Experiences and lessons from Cuba on the road to Universal Health in the Americas**Official English translation from the original Spanish manuscript made by the Pan American Health Organization. In case of discrepancy, the original version (Spanish) shall prevail.

Cristian Morales James Fitzgerald About the authors

Cuba is indisputably a source of inspiration for progress with the Universal Health strategy, as defined in the resolution adopted by the Member States of the Pan American Health Organization (PAHO) (11. Organización Panamericana de la Salud. CD53.R14 Estrategia para el acceso universal a la salud y la cobertura universal de salud. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=27597&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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). The country's importance is underlined both by its achievements in health and by the strength and resiliency of its national health system (known as the SNS), which responds to people's needs with comprehensive and quality services that are provided through integrated networks based on primary health care. In the SNS, the first level of care focuses on people and their families, ensuring community outreach that is the material expression of an intersectoral approach that puts health in all policies. Coherent governance of the sector—based on strong leadership and the participation of national, provincial, and local health authorities in the relevant decision-making bodies—is complemented by the high fiscal priority attributed to the SNS. This makes it possible both to provide sufficient financing for the incorporation of appropriate and innovative health technologies at the different levels of care, and also to maintain and develop human resources for health in sufficient quantity and quality to serve the country's needs. Indeed, even the needs of other countries can be met, as is demonstrated by the mobilization of medical brigades to remote areas in different countries, as well as emergency disaster and response teams that are deployed wherever the need arises.

This special supplement of the Pan American Journal of Public Health begins with an overview of the transformations necessary to ensure that the SNS achieves a higher level of efficiency in order to consolidate its achievements and guarantee the sustainability of Cuba's journey toward Universal Health. In 2010 an important process got underway, aimed at regionalizing, concentrating, and increasing the efficiency of the SNS's socially organized response to the needs of a population that is undergoing significant changes in its epidemiological profile (noncommunicable chronic diseases are the main cause of morbidity and mortality, in addition to the burden of new and old communicable diseases) and in its demographic make-up (with nearly 20% of the population over 60 years of age, Cuba has one of the highest rates of population aging among the countries of the Region).

From different angles, six articles address Cuba's main results in health. The first article deals with communicable disease prevention and control, and the other five touch on various aspects of health throughout the life course and the response to communicable diseases: maternal and child care, the quality of maternal mortality statistics, experiences in immunization, the challenges involved in the response to communicable diseases, and the challenges that an aging population poses for the SNS.

These articles explain, for example, how Cuba has implemented actions to contain vaccine-preventable diseases (and successfully eliminate 11 of them), in response to several PAHO resolutions on the right to vaccination (22. Organización Panamericana de la Salud. CD54/7 Plan de acción sobre inmunización. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31247&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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3. Organización Panamericana de la Salud. CD52.R5 Principios del Fondo Rotatorio para la compra de vacunas de la Organización Panamericana de la Salud. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=23269&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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4. Organización Panamericana de la Salud. CD52.R14 Formulación de políticas basadas en la evidencia para programas nacionales de inmunización. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=23355&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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5. Organización Panamericana de la Salud. CD47.R10 Estrategia regional para mantener los programas nacionales de vacunación en las Américas. Disponible en http://iris.paho.org/xmlui/handle/123456789/355 Acceso el 9 de marzo de 2018.
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-66. Organización Panamericana de la Salud. CD25.R27 Programa Ampliado de Inmunización. Disponible en http://iris.paho.org/xmlui/bitstream/handle/123456789/2381/CD25.R27sp.pdf?sequence=2 Acceso el 9 de marzo de 2018.
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). They also discuss how Cuba has tackled communicable diseases, becoming the first country in the world to certify the elimination of vertical transmission of HIV and congenital syphilis, after taking specific action to prevent and control HIV infection and sexually transmitted infections, as PAHO has urged (77. Organización Panamericana de la Salud. CD55.R5 Plan de acción para la prevención y el control de la infección por el VIH y las infecciones de transmisión sexual 2016-2021. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36385&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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). These articles also show PAHO's recommendations are linked with Cuban programs in order to address neglected diseases (88. Organización Panamericana de la Salud. CD55.R9 Plan de acción para la eliminación de las enfermedades infecciosas desatendidas y las medidas posteriores a la eliminación 2016-2022. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36404&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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.99. Organización Panamericana de la Salud. CD49.R19 Eliminación de las enfermedades desatendidas y otras infecciones relacionadas con la pobreza. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=3125&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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), advance toward the elimination of tuberculosis (1010. Organización Panamericana de la Salud. CD54.R10 Plan de acción para la prevención y el control de la tuberculosis. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31899&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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), prevent and control arboviral diseases (1111. Organización Panamericana de la Salud. CD55.R6 Estrategia para la prevención y el control de las enfermedades arbovirales. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36384&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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), and implement the International Health Regulations (1212. Organización Panamericana de la Salud. CD55/12, Rev. 1 Documento de Trabajo. Aplicación del Reglamento Sanitario Internacional (RSI). Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36187&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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).

Three other articles offer a better understanding of factors related to the components and structure of the SNS that have contributed to achieving the health outcomes presented in the six previous articles. The first one focuses on the organization of the SNS, with the experience of the family doctor and nurse program as the cornerstone of health services organized around the first level of care, allowing for integrated health service networks based on an intersectoral and primary health care approach. The next article in this group addresses the education of human resources for health and shows how Cuba manages to have one of the world's highest physician-to-population ratios, while also maintaining over 48 thousand health professionals in remote areas of 62 countries. The third article presents aspects related to the financing of the SNS, linking fiscal priority (expressed in terms of public health expenditure) with progress toward Universal Health. These three articles show how Cuba's construction of its national health system coincides with PAHO resolutions both on Universal Health (11. Organización Panamericana de la Salud. CD53.R14 Estrategia para el acceso universal a la salud y la cobertura universal de salud. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=27597&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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) and on human resources for Universal Health (1313. Organización Panamericana de la Salud. CE160.R4 Estrategia de recursos humanos para el acceso universal a la salud y la cobertura universal de salud. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=40785&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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).

Another article in the supplement addresses the SNS's recognized capacity for preparedness and response to emergencies and epidemic outbreaks within the framework of climate change, explaining aspects of the system's resiliency and how it has made early progress in implementing PAHO resolutions on resilient health systems (1414. Organización Panamericana de la Salud. CD55.R8 Los sistemas de salud resilientes. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36477&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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) and on disaster risk reduction (1515. Organización Panamericana de la Salud. CD55.R10 Plan de acción para la reducción del riesgo de desastres 2016-2021. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=36403&Itemid=270&lang=es Acceso el 9 de marzo de 2018.
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).

This special supplement is rounded out with two articles that address the contribution that the Cuban research system has made to the progress toward Universal Health and to the development of eHealth as one of the main pillars of innovation and efficiency. The first article shows the progress of the Cuban health sciences and innovation system, and how the SNS implements PAHO resolutions on health policy and research (1616. Organización Panamericana de la Salud. CD49.R10 Política de investigación para la salud. Disponible en http://iris.paho.org/xmlui/handle/123456789/390 Acceso el 9 de marzo de 2018.
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) and on access to and rational use of strategic and high-cost drugs and other health technologies (1717. Organización Panamericana de la Salud. CD55.R12 El acceso y uso racional de los medicamentos y otras tecnologías sanitarias estratégicos y de alto costo. Disponible en: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&Itemid=270&gid=36571&lang=es Acceso el 9 de marzo de 2018.
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). In late 2016, more than 2,000 health studies were being carried out in Cuba and 3,214 researchers were contributing their efforts to the improvement of health services for the population and to the development of innovations that will (through BioCubaFarma) help turn their research into innovations that prolong and improve the quality of life.

The second article discusses programs such as (Galen) electronic medical records and the experience of the Cuba Node of the Virtual Campus for Public Health, which respond directly to PAHO recommendations (1818. Organización Panamericana de la Salud. CD51/13. Estrategia y Plan de acción sobre eSalud. Disponible en: http://iris.paho.org/xmlui/handle/123456789/7663 Acceso el 9 de marzo de 2018.
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).

We are confident that this supplement will contribute new scientific evidence and inspiration for the health professionals working to strengthen health systems in the Region of the Americas.

Acknowledgement

Our gratitude to all those who have devoted countless hours to bring this special supplement to fruition, especially to Gisele Almeida and Lizette Pérez, to the willingness of the authorities to ensure access to the necessary data and information sources and, especially, to the thousands of Cuban health professionals who, both in their own country and in dozens of countries in the Region of the Americas and around the world, make health for all—and indeed, Universal Health—an attainable goal.

  • Suggested citation (original article) Morales C y Fitzgerald J. Experiencias y lecciones desde Cuba en el camino a la Salud Universal en las Américas. Rev Panam Salud Publica. 2018;42:e63. https://doi.org/10.26633/RPSP.2018.63
  • *
    Official English translation from the original Spanish manuscript made by the Pan American Health Organization. In case of discrepancy, the original version (Spanish) shall prevail.

References

Organización Panamericana de la Salud Washington - Washington - United States
E-mail: contacto_rpsp@paho.org