. It produces eight of the ten routinely used vaccines in the country, and supplies millions of doses abroad.

Cuba had handled the first wave of Covid-19 well and pressed the entire medical and health staff, including all medicos, into service to deal with the deadly blow served by the virus during the second wave. The country recorded 1.59 lakh Covid positive cases and 1,098 deaths so far though the country is a cut above the other Latin American nations in terms of the recovery rate.

The Lancet report states that Cuba is in the process of manufacturing five candidates of vaccines for Covid-19. A second phase 3 trial of Soberana-2 is planned for Iran, as part of a partnership between the Finlay Institute and the Pasteur Institute of Iran. A phase 2/3 trial has been scheduled for Soberana-1, which was also developed by the Finlay Institute. Abdala and Mambisa, a nasal spray, both entered phase 1/2 trials late last year.

Cuba's 'spirit of sovereignty' can be noticed in the names given to these vaccines. Soberana (sovereign in Spanish), Abdala (the title of a poem by a Cuban revolutionary), and Mambisa (name of the guerrillas who fought against the Spanish colonialists) suggest that the inoculation drive is a matter of national pride. China and Cuba are working on a vaccine, called Pan-Corona, which will be effective against different strains of the SARS-COV-2 and prevent Covid-19, in a facility in the central city of Yongzhou, Hunan province. Cuba is planning to complete the vaccination drive by the end of 2021.

No healthcare system in the world is fool-proof and Cuba is no exception. The ground realities may not be as rosy as we imagine. The Communist regime is criticised for the worst human rights record, abysmal medical infrastructure, poor pay for doctors and so on. As our free market-based health care system, buoyed by the foreign investment flows, proved to be a disaster for majority of Indians during the Covid crisis, there is an urgent need to overhaul our healthcare system by taking a leaf from others' book.

The abnormally high cost of the medical education should be brought down considerably without further delay. The clinical and pathological investigations should be done free of cost. Being the pharmaceutical and biotechnology major, India can lessen the burden on its citizens by offering medicines and vaccines for reasonable rates. It may be impossible for our governments to dispense with the private and corporate hospital system at this juncture but at least the spirit of 'people-over-profit' may be inculcated among these non-government operators while giving a facelift to the government-run medical set up. Healthcare is more important than health insurance.

Dr. Martin Luther King once remarked, "Of the forms of injustice, inequality in healthcare is the most shocking and inhumane." To give human face to the healthcare in India, the pill of the hour is: political will.

(The author, a PhD in Communication and Journalism, is a senior journalist, journalism educator and communication consultant)