Thursday, September 20, 2018

#NotesFromHavana: Healthcare in Cuba: Lessons for South Africa.

#NotesFromHavana: Healthcare in Cuba: Lessons for South Africa.

Floyd Shivambu

In a perspective titled On Revolutionary Medicine, Che Guevara, a Medical Doctor by profession and a revolutionary Internationalist par excellence, said in 1960 that “The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices”.

This principle, expressed more than 50 years ago came to underpin Cuba healthcare system. It is a globally accepted fact that one of Cuba’s greatest achievements since the victory of the Cuban revolutionary forces in 1959 is its public healthcare system. Cuba’s healthcare system is one of the best if not the best in the world.  This is reflected on the globally accepted indicators.

The World Health Organization gauges a country’s infant mortality and life expectancy rates as the most reliable indicators of a healthy nation. Of course, a country’s ability to preserve lives of newborn children and concurrent prevention of avoidable deaths are indicators that a nation state has working and impactful healthcare system.

The WHO’s latest report illustrates that Cuba’s infant mortality is 4.3 per 1000 births. This is far much better than the industrially and economically superior nations such as the US, Canada, and many Western Europe countries whose per capita income and GDP rates are miles ahead of Cuba’s meagre income and GDP per capita levels.

The other important indicator is life expectancy. The latest globally accepted reports illustrate that Cuba’s life expectancy is 79 for males and 80 for females. This is qualitatively and quantitatively higher than most developed nations in the world. When the Cuban revolutionary forces triumphed over the US controlled regime of Batista in 1959, Cuba’s life expectancy was just under 60 years. This means the socialist revolutionary healthcare reforms qualitatively and qualitatively expanded under the leadership of Fidel Castro.

Cuba expends more than 10% of its GDP on Healthcare, and about 20% of its annual budget is allocated to healthcare. It has 150 hospitals, 497 clinics, and 495 000 Health Practitioners, and of those, more than 90 000 of those are Medical Doctors. What this means is that in Cuba, there is 1 Medical Doctor for every 122 citizens. Cuba additionally has 12 Health Research and speciality institutions, whose main aim is to focus on the intricate details and specifics of each disease. These include specialized focus on Cancer, and other diseases.

Additional to this, Cuba’s 13 Medical Schools, which are evenly spread across its 15 provinces, produce 7000 Cuban doctors annually. As part of their curriculum and qualification sine qua non, Cuba Medical Trainees are obliged to provide family medical care for a minimum of 3 years before they can specialize, be sent on medical missions in any part of the country or abroad.

Cuba currently has more than 50 000 doctors practicing outside of Cuba, and in countries that understand and have internalized their modus operandi, these doctors focus on primary healthcare. Brazil has 8500 medical doctors from Cuba, and SA has 450. Cuba’s Medical Schools also train Doctors from 121 Countries including South Africa, China, US, and many African countries.

These statistics are however not the main reason why Cuba is the most healthy nation in the world. At the core of Cuba’s healthcare system is its focus on primary healthcare, which the ministry of health says is based on prevention, promotion of  and education on healthcare.

The global norm on healthcare is primarily focused on the philosophy of diagnosis, treatment and rehabilitation. Whilst Cuba excels on this front, it deliberately and emphatically focuses on the pillars of prevention, promotion of and education on healthcare. What this means is that Cuban Doctors and other health practitioners go to communities to consistently and reliably test its people, and prevent diseases before they escalate to the levels of hospitalisation.

Cuba’s focus on primary healthcare is what brings stability and excellence to its healthcare system. The essence of Cuba’s healthcare system is its emphasis on prevention of diseases, promotion and education on healthcare. Cuba’s Medical Practitioners philosophical approach to healthcare is humanist, and veritably not obsessed with profit maximisation like is the case with South Africa’a Healthcare system. This is evidenced on Doctors’ focus on family units and the medical history and complexities of each family in order to curb the root cause of the disease.

Despite its massive achievements and indicators that come as a result of maximum focus on primary healthcare, Cuba has developed excellent pharmaceutical capacity through the State Owned Centre for Genetic Engineering and Biotechnology or in Spanish, Centro de Ingeniería Genética y Biotecnología (CIGB), which the Parliamentary delegation visited and engaged with in Havana.

The CIGB works in more than 20 projects aimed at the obtainment and development of biomedical products for the prevention and treatment of infectious diseases, cardiovascular, neurodegenerative, cancer, inflammation, autoimmunity, healing and cytoprotection. It comprises the departments of Vaccines, Pharmaceuticals, Immuno-diagnosis and Genomics, Chemical Physics and System Biology, and Control of Scientific-Technical Activity and Administrative. It has 200 workers: 41% holding the degree of Doctor in Sciences and 37% Masters in Sciences.

As part of its programmes and promotion of South to South relations, CIGB has built and co-developed state of the art pharmaceutical factors in many parts of the world including in South Africa. The CIGB is part of an umbrella body called BioCubaFarma, which has 38 Enterprises and more than 22 000 qualified workers. BioCubaFarma manufactures generic drugs, therapeutic and prophylactic vaccines, biomedicines, diagostic systems, and high tech medical equipment. It also does researches in neuroscience and neuro-technology. As a matter of fact, BioCubaFarma domestically manufactures 583 of 881 generic drugs used in Cuba.

Cuba has also established an industrial Development zone which permits investors to play a role, with security of tenure and protection of investments in the pharmaceutical space. Furthermore, Cuba is willing to transfer skills and technology to the developing countries as evidenced by the partnership  with Biovac Institute South Africa. Biovac Institute  manufactures different vaccines and some of the vaccines being manufactured are awaiting approval after clinical tests and all the processes that have to be followed.

Added to these realities, access to healthcare in Cuba is free, and this right is enshrined in the constitution. In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban Constitution  which states "Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population cooperates in these activities and plans through the social and mass organizations."

In the dominant capitalist narratives, quality healthcare is a by product of an efficient free market and economic superiority. Cuba has illustrated without any sensible doubt that a quality healthcare system that takes care of its children and elderly can be built even without huge economic resources and certainly without capitalism.

South Africa.

South Africa has one of the most devastating health burdens in the world. This is reflected on the number of South Africans with HIV, at 7 million. Infant mortality rate in South Africa is at 32 per 1000 births, compared to Cuba’s 4.3 per 1000 births. South Africa’s life expectancy is about 64 years, and this is below the global average and far below Cuba’s average whose economy is not as big as that of South Africa.

The South African Medical Research Council’s National Disease Burden points to the fact that, “that non-communicable diseases have now become the leading group of causes resulting in death in South Africa accounting for almost 40% of total deaths and 1 in 3 deaths before the age of 60 years”. Furthermore the MRC says, “Our communities need to be empowered to adopt healthy lifestyles and our primary health care services need to better manage these conditions and their risk factors“.

Primary Healthcare is the future:

The World Health Organisation says Primary Healthcare, “is about caring for people, rather than simply treating specific diseases or conditions.

PHC is usually the first point of contact people have with the health care system. It provides comprehensive, accessible, community-based care that meets the health needs of individuals throughout their life.

This includes a spectrum of services from prevention (i.e. vaccinations and family planning) to management of chronic health conditions and palliative care”.

The emphasis is obviously on primary healthcare, and that is what South Africa should direct its focus to. The National Department of Health should set a target on Doctor to patient ratio and roll out a plan on training of those doctors. Furthermore, Medical training institutions should be empowered to produce as many health practitioners as possible and the entire healthcare system should shift into prioritizing primary healthcare.

The immediate focus should be on establishment of one clinic or polycyclic per Ward, and the focus will vary according to population size in each Ward. All Clinics should have permanent doctors and health practitioners such who will not just wait for patients to come to the clinic but should consistently visit households and individuals in their work places to develop a Ward based healthcare profile. In this way, the healthcare system will be able to detect the common diseases per Ward and thereafter develop mechanisms to prevent their spread before they reach crisis levels.

The overall target in South Africa should be that there should never be a citizen who finishes more than 3 months without undergoing medical checkup. Additional to this, health education and promotion should be encouraged through campaigns and different communications and mass media platforms. Citizens should be aware of basic healthcare practices and needs so that they get to the extent of self help and assistance when they detect early instances of diseases.

Currently, majority of South Africans have not had any form of interaction with formal medical checkup because medical checkup are a commodity. This therefore calls for the complete de commodification of healthcare, and it be Constitutionally declared an essential human right. This should be distinguished from the lax rights in the Constitution that come with a disclaimer that the State can guarantee access to healthcare only if it had available resources to do so.

South Africa should escalate its relationship with Cuba and establish a State Owned Pharmaceutical Company. This is certainly one of the component Cardinal pillars in the EFF Founding Manifesto, which states under building state capacity, that South Africa should establish a pharmaceutical company. The State Owned pharmaceutical Company should be competent and professionally run and produce generic drugs, vaccines and all the necessary medications needed for the phase of healthcare that deals with diagnosis, treatment and rehabilitation.

Due to massive South African intra-migration for economic and educational purposes, it is long overdue that the entire healthcare fraternity should establish an electronic healthcare data system which will keep the health history of each and every citizen. Once checked or diagnosed in one health facility, there should not be a need to repeat the same exercise if a patient migrates from one province/region to another. Of course this should be subjected to the standing quality controls and Doctor/Patient Laws that govern healthcare in South Africa.

It is reality that South Africa does not maximally utilize the spaces provided in Cuba’s civilian and military Medical Training institutions, whilst there are massive shortages of doctors in our rural communities. This should immediately change, and all the spaces that Cuba avails for the training of medical practitioners should be filled. A consideration should additionally be given to opening campuses of Cuba’s Medical Schools in South Africa, similar to the Escuela Latinoamericana de Medicina(ELAM), the Latin American School of Medicine. ELAM trains Medical Doctors from more than 100 countries and considered one do the best Medical Schools in the world whose philosophical approach is primary healthcare.

The reality is that at this stage, South Africa’s medical schools largely produce doctors who are ready for commercial healthcare, which is a preserve of the few. Additionally, South Africa’s medical schools tuition fees and admission criteria are prohibiteve to new black entrants, and those who get admitted struggle with finishing their medical degrees. South Africa needs to move to a new trajectory in terms of medical practice, medical doctors’ training and healthcare in general.

The essence of healthcare in South Africa has to be primary healthcare. The National Health Insurance should be located within the context of a comprehensive, implementable and cogent National Health System, whose philosophy should be prevention of diseases, promotion of and education in healthcare. The people of South Africa are dying due to preventable and curable diseases. The move towards primary healthcare is long overdue, and requires decisive and willing revolutionary political leadership which will define the philosophical approach and monitor its roll out.

As Che Guevara said, “Some day, therefore, medicine will have to convert itself into a science that serves to prevent disease and orients the public toward carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society we are creating“. Salute•

Floyd Shivambu is EFF Deputy President. 

1 comment:

Anonymous said...

Aluta continua, victory is certain!

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