Back in 1978, a conference was held in Almaty (formerly Alma-Ata), the city in Kazakhstan where the one of the most significant public health declarations emerged. One of the most significant excerpts of the Declaration was the profound role of primary health care in establishing the concept of “Health for All”. According to the World Health Organization (WHO), an adequate availability (adequate supply of healthcare), accessibility (adequate distribution of healthcare) and acceptability (treating all patients with dignity) of a healthcare system is required to ensure the best possible health outcomes in a population. Cuban healthcare system is established to meet the aforementioned standards, and by many criteria, this system is currently unique and one of the most efficient healthcare systems worldwide (1).
National Healthcare Policy Goals
Back in 1983, Cuba introduced a Public Health Law establishing basic principles of the healthcare organization. The main characteristic of this healthcare system is that healthcare represents a right that is available equally to all and is completely free of charge (2). One of the major differences between Cuban and American healthcare principles is that in Cuba, healthcare is the responsibility of the state. Additionally, the law promotes global cooperation of health systems and its professionals.
On the contrary, a profit-driven healthcare system in the United States results in great imbalances of knowledge and quality of health services, and more importantly, creates a population that cannot afford a proper healthcare leading to healthcare quality being unpredictable and dependent on the financial state of each individual (3).
National Health System of Cuba, that has been founded on a very effective primary health care, is producing impressive results. Rates of immunization are amongst highest in the world. Over 98 percent of children are vaccinated against 13 illnesses by the age of 2 (4). Antenatal care is provided to 95 percent of pregnant women and mortality rate of infants is 5 per 1000 births. Control of blood pressure at least once per year is available to the entire population (5). As a result of exceptional healthcare outcomes, Cuba is officially at the top of the list of countries that meet the United Nation’s Millennium Development Goals, focusing on the social components of healthcare services.
The pillar stone of Cuban healthcare system is the primary healthcare institutions. A community-based polyclinic, covering a population of 30000 to 60000 individuals represents a centerpiece of primary health care. These polyclinics serve as a hub for family doctor and nurse practices, where each family doctor covers a population of approximately 600 to 800 individuals. The polyclinics are also centers for education and training of the new physicians, nurses and other healthcare sciences students. Interestingly, Cuba was one of the first countries worldwide which introduced the concept of family care physicians (6). This model of healthcare organization increased the prevention of chronic conditions such as diabetes, hypertension, heart failure, obstructive pulmonary disorders, and significantly decreased the need for “high-tech“ technologies in diagnosing and treating diseases (7).
The polyclinics are advancing even today. The goal is to extend the range of health services at the primary healthcare level. Polyclinics are being equipped with ultrasound, X-rays, endoscopy, emergency care, immunization, rehabilitation services and many other (1). Approximately 800 to 1000 patients use the services daily.
Drug Research and Development
Cuba is investing a significant amount of funds into drug research and development. The approximately US $1 billion investment in pharmaceutical and biotech industry resulted in the production of innovative medicines, vaccines and diagnostic kits that are now being sold internationally (8). The most significant achievements of drug development will be discussed here.
SEROGROUP B MENINGOCOCCAL VACCINE
Cuba developed and registered this vaccine back in 1989 in order to prevent childhood meningitis. The United States Food and Drug Administration (FDA) registered this exceptional medicinal product only recently, in 2014, when it was manufactured by Pfizer.
The drug has been developed in the CIGB (Center for Genetic Engineering and Biotechnology) of Havana. It is a combination of two interferons. The result of its complex mechanism of action is tumor growth suppression, particularly basal cell carcinoma (CBC) no matter of its size, location and subtype. Although most of the skin carcinomas can efficiently be cured surgically, in some cases, it’s not that simple (face- surgical procedures are often mutilating causing severe reduction of the quality of patient’s life).
The drug was registered in Cuba in 2006 and, since then, 15 more countries registered it, and more than 100.000 patients around the world have received the treatment with incredible results. The target patients are those with chronic diabetic ulcers resistant to other modalities of treatment (high amputation risk). By its structure, Heberprot-P is an epidermal growth factor (EGF), and it’s administered by injection, locally.
According to the clinical research, Nimotuzumab, due its safety profile, is an excellent ad-on therapy for the patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN). The study published back in 2009, clearly demonstrated that Nimotuzumab, combined with radiotherapy, triples the 30-month survival rate compared to the group of patients who received radiotherapy only.
1994 was the year when Cuban Center for Molecular Immunology started investigating this medicinal product for the purpose of treating non-small cell lung cancer (NSCLC). Studies have shown a significant increase in survival of NSCLC patients. Earlier this year, more than twenty years after the product was developed in Cuba, Roswell Park Cancer Institute in Buffalo, New York, decided to initiate the clinical trial in order to investigate the efficacy and safety of this vaccine for the treatment of patients suffering from NSCLC.
This interesting vaccine received approval in Latin American countries back in 2013, following completion of phase II/III study involving patients with advanced and progressive NSCLC. Racotumomab showed a significant increase in survival of patients suffering from end-stage NSCLC. This promising medicinal product is being evaluated in a multinational phase III study aiming to investigate the effects of this vaccine on health outcomes in NSCLC patients (NCT01460472).
The drug is an alcoholic extract from human placenta. The Melagenina Plus lotion is applied once a day to the affected areas. It causes the repigmentation by stimulating melanocytes in a chronic region of the skin (white patches). Available all around the world for more than 20 years, it claimed the title of miraculous vitiligo drug.
In conclusion, it appears from the above that the industry in the United States still does not possess adequate mechanisms in providing innovative medicinal products when compared with Cuba.
HIV/AIDS, EBOLA OUTBREAK
Cuba was the first country in the world recognized by the WHO for eliminating mother-to-child transmission of HIV and syphilis (9). According to the Center for Disease Control (DCD), up until 2014 in the United States, there were 5419 deaths among the population who acquired HIV through perinatal transmission. Recently, Cuba has sent a large group of physicians in order to fight the Ebola outbreak.
These were just some of the characteristics of Cuban healthcare system that continues to impress and produce enviable results. There are plenty of lessons to learn from Cubans in terms of proper healthcare organization with only one goal: to ensure a healthier future.
- Cuba’s primary health care revolution: 30 years on. http://www.who.int/bulletin/volumes/86/5/08-030508/en/. [Online] [Cited: February 24, 2018.]
- Ley No. 41. Ley de la Salud Pública. http://www.parlamentocubano.cu/index.php?option=com_content&view=article&id=257:ley-no-41-salud-publica&catid=46:leyes&Itemid=79. [Online] [Cited: February 24, 2018.]
- Gray, Bradford H. For-Profit Enterprise in Health Care. s.l. : Washington (DC): National Academies Press (US), 1986.
- Eradication of poliomyelitis in Cuba: a historical perspective. P, Más Lago. s.l. : Bull World Health Organ, 1999, Vol. 77(8). 681-7.
- Caring for Them from Birth to Deat. C, Perez. s.l. : Lanham, MD: Rowman & Littlefield Publishers, 2008.
- Health for all: a dream realized in Cuba. CW, Keck. s.l. : Medical and Health Annual. Chicago, IL: Encyclopaedia Britannica Inc., 1994. 357–362.
- he Cuban health system: responsiveness to changing population needs and demands. SM, Santana. s.l. : World Dev, 1987, Vol. 15(1). 113–125.
- The Curious Case of Cuba. Keck, C. William. s.l. : Am J Public Health, 2012, Vol. 102(8). e13–e22.
- WHO VALIDATES ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HIV AND SYPHILIS IN CUBA. s.l. : Saudi Med J, 2015, Vol. 36(8). 1018-9.