Evaluation of the Cuban Health Care System using Depleset.

1. SYNDICATE GROUP 1 SHRABANI BOSE, CHOI CHAN, DESPINA CRASSA, ABAYOMI BANKOLE, LEROY EDWARDS, REUBEN LEWIS HEALTH SYSTEMS, POLICY & FINANCING : INTERNATIONAL HEALTH MANAGEMENT

3. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References

4. CONTENTS Health System in Cuba Background Health System Analysis Accomplishment Conclusion References

6. ECONOMIC INDICATORS Health System in Cuba % % % www.indexmundi.com/cuba/gdp Indicators (%) 2007 GDP-real growth rate 9.5 Inflation rate 5.0 Unemployment 1.9

8. Health System in Cuba Everyone has the right to health protection and care HEALTH SYSTEM IN CUBA Levers GOAL Intermediate Goals Financial Resource Fully integrated system funded by general taxation with Low out of pocket payments Equity 99% accessibility in rural and urban Steward- ship National Health System Decentralization Service Provision Polyclinics Family Doctor Program Immunization Resource Allocation Allocated through national, provincial and municipal levels Efficiency 7.1%GDP for Universal coverage Responsiveness National Health Plan and Policy Effectiveness Infant mortality death rate Life expectancy

9. GLOBAL COMPARISON Health System in Cuba Source for Cuba indicators: Annual Health Statistics Yearbook, 2006. National Health Statistics Bureau. Havana: 2007. Source for US indicators: Health, United States, 2006. National Center for Health Statistics. Hyattsville, MD: 2006. UNITED STATES CUBA CARIBBEAN LATIN AMERICAN LIFE EXPECTANCY 77.6 77.8 69.3 77.3 PHYSICIANS (PER 10,000 INHABITANTS) 62.7 26.3 NA NA NURSES (PER 10,000 INHABITANTS) 78.9 79.5 NA NA % BIRTHS ATTENDED BY SKILLED HEALTH PERSONNEL 99.9 99 NA NA INFANT MORTALITY RATE (PER 1,000 LIVE BIRTHS) 5.3 6.8 22 22 UNDER 5 MORTALITY RATE (PER 1,000 LIVE BIRTHS) 8 8 33.4 27.7 MATERNAL MORTALITY RATE (PER 100,000 LIVE BIRTHS) 49.4 13.1 NA NA % OF ONE-YEAR OLDS IMMUNIZED WITH DPT3 99 96 NA NA DEATH DUE TO HIV/AIDS (PER 100,000 INHABITANTS ANNUALLY ) 1 5 NA NA GENERAL GOVERNMENT EXPENDITURE ON HEALTH AS % OF TOTAL GDP FOR 2004 87.8 44.7 NA NA

11. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References

13. DEMOGRAPHIC Health System in Cuba Rate / 1,000 Year The World Health Organization gives Cuba’s single-payer healthcare system high marks in areas such as infant mortality. Global Health Facts WHO Statistical Information System (WHOSIS) Diagram from Earth Trend Indicator (per 1,000) 2007 Infant Mortality 6.04 Total Fertility Rate 1.6 Birth Rate 11.4

14. EPIDEMIOLOGICAL Health System in Cuba http://www.saludthelilm.net/ns/main.html

18. ECONOMIC EFFECTS ON HEALTH SYSTEM Health System in Cuba 1991 Collapse of Soviet Union 35% drop in Cuba’s GDP Loss of approx. 80% of imports & exports. Along with food and medicines, 99% of the oil Cuba imported from the USSR. 1993 Government reforms health care policy to adjust to financial crisis; emphasis on first-line health care, 97% of medical students graduated as general practitioners, prevention, better drugs and emergency medicine. Cubanacan Health & Tourism Over 20,000 health tourists received treatments in 2006, at prices 80% less than US prices Doctors exchanged for $1bn subsidized oil from Venezuela annually. Est. 20,000 doctors working in Bolivia, China and Africa 2003 Drugs for Debt – Havana’s 1.9bn US dollar debt to Argentina will be reduced by 75% in exchange for drugs

23. TECHNOLOGICAL Health System in Cuba (Seror AC, 2006)

25. DYNAMIC MAPPING Health System in Cuba Strength High Low Short Long Time Horizon: 5-10 years D Ep P L En El S T D Demographic Ep P L En S T El Epidemiological Political Legal/Regulatory Economic Social Ecological Technological

26. DYNAMIC MAPPING Health System in Cuba Strength High Low Low High Certainty D Demographic Ep P L En S T El Epidemiological Political Legal/Regulatory Economic Social Ecological Technological D Ep P L En S El T

27. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References

28. HEALTH SYSTEM ORGANIZATION Health System in Cuba INFORMATION FLOW WITHIN HEALTH SYSTEM AND SPECIFIC GOVERNMENT BODIES http://www.medicc.org/publications/medicc_review/0905/cuban-medical-literture.html

29. HEALTH SYSTEM FINANCING Health System in Cuba First-level providers Second-level providers Government Population & Business Patient Compulsory, income related specific contribution or general taxes or income from foreign patients Ownership of buildings employment of staff Salaries and budget Ownership of buildings employment of staff Salaries and budget Deferral Service Service

33. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References

35. ACCOMPLISHMENTS Health System in Cuba Richard SC. Health in Cuba. International Journal of Epidemiology 2006 First country to eliminate polio—1962 First country to eliminate measles—1996 Lowest AIDS rate in the Americas Most effective dengue control program in the Americas Comprehensive health care: 1 physician per 120–160 families Highest rates of treatment and control of hypertension in the world Reduction in cardiovascular mortality rate by 45% Crude infant mortality rate of 5.8 per 1000 Development and implementation of a ‘comprehensive health plan for the Americas’ Free medical education for students from Africa and Latin America Indigenous biotechnology sector; producing the first human polysaccharide vaccine Support of 34 000 health professionals in 52 poor countries Creation of a national biomedical internet grid (INFOMED)

38. CONTENTS Health System in Cuba Background Health System Analysis Key Contextual Factors Conclusion References