Cuba: plenty of care, few condoms, no corruption.

ABSTRACT

PIP: The health system in Cuba guarantees accessibility to the entire population, and it is free of charge. Cuba's health figures are on a par with developed countries that have 20 times the budget. Each year around 4000 students start their medical training at 23 different universities. Since 1980 there has been a training course for family doctors. By 1995 22,000 of them have been trained covering 90% of the population. Their main work is preventive: health promotion and offering basic curative care. The family doctors are backed up by 400 polyclinics, where specialists offer their services to about 30,000 people. Life expectancy is 77 years and infant mortality a mere 9 per 1000 live births. Malaria has been eradicated and dengue fever successfully reduced. Leading causes of mortality are cardiovascular diseases, neoplasms, accidents, and homicides. Up to now only 1089 people have been diagnosed as HIV positive. From a mere epidemiological point of view, strict isolation could contain the epidemic in a closed society. In practice, however, the island opened the doors to tourism, with a side effect of increasing prostitution. Condoms or any contraceptives are in short supply. Nevertheless, the number of abortions is low, less than 1 per 100 deliveries. The reason is that all women whose expected menstruation is late by two weeks are offered a microaspiration in the polyclinic. 700 regulations are performed for every 5000 fertile women. Pregnancy tests are not performed as they are not available. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years' trade embargo by the United States and the gradual change from a centrally planned economy towards more of a free market system. Family planning and AIDS seem two topics that need further exploration. Even if their system is under strain, health indices do not show a deterioration in health yet.