Meanwhile what can we learn from Cuba next? Why Cuba?

Why Cuba of all places? Is the Cuban health care system really as great as people claim?

It is not as if we do not have other doctors from elsewhere. Kenya Medical Practitioner’s & Dentists’ Board (KMPDB) sources by February 2018 indicated that out of the 1,019 foreign doctors currently practicing in Kenya, 358 were Americans, and now we will be having 100 Cubans. US had 358, India 143, Germany 65, Congo 45, Burundi 35, Uganda 32, Egypt 31, Italy 29, Spain 25, UK 25, Rwanda16, Sudan 16, Canada 15, Somalia 15,  Ethiopia 13, S. Korea 11, Others 199. I also remember there was a good number from Ukraine.

Mathematically, its like 1/10 of all foreign doctors in Kenya will be Cubans. If we were to add the blossoming number in alternative medicine from Asia and far east, then —

We now have doctors from Cuba working as expatriates in Kenya. Is it worth the effort? We have been looking at Universal Health Care. It is good fodder for the current regime and this is one thing the Jubilee government cannot afford to fail in. It is a pet subject with the possibility of changing the landscape of the health system forever.

So why Cuba?

According to the UN’s World Health Organization (WHO), Cuba’s health care system is an example for all countries of the world for its excellence and its efficiency in universal health care. Despite the challenge’s experienced in term of resources Cuba has managed to guarantee access to care for all segments of the population and obtain results similar to those of the most developed nations (Lamrani, 2014).

During the International Health Convention in April, 2018 Dr.Tedros Adhanom Ghebreyesus, the World Health Organization’s (WHO) Director-General, stressed that Cuba is the perfect place to learn how to achieve universal access, even with few resources. (Agencia Cubana de Noticias, 2014) sincerely hope that all of the world’s inhabitants will have access to quality medical services, as they do in Cuba,”

The Cuban health system was borne out of its revolutionary socialist ideology. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run. It focuses heavily on a preventative approach to medicine. A doctor to population ratio of one per 150, which surpasses many developed nations like the UK with 2.8 per 1000 people according to World bank Reports. Kenya doctor to population ratio  0.2.per 1000 (UN targets in 2014 was 7.5:1000).

In applauding Cuba, WHO stresses that it is possible for Third-world countries with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name. There is no one size fits all in UHC -it will depend on local circumstance and national dialogue.

Kazungu J. and Barasa E. of KEMRI echoed the same, that Kenya can manage a universal tax-funded, prepayment mechanism …that ensures universal care of its population (Kazungu, J. Barasa, E., 2017). Of course this will only be possible if there was going to be a high degree of transparency and efficiency in managing the program. Challenges of fraud, wastage, and abuse would need to be addressed. We Kenyans are so wasteful, We should see how much Cubans were able to accomplish with so little.

Cuban doctors who arrived in Kenya early this month (Photo Courtesy of The Conversation)

In the words of Dr. A. Copo ‘… we share the little we have between everyone as best we can’. A citizen said proudly ‘I’ve no worry for the future because the Cuban government has always put the health of Cubans first”.  So what can we learn from Cuba next? All these we must learn within the 2-year contract ( 2 months almost gone by now). Most of them were captured in the UHC in Africa: A Framework for Action

  • Priority lesson is on to do More with less – what would be the most impactful health package that we can afford under our circumstances? Albeit we mean More but Better Spending with Effective Financial Protection;
  • Next -Population Participation in Health Policy-making;
  • Political and Institutional Foundations for the UHC Agenda;
  • Strengthening Health Security against disease outbreaks.  Whereas elimination of preventable maternal and child deaths, malaria, AIDS, TB, and other diseases in Africa is within reach;
  • Accelerating Progress Toward UHC

All these are no Biggie for Cubans as we are made to believe. Cuban overseas missions is a real catch for Cuba’s economy at US$8 annually. In other words, Cuban medics are used to going out to showcase. A good number of those who are here going by their profiles have been to places, including other African countries.

Kenyan troops are great at peacekeeping missions, we have to be doing it all the time, why because there are those who need our expertize. A good number of Africa public systems run on the Kenyan model, name it Botswana, S.Sudan etc. Our constitution has been cited to be the most progressive world over. Devolution is a catch.

‘Cubans find the strength to push through serious obstacles and challenges to deliver a service worthy of praise!’- The words of Rich Warner, an American who had who trained as a doctor in Cuba and experienced Cuban Health systems first hand.

In the words of Ban Ki Moon UN Secretary-General – Cuba is a model for many developing countries. Lets keep their doctors here, afterall they will be well taken care of. The politics of this is – that if the pay at home is low (physician earns equivalent of Ksh 5,377 a month) look for greener pastures and Kenya is quite green.  Condition – they must endeavour to make a biG difference.

Last time we looked at universal health care or cover and asked which was a priority. You can look at this background too. Subjective evidence shows that many health care providers have a challenge understanding the complexities of health systems as a starting point.  Please post your comments below. Read link to Why we better start embracing Cuban Docs and, export our Kenyan Nurses elsewhere in this blog.

 

A picture of a patient, obviously in pain waiting to be attended outside an empty consulting room during the 100 days doctors’ strike in Kenya. [Courtesy of the photographer as appeared in the media]
Kenyans want to see if the Cubans can make them at least realize their right to health. This right was contested vis a vis labour rights of health care workers in much of 2017. Quote KNHCR  sometimes 2016    ‘… the sector is slowly degenerating further into a ‘no-access’ to healthcare at all let alone the quality of services offered. It is disturbing to see patients in dire need of treatment lying desolate on waiting benches in county hospitals. It is equally moving to see frail patients, some carried on wheelbarrows because they could not afford ambulance charges being turned away’.

This author holds a Masters in Nursing Leadership & Health Systems Administration from University of Colorado Denver

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