Healthcare in Pakistan, Lessons from Cuba

There has been no noticeable improvement in the new Budget with regards to the health and education sectors. Our policy makers still continue to ignore these leading indicators of public welfare.

The ratio of doctors to population in Pakistan is 1 to 1254. Dentist to population ratio is 1 to 20839. It is thus no wonder that the health indicators of Pakistan are dismal. It is estimated that 80% of all deaths and 90% of all illnesses in Pakistan result from diseases which are preventable. All this and many more indicators such as high population growth rates, high infant mortality rates, high maternal mortality ratio, and a high prevalence of communicable and non-communicable diseases cry foul the government's social development promises.

Pakistan's health sector portrays an array of public and, highly unregulated, private services. About 80% of total healthcare expenditure consists of private expenses, and the majority of this is out-of-pocket payments. In a poor country such as ours, the prevalence of private practices and their incumbent costs helps to discourage people to get treatment for conditions that may become complicated and thus even more costly to cure.

In the past there has not been much support by policy makers and health specialists towards increasing the social security net. A national health plan which envisages free healthcare for all is seen by the majority as unattainable and utopian. It is usually argued in Pakistan that such a national health system is only possible in developed countries with a broad tax base.

This 'precondition' for a working and successful national health system is proved wrong by the case of Cuba. Cuba's health system works; and it is completely run by the government which assumes fiscal and administrative responsibility. Cuba has the most impressive doctor to patient ratio of 1 to 175. All this and more while facing more than 40 years of US trade and financial embargoes.

The US imposed embargoes on Cuba in early 1960’s; three years after Fidel Castro took power in 1959. At that time there was a mass exodus of Cuban doctors to the United States leaving the country with only 3000 physicians and 16 medical professors. A program of nationalization and regionalization of medical services was started in 1960 to deal with this shortage. Cuba now has 66,600 physicians, 83,880 nurses, and 9,841 dentists. It's density of physicians per 1000 population is 5.91, much better than the US at 2.3 and the UK at 2.56. Its life expectancies are at par with the most developed countries and its infant mortality rate is also the lowest.

The success of Cuba's healthcare system, despite the economic difficulties that it faces and its status as a third world country, is recognized widely. Former UN secretary general Kofi Annan has lauded Cuban healthcare; along with other western diplomats. "Health and education are the revolution's pillars of legitimacy so the government has to make them work," says a senior western diplomat in Havana. "If they don't it loses all its moral authority. My sense is that the health system is quite good."

The Cuban government also operates possibly the largest medical school in the world, the Latin American School of Medicine (LASM) which is a major part of the Cuban healthcare system. The majority of students are foreign and all study there for free. The only condition is that they have to go back to their countries and help their impoverished communities.

These measures are part of Cuba's foreign policy which was also demonstrated after the October 2005 earthquake. The largest contingent of aid workers to arrive in Pakistan was from Cuba. There were around 2,600 medical personnel, which included 1,430 doctors, sent to treat the earthquake-affected people from Cuba. Cuba also donated 30 mobile hospitals and a large quantity of medicines and equipment to Pakistan. These medical personnel not only lived with the affected people in the same surroundings but stayed on longer than other medical professionals from different countries.

The success of the Cuban healthcare system is mainly due to the commitment to 'preventive' rather than 'curative' medicine. Economically starved Cuba cannot afford expensive medicines and even basics such as Aspirin are sometimes not available. Therefore the system promotes exercise, hygiene, and regular check ups to identify and cure diseases before they become advanced and costly. Policy makers from UK's National Health Service (NHS) have visited Cuba to learn from their success and to try to move from a system that focuses on keeping people alive to one that keeps them healthy.

If such a country as Cuba suffering from 47 years of economic embargoes can have such a successful health care system, then Pakistan with all its foreign aid surely does not have an excuse. If more resources were directed towards the welfare of our population rather than paying off huge foreign debts and sustaining our defense expenditure, then there can be no impediment towards achieving a healthy nation.