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The Complications of Adopting Cuba’s Healthcare Policies

 

Led by health secretary Paulyn Ubial, a team of DOH officials were assembled to make their way to Cuba. The trip, which lasted from August 23 to 28 last year, was a chance for our country’s top DOH decision-makers to observe one of the world’s most organized healthcare systems at work. Cuba boasts of high life expectancies, low maternal mortality rates, and low infant and under-5 mortality rates among its population. These statistics sounded well enough for President Rodrigo Duterte to instigate DOH’s Cuban trip during the first cabinet meeting.

Reporting in a Malacañang conference after her return from Cuba, Secretary Ubial related, “We went to the Ministry of Health, the Family Physician’s Office- that’s the most frontline facility, their multidisciplinary outpatient clinic, their tertiary hospital facilities, as well as other support facilities like a mental health unit, maternity waiting home for high-risk pregnant women, and also geriatric home.”

She highlighted the need for more Filipino doctors, stating that since the Cuban medical schools are under their Ministry of Health, it was easier for the government to disseminate and enforce national health plans. “For us, we have only five state-owned colleges of medicine and our production is not that many. In fact, even our board exam passers for medicine is about 30-40%. In Cuba, it’s 98%,” she added.

The DOH Secretary estimated that at least P57 billion would be needed to cover the adjustments needed for our healthcare system to be more like that of Cuba.

Not easy

In a recent interview for the Monthly Index of Medical Specialities’ website, MIMS.com, Dr. Emerito Jose A. Faraon, Assistant Professor at the College of Public Health (CPH) of the University of the Philippines Manila, offered his two cents on the proposed plans to imitate the Cuban health system. He stated, “While the Cuban heath care system is a model of an effective and efficient health system, it is not easy to fix our own health system and make it just like theirs.”

He then proceeded to list down some of the factors that may hinder us from fully adapting a Cuban-style healthcare system.

1. Differing Government Systems
As a communist country, Cuba places everything concerning social welfare within the government’s control. This allows for a more organized management and regulation of healthcare service distribution. This level of control would be more difficult to enact in a democratic country like the Philippines.

2. Population
The Cuban population in 2015 was recorded to be at around 11.2 million. This is a stark contrast to the Philippines’ population that same year which reached 102.4 million, almost 10x Cuba’s. As Secretary Ubial herself had relayed in the aforementioned conference, the ratio of doctor to patient is 1 : 33,000 in the Philippines, significantly greater than Cuba’s 1 : 1,075 ratio.

3. Geography
The geographical difference between the two countries plays a major factor on why one healthcare system is better executed than the other. Dr. Faraon said that “it is relatively easier to manage universal healthcare coverage in one continuous island of 11 million people than a country like the Philippines with more than 7,000 islands of more than 100 million people of diverse cultures and dialects.”

4. Human Resources
“We do not have the budget for the necessary human health resources needed to achieve the level of preventive health care that Cuba enjoys now,” Dr. Faraon stated. The ideal of having one doctor per barangay would be an uphill climb, considering that what we currently have is one doctor per municipality, which covers about 20-30 barangays. 35,000 doctors are needed to even out the odds, which we are still struggling to collate.

More than a matter of ratio

Dr. Johnny Tamon, a graduate of the Ateneo School of Medicine and Public Health, shared the same sentiment in a separate interview. He further asserted that “achieving a healthcare system similar to Cuba goes beyond simply achieving an ideal doctor to patient ratio.”

Given that the shift is a national matter, it needs a firm and consistent implementation from our government. Our government structure makes it taxing to ensure an enduring healthcare solution. Dr. Tamon stated, “These are huge changes and they require strong political will with a lasting commitment to change the system. The DOH can provide the direction for the necessary changes, but it entails continued effort beyond what one can achieve in a 6-year presidential term or political cycle.”

Not feasible

At the present state of things, aspiring for a Cuban-like system seems almost far-fetched. What worked for the Cubans may not necessarily work with us, given our differences in circumstance. While we may take on what they’ve been doing right, like a more solidified mental healthcare, DOH must look internally to create a new system better suited for our situation. The issues of national and local government corruption must first be dealt with before any step towards nationwide healthcare revisions can be made. As Dr. Faraon had said, “The hope is to strengthen primary healthcare in the smallest unit of government, which is what the Cuban health system model is all about. At present, this is not feasible.”

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