Cuba did it, why can’t we?

“Out of the blue,” she said, the president-elect told her to go to Cuba. It was May, 2016. “What is there to see in Cuba?” she asked, rather perplexed. “Just go and find out,” were the marching orders of President-elect Rodrigo Duterte to Dr. Paulyn Jean Rosell Ubial, now secretary of health. That was how she began her speech as government representative to the 8th Asia Pacific Regional Conference for Solidarity with Cuba, held in Metro Manila last week.

There were ten of them who went to Havana for a three-day visit; they were heading for Peru to attend an Asia-Pacific Economic Cooperation (APEC) meeting and Secretary Ubial asked the World Health Organization (WHO) to make the arrangements. This is what they saw in Cuba:

“The strength of their health system is human resources! They have one doctor per 1,000 population! The WHO standard is 1:10,000! In the Philippines it is 1:33,000. How did that happen? Cuba had 40 years or so to keep at the plan. Fidel Castro, after the revolution in 1959, started the Master Plan for Health, developing a health system that is anchored on primary health care. They invested 26% of the national budget in health. In the Philippines less than 5% is invested in health, whereas, the WHO standard is 5% of the national budget, or greater. Many of our neighbors here in Asia like Malaysia and Thailand have 10% of the GDP invested in health. Do you wonder why the health outcomes in the Philippines are so dismal? Our investment in health is not enough.”

The secretary corroborated what Dr. Robert Corpuz, who spent 7 years studying and working in Cuba, had told us some months ago, during a talk at the University of the Philippines. As soon as Secretary Ubial and her group returned to Manila, they organized a technical working group to plan how to put in place a health system patterned after the Cuban model.

During those three days in Havana, she observed the following: “Their strength is really having annual mandatory check-ups for all 12 million Cubanos. So, they detect illness early and are able to prevent catastrophic and advanced stages of diseases. In the Philippines, the 2010 survey shows that 30% of Filipinos die without even seeing a doctor. We have to verify this with another survey. So, in Cuba, the doctors have to see each Cubano at least once a year! In the Philippines some people don’t even get to see a doctor in their lifetime! Of course we are 102 million, but if we plan and work on it, I am sure we can reach this goal.”

In October, 2016, Secretary Ubial presented to President Duterte the “Cabinet the Master Plan” on what can be done “to emulate the Cuban model for a health system… to have at least 1 health worker per barangay. We cannot have one doctor per barangay because we are not producing enough doctors. In Cuba they produce 2,000 doctors a year. In the Philippines, we produce 2,600 a year but half of them go abroad! The plan is to have one health worker per barangay and our hope is to field a nurse or midwife as we produce enough of these categories of health professionals. We have 46,500 barangays, and we have only 20,000 health workers in the barangays at this moment. We lack 26,500 professionals for the remaining barangays. However, we need more health professionals than the number of barangays because there are huge barangays, with more than 20,000 population, while there are also barangays that are spread in 3 islands, so we need a health worker in each island.”

The secretary said the Department of Health will need an additional P25 billion a year for salaries alone and P220 billion as a one-time investment to either build or rent a health station in every barangay, a polyclinic in every municipality, a secondary hospital (equipped to perform operations) for every 5 municipalities, and apex hospitals in every region. That is a tall order indeed because at present, the Health Department barely has P24 billion a year for capital investments in health facilities. “So, if we go on a business-as -usual mode, we can reach the goal in 10 years! Much investment is needed to put the Cuban model in place. But we are hopeful that with the President’s vision and full support, this can be attained by 2022, “ affirmed the Secretary Ubial with a measure of optimism.

The good news is that there are already plans to pilot the Cuban model in Surigao del Norte. Apparently, the provincial governor, Sol Matugas, organized a team and they visited Cuba in November, 2016. Said the secretary: “We will start planning with the technical working group this May and once we put the system in place, next year we will do it in the whole country. We have submitted a 2018 budget, hopefully it gets approved.”

Secretary Ubial expressed her gratitude to the Cuban governmentf or sharing their best practices. “Healthcare in Cuba is one of the best in the world, better than the USA’s and many so-called developed countries. We have so much to learn from Cuba and they have so much to show the world. Thank you Cuba! Viva and Mabuhay.”