The Cuban Health System
Established in 1960 as an integral part of post revolution reforms, Cuba's Single Health System is rights-based and continuously adapted in response to emerging challenges. The system aims to increase the efficiency and quality of services, ensure sustainability, and generate research that can inform efforts to eliminate any remaining inequities in health status and access to services. It is governed by the principles of universal, free, accessible, equitable, and participatory health services.
Meets the criteria established under Health in All Policies:
- Political commitment. Cuba's health promotion–centered Single Health System enjoys political commitment at the highest levels. It is constitutionally mandated and coordinated by the Ministry of Public Health.
- Separate structure. With the triumph of the revolution in 1959, the country instituted political, economic, and social reforms—particularly in the health and education sectors—to improve people's living conditions. The Health Commission of the National Assembly of the Popular Power (Parliament) promotes public policies, guidelines, and regulations to achieve health objectives. Health councils were established at the national, provincial, municipal, and local levels to implement policies and actions. The councils include representatives from all central government agencies, non-governmental organizations, religious institutions, and others.
- Participation of other sectors. Sectors other than health participate in the Single Health System. The Ministry of Education trains teachers in health topics to encourage healthy lifestyles. The Cuban Institute of Radio and Television (ICRT) collaborates in the area of health communication. The Institute of Sports, Physical Education and Recreation (INDER) promotes physical activity and recreation as a means of protecting health and quality of life. The Ministry of Transportation and the National Traffic Control Office work on accident prevention. The Ministry of Agriculture prioritizes food production to improve diets. Finally, Civil Defense is responsible for emergency and disaster response.
- Separate budget. The health system has its own budget, which includes allocations from each participating agency. Communities participate actively in local volunteer activities.
- Focus on reducing inequity. The system is accessible to the entire Cuban population, with special emphasis on vulnerable groups and disadvantaged communities.
- Intersectoral action. It is premised on intersectoral action involving all of the agencies mentioned above.
- Public policy. The system develops public policies that impact health. Policies are reviewed periodically and modified as needed, based on the social determinants of health they are intended to address. For example, in the area of internal trade, there are regulations governing the sale of tobacco and alcohol to minors. The education sector prohibits smoking on school grounds; conducts circles of interest (dialogues on topics such as sexual and reproductive health, first aid, addiction and violence prevention, safe food handling, etc.). Trade unions are involved in activities to protect worker health and safety. The agriculture sector sets priorities for crop production. And the Ministry of Culture bans smoking in theaters, cinemas, art galleries, and other public cultural venues.
- Evidence of results. Programs are held accountable through community assemblies to evaluate health activities. The Ministry of Public Health has established internal control mechanisms, internal and external audits, and procedures to address public grievances and recommendations. The government conducts systematic research on the health situation and designs strategies and action plans based on the findings. Scientific evidence is obtained through studies of behavioral changes as a result of prevention and control activities, evaluations of the main indicators for health, mortality and morbidity, and national surveys on risk factors.
- It has scientific based evidence of its results. Assemblies for accountability before the population were established to evaluate the actions of health. The Ministry of Public Health has established control mechanisms, internal and external audits and mechanisms to address complaints or recommendations of the population. There are also systematic analyses of the health situation and strategies and action plans are established accordingly. Studies on behaviors of the population in response to prevention and control in health are carried out; Analysis of the main indicators of health and mortality and morbidity are taken into account; as well as national surveys of risk factors.
- Social participation. The health system coordinates with social organizations like the Federation of Cuban women (FMC), the Committee for the Defense of the Revolution (CDR), and the National Association of Small Farmers (ANAP).