To the Editors:

Since the 1960s, the Cuban health care system has focused on primary preventive health care that meets community health needs and results in optimized population health outcomes. This foresight to train the Cuban health workforce has resulted in three significant milestones: free health professional education (1960s), establishment of community polyclinics (1970s), and development of family doctor-and-nurse teams in the 1980s (described in Gorry’s Feature in January 2017).[¹1 Gorry C. Cuba’s family doctor-and-nurse teams: A day in the life. MEDICC Rev. 2017;19(1):6–9.] The Cuban health system highlights the key role of nurses in clinical practice, following the World Health Organization’s (WHO) promotion to strengthen nurses’ training and leadership,[²2 World Health Organization. Nursing and midwifery in the history of the World Health Organization, 1948–2017. Geneva: World Health Organization; 2017.] and serves as a model for international health systems in two ways.

First, high-quality academic training provides Cuban nurses with didactic and clinical training at three specialty levels: specialist (e.g., postgraduate level), professional (e.g., baccalaureate-level), and technical (e.g., associate-level). By promoting the continuous assessment and risk evaluation (CARE) process for medical evaluations in clinic and home visits, nurses can assess physical and psychosocial health, unhealthy behaviors (e.g., physical inactivity, toxic behaviors), and environmental risks (e.g., poor air and water quality, mosquito-breeding sites). Hence, nurses understand that social determinants of health can impede health equity and optimal family and community health. They are skilled in coordinating disease prevention and medical treatment plans in their designated communities or as part of the Henry Reeve International Medical Contingent global deployments to disaster sites.

Second, collaborative teamwork and communication between Cuban nurses and physicians in clinical practice foster increased efficiency of task coordination in community clinics and home visits. This practice emphasizes shared decision-making with patients, complemented by nurses’ holistic training in health and wellness and physicians’ expertise in the medical model. As they work side-by-side in domestic and international communities, they gain insight on fruitful interdisciplinary collaborations based on professional autonomy, respect, and solidarity in primary care.[³3 House S, Havens D. Nurses’ and physicians’ perceptions of nurse-physician collaboration. J Nurs Adm. 2017;47(3):165–71.]

The future global health workforce requires highly trained nurses who can promptly identify health risks, participate in shared decision-making with patients, and provide appropriate holistic care in communities. Recognizing the universal health coverage targets of the Sustainable Development Goals, we are pleased to see that Cuban nurses, alongside their global counterparts, will continue to lead efforts in providing health service delivery to citizens of all ages.

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