Legal aspects of national healthcare service in Cuba
Prawne aspekty ochrony zdrowia na Kubie
Varna Free University, Varna, Bulgary
W Republice Kuby, ostatnim istniejącym socjalistycznym państwie na świecie, opieka medyczna była zawsze uważana za prawo człowieka przysługujące wszystkim obywatelom. Kubańska polityka zdrowotna kładzie nacisk na podstawową opiekę zdrowotną wraz z profilaktyką oraz udział obywateli i usług w społeczności. Takie działania prowadzą do poprawnego funkcjonowania systemu ochrony zdrowotnej. Kubańskie doświadczenia pokazują prawidłowo funkcjonującą politykę świadczenia opieki medycznej. Chociaż istnieje obszerna literatura na temat opieki zdrowotnej na Kubie, nadal temat konstytucyjnych praw pacjenta do opieki medycznej nie jest w pełni zbadany. Celem tego artykułu jest pokazanie, w jaki sposób kubański system opieki medycznej został rozwinięty, koncentrując się na dobrobycie ludzi, w porównaniu z korzyściami finansowymi.
In the Republic of Cuba, the last remaining socialist state in the world, medical care was always considered a human right for all citizens. Cuba’s health policy underlines primary health care along prevention, and the participation of citizens and services in the community, and such policies lead tow working fairly well health system. The Cuban experience demonstrates properly working policymaking on the provision of medical care. Although there is large body of literature on health care in Cuba, still the topic of constitutional patient’s rights to medical care is not fully explored. Therefore, the purpose of this paper is to show how Cuba’s medical care system has been developed by focusing on human well-being versus financial gains.
In the Republic of Cuba, the last remaining socialist state in the world, medical care was always considered a human right for all citizens. Cuba’s health policy underlines primary health care along prevention, and the participation of citizens and services in the community, and such policies lead tow working fairly well health system. The Cuban experience demonstrates properly working policymaking on the provision of medical care (1). Although there is large body of literature on health care in Cuba, still the topic of constitutional patient’s rights to medical care is not fully explored. Therefore, the purpose of this paper is to show how Cuba’s medical care system has been developed by focusing on human well-being versus financial gains. Scientists too often claim objectivity and empiricism used to support an argument that they make unique contributions to domestic health system. To justify those claims in the arena of legal system of health care in Cuba, an open discussion should take place on the potential lessons to be learned from the Cuban experience. Contemporary Cuba’s medical care system is unique because rather than focusing on remuneration, it has made its emphasis the health of country’s citizens. Cuba from the beginning in 50th last century, has formed their medical care system into a free service, becoming the constitutional right. This article analyzes the importance of providing medical care in Cuba, formed on the constitutional principles that guarantee the recognition and guarantee of human rights in Cuba, in particular, the right to health (2). Used legal approach, highlights the meaning of the general knowledge regarding the content of the constitutional rules that support the right of Cubans to medical services. The Art. might be an interesting topic for the health professionals, that is related to the importance of having an elementary knowledge on the constitutional rules of Cuban’s constitution to be followed in medical services.
Structure of national health system
Cuba’s national health system – Sistema Nacional de Salud (SNS) – strongly focused on prevention, using low technology is fairly effectively. Health education are promoted, and universal medical care is free, and everyone has access to a family physician and nurse. This country has managed to guarantee access to care for all segments of the populace and obtain results similar to those of the most developed countries (3). Unfortunately, the quality of primary healthcare, which has been fundamental to Cuba’s success, has been declining in last decades (4). In accordance with the National Statistics Office Oficina Nacional de Estadística e Informacio ONEI between 2009 and 2014 there was a 62 percent fall in the number of family doctors, from 34,261 to 12,842 (5). At the present Cuba’s health service was divided in two parts, whereas the first one for Cuban’s citizens and the second for foreigners, who receive better quality care, while the national populace has to be satisfied with dilapidated facilities and a lack of medicines and professionals. The medical staff is sent abroad to earn hard currency for Cuba. Cuba’s healthcare system is the existence of special clinics, reserved for tourists, politicians and other people accorded special privileges (6). The Cuban government usually reserves the best hospitals and physicians for the national privileged and foreigners, while citizens occasionally must turn to the black market or ask friends or family to send medicine (7). Cuba represents an important example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those to developing countries. The special health care embodies control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others. However, under the communist style government the major public health system in Cuba, and the underlying strategy that has guided its health gains, have been to some extent ignored (8). The historical context might explain the absence of Cuba from the general conversation on public health and medicine but should not be dismissed as passive acquiescence of the health professions to the demands of communist regime (9). The main goal of national of the health care is the discovery of new knowledge and the use of that knowledge to improve health system. In major areas critical of public health and medicine facing less developed countries Cuba has achieved quite success, include creating a high quality primary health care network and an working public health system, sustaining a local biomedical research infrastructure, controlling infectious diseases, achieving a decline in non-communicable diseases, and meeting the emergency health needs of this country (6, 10).
1976 – Constitution of Cuba
The first constitution since the Cuban Revolution was drafted in 1976 and has since been several times amended. In 2018, Cuba prepared a major revision of its Constitution, which was then enacted in 2019. The 1976 constitution recommitted the Cuban government to provide its citizens with access to free medical health care, as in the Art. 80 of the 1940 constitution (11). The Cuban Constitution recognizes the right to health, and the country’s single, free, universal public health system and high-level political commitment promote intersect orality as a strategy to address health problems (12). Intersectional networking is reflected in national regulations that encourage participation by all social sectors in health promotion/disease prevention/treatment/rehabilitation policies and programs. The strategy has increased the response capacity of Cuba’s health system to face challenges in the national and international socioeconomic context and has helped improve the country’s main health indicator.
The National Assembly of People’s Power Asamblea Nacional del Poder Popular de la República de Cuba are the maximum authorities of the Cuban government at the local level, with members elected by popular vote. The Asamblea Nacional del Poder, is the supreme organ of the Cuban government and is the only body with constitutional and legislative power. La Asamblea Nacional has standing working commissions in place to control and supervise the activities of respective agencies, such as the Commission on Health, Sports, and the Environment Comisión Cubana de Salud, Deportes y Medio Ambiente. The SNS is completely financed by state resources. The system’s budgetary process guarantees compliance with development objectives for the health sector. Budgetary policies are formed on an analysis of joint interests and options pursued by the Ministry of Public Health Ministerio de Salud Pública MSP and the Ministry of Finance and Pricing Ministerio de Finanzas y Precios, which are the regulatory agencies for both activities.
1976 Cuban Constitution granted the range of access to health to the category of constitutional law. Constitution embodies several provision of free medical and hospital care, through the network of rural medical service facilities, polyclinics, hospitals, prophylactic centers and specialized treatment; with the provision of free dental assistance; with the development of health dissemination and health education plans, periodic medical examinations, general vaccination and other disease prevention measure (13). Particularly Art. 43 of Cuban Constitution endorsed that the Cuban State enshrines the right that citizens, regardless of race, skin color, sex, religious beliefs, national origin and any other lesion to dignity Human assistance in all health institutions. Note allusion to all institutions, which in fact excludes any form of discrimination. The citizens, from the constitutional point of view, does not need to credit capital, assets or other conditions to receive care in any of the institutions, including specialized center of the country in the case of medical care or in the other social institutions where services are offered in several way that contribute to the physical well-being of citizens and by that to their physical and mental health. The access to Cuban medical care is not be limited only to the system of institutions such as offices, hospitals, clinics, etc. (14). Art. No. 44 states that The Cuban government organizes institutions such as children’s circles, seminars and boarding schools, care homes to the elderly and services that facilitate the working family the performance of their possibilities by ensuring their health and a healthy offspring as well as that the Cuban government grants paid maternity leave to the working woman, before and after childbirth, and temporary work options compatible with their maternal function. Further Art. 46 stipulates that everyone who works has the right to rest, which is guaranteed by the working day of eight hours, the weekly rest and the annual paid vacations as well as that the Cuban government encourages the development of facilities and vacation plans. With respect to this same issue, Art. 47 states that through the social security system, the Cuban government guarantees adequate protection to all workers hindered by their age, disability or illness, as well as, in Art. 49 that the Cuban government guarantees the right to protection, safety and hygiene at work, by taking appropriate measures to prevent accidents and occupational diseases. Art. 50 proclaims that everyone has the right to have their health treated and protected. It is important to remember that this right for citizens excludes the distinction of race, skin color, sex, religious beliefs, national origin and any other damage to human dignity.
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