Monday, 2-27-17: Polyclinic Visit
The team visited a Polyclinic, where an overview of the Cuban health system was provided by Professor Alex Carreras, the head of the department of international relations at the Ministry of Health. Cuba provides free health coverage to all its citizens, with equal access and coverage of rural and urban areas.
The system is built on the principle that healthcare is a right for all citizens and that prevention of illness through strong primary care and health promotion across the entire population results in better outcomes and lower costs in the long term.
The basic health system unit is a “consultario” - a neighborhood clinic staffed by a nurse/doctor dyad living in the community (often above the clinic). This clinic is typically within walking distance for everyone in the neighborhood and serves 15-20 families. This team is intimately familiar with the population it serves; home visits are routine and encouraged to facilitate a thorough evaluation based on the bio-psycho-social model. This is possible due to the large number of providers: Cuba has 87,000 doctors, each of whom is trained in family medicine, pediatrics, PBGYN and basic psychiatry/psychology. With a doctor: patient ratio of 1:127, and a nurse: population ratio of 1:125, there is no shortage of family physicians.
According to Dr. Carlos, the director of the Polyclinic, 2nd tier medical facilities (aka “Polyclinics”) serve 300 families, are led by a family physician with at least five years of clinical experience and provide five basic services: emergency care, geriatric services, maternal and child care and prevention of communicable diseases. The population is classified according to health risk into four tiers: apparently healthy, some risk/illness, chronic medical conditions and those with complications or disabilities from their illness. Polyclinics provide contrast x-rays, labs, endoscopy, 24-hr dental care and a 24-hr ER. Each polyclinic is staffed by its own specialists.
The system boasts remarkable outcomes: Cuba has eradicated several communicable diseases including pertussis. At the local polyclinic, the team reported that there have been no maternal deaths in 12 years and no maternal-child HIV transmission in 12 years. The average life expectancy for women is 80 years and 78 years for men. Child mortality statistics are particularly impressive at 4.9/1000 births.
Cuba exports medical services to other countries (including Venezuela and the African continent), trains many physicians from countries around the world for free, has a thriving biomedical research industry which has produced several brand-new medications including Heberprot-A, (a growth-factor based agent which promotes diabetic foot ulcer healing and reduces amputation rates). The industry also manufactures and exports vaccines. The system also incorporates alternative treatments and has a separate department for Chinese and alternative medicines.
My main takeaway was that I was struck by Cuba’s simple, common sense, pragmatic yet effective health system strategy. It seems the strategy has delivered on the promise of improving quality and outcomes at lower costs.