Primary care services form the core of the Cuban health system. More than 80 percent of health visits take place with primary care providers in consultations [1].
The Cuban health care system relies heavily on primary care providers both physicians and nurses, and Cuba has a robust, free medical education program to ensure sufficient trained health workforce to provide comprehensive primary care.
In 2013, Cuba trained more than 10,000 physicians and approximately 30,000 total clinicians [3].
Cuba has 6.7 physicians and 8.2 nurses for every 1000 people. By comparison, the United States has 2.8 physicians for every 1000 people [2].
Cuba requires that all graduates of medical school to first complete family medicine training before they can specialize. This is to bolster the primary care system.
Ultimately, 70 percent of physicians remain in family medicine as primary care providers (PCPs), compared to only 10 percent in the United States [3].
A focus on Prevention
Primary health care in Cuba is facilitated by a system of “geographic empanelment,” which assign patients to a primary care team using fixed geographic areas to delineate patient grouping. Each Family Clinic (Consultorio) is staffed by a doctor, a nurse and a medical assistant who together are responsible for the health of 600-700 patients, or approximately 150 families [1, 5].
The primary Health Care teams view their “patients-populations” as cohesive groups rather than unrelated individuals. For instance, medical records are organized by family.
In Cuba the health approach is focused on prevention of illness & disease and determinants of health.
At a collective monitoring level, the primary care team conduct active surveillance and risk identification within their empaneled population minimum twice a year.
At the individual monitoring level, explicit risk stratification categories are used to assess each patient in the panel and physicians must report the number of patients in each risk category to the local health district.
Each family doctors teams typically spends half of their time conducting home visits, which allows them to closely monitor patients identified as high-risk and identify health concerns before they advance. All Cubans receive at least two family doctors home visits per year, and patients
identified as high-risk can be seen as often as two times per week.
In addition to improving the continuity of care for patients with chronic conditions, home visits facilitate conversations between PCPs and family members about how to best address the patient’s health and well-being.
A Community-oriented approach to Health
PCPs live in the communities they serve and “Consultorios” are generally attached to or are near the homes of PCPs [1]. This continuous community presence increases community trust in the primary care teams.
Primary care teams conduct specific activities to further strengthen their ties to the communities they serve.
Family Clinics conduct public health situation analysis every year to review their annual performance, determine issues to be addressed, plan ways to promote wellbeing and to tackle community health issues in the year to come.
Community members are encouraged to attend and participate in the decision-making process of the Family Clinics plan of actions to improve the population health determinants & the community health& well-being.
Multidisciplinary health clinics
In Cuba, the managers & care providers of the Family and Multidisciplinary Clinics of the primary care work hand-in-hand together and with the secondary health care providers to ensure that no information that could negatively impact the health of a patient is lost.
Primary care services are also provided at multidisciplinary health clinics, called “Policlinicos”, each of which serves the population of 30-40 Family Clinics [1].
Guidelines are set to promote the formation of strong relationships between primary care physicians and specialist physicians working in multidisciplinary health clinics in order to improve the continuity and coordination of care for patients.
Dual referral systems allow patients to be transferred smoothly from primary to secondary care and from secondary care back to their PCP.
A member of the Family clinics also often accompanies their patients in person to the Multidisciplinary health clinics and/or have specialists come directly to the Family Clinics to perform consultations [5].
In the event that a patient is admitted to the Multidisciplinary health clinics, a team member of the Family Clinic either accompanies patients to the hospital or are personally briefed by the emergency department physician [5].
International missions
Every year Cuba sends 30,000 physicians to countries in need across Latin America and Africa [2].
- Domínguez-Alonso, E. and Zacea, E. “[The health system of Cuba],” Salud Pública México, vol. 53 Suppl 2, pp. s168–176, 2011.
- Elio D. L., “Massive Graduation of Doctors in Cuba,” Havana Times.org, 29-Jul-2013. .
- Campion, E. W., and Morrissey, S., “A Different Model — Medical Care in Cuba,” N. Engl. J. Med., vol. 368, no. 4, pp. 297–299, Jan. 2013.
- Greene, R., “Effective community health participation strategies: a Cuban example,” Int. J. Health Plann. Manage., vol. 18, no. 2, pp. 105–116, Apr. 2003.
- Lang, J., “Notes from Cuba: the importance of primary care,” Lond. J. Prim. Care, vol. 3, no. 2, pp. 129–130, Dec. 2010.
