Forty years after Alma-Ata, implementation of the Strategy for Universal Access to Health and Universal Health Coverage -Universal Health- (¹1. Organización Panamericana de la Salud. Resolución CD53.R14: Estrategia para el acceso universal a la salud y la cobertura universal de salud. Disponible en: http://iris.paho.org/xmlui/bitstream/handle/123456789/7652/CD53-R14-s.pdf?sequence=4&isAllowed=y.
http://iris.paho.org/xmlui/bitstream/han... ) of the Pan American Health Organization (PAHO) has emerged as the main tool for achieving health for all in the 21st century. The countries of the Region of the Americas have made varying degrees of progress on this path and, since 2014, a significant number of them have established road maps and frameworks for monitoring and evaluating their progress toward Universal Health. Cuba is one of the countries that shows the greatest progress in this regard; hence the importance of better understanding its experience in the construction of its national health system, as well as the scope of its achievements.

Cuba's successes in health are recognized worldwide and reflect a firm and systematic commitment on the part of the country's highest authorities to developing health, since 1959. Knowing (and understanding more fully) which public policies have been implemented in the health sector, which programs have had the greatest success in achieving the health indicators that Cubans enjoy today, and how the intersectoral and primary health care approaches have been essential to these achievements offers useful lessons, considerations, and definitions for other countries that are advancing toward Universal Health.

This special supplement of the Pan American Journal of Public Health presents Cuba's experience in the 60 years it has been building its national health system. It identifies lessons learned and allows a better understanding of current approaches, as well as the challenges: maintaining what has been achieved, planning new achievements, and continuing to strengthen a model centered on people, families, and communities, with free services at the point of contact, quality care, and an intersectoral approach with community participation.

Cuba is a case study of great interest for all, having achieved a life expectancy at birth of 78.4 years in 2016, low infant mortality (4.6 per 1 000 live births), and the elimination of 11 vaccine-preventable diseases and malaria in the early 1970s. More recently, it became the first country in the world to certify the elimination of mother-to-child transmission of HIV/AIDS and congenital syphilis. The resiliency of its national health system, its capacity for preparedness and response to emergencies and epidemic outbreaks, the presence of over 48 000 health collaborators in 62 countries, the significant interventions of Cuba in emergencies such as the Ebola outbreak in western Africa in 2014, and the earthquakes in Ecuador (2016) and Mexico (2017)--to give only a few examples--as well as having graduated more than 28 000 physicians from over 100 countries, all reflect the significance of the Cuban experience in the progress toward Universal Health and the importance of understanding better how all this was achieved.

The Cuban national health system is based on values that are consistent with those promoted by PAHO, focusing on solidarity, equity, and the right to health. A key aspect of the construction of the national health system and the scope of its achievements has been the political will to prioritize health within its human development strategy. This prioritization is reflected in public spending far above the 6% that PAHO recommends, putting Cuba among the few countries in the Region to achieve that indicator. Without a doubt, another key aspect of Cuba's success in the health sector has been the innovative approaches the country has taken to solving the problems posed by a lack of human, material, and financial resources in its recent history. But perhaps the most fundamental characteristic of the Cuban national health system has to do with its people- and family-centered approach to primary health care: focusing on communities, territorially and on an intersectoral basis; organizing services in integrated networks, with a problem-solving capacity at the primary care level that reaches every corner of the country; and ensuring the availability of comprehensive quality services to meet the needs of the population within a broad framework of public policies that address the social and environmental determinants of health.

This special supplement presents experiences and lessons from Cuba at a decisive moment, as the Region of the Americas positions itself to be the first region in the world to achieve Universal Health. It is not necessary for other countries to copy Cuba's solutions, but they can serve as inspiration on a long, complex road to achieving health for all, with equity and without leaving anybody behind; in other words, achieving Universal Health.

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