COMPARATIVE ANALYSIS OF HEALTH CARE SECTOR IN INDIA AND CUBA
COMPARATIVE ANALYSIS OF
HEALTH CARE SECTOR IN INDIA AND CUBA
WRITTEN BY: MANAV JHA
3rd YEAR - B.A. LL.B
LLOYD LAW COLLEGE, GREATER NOIDA
SHAMBHWI PANDEY
LL.B. GRADUATE
UNIVERSITY OF ALLAHABAD
EDITED BY: KASHAF ALI
3rd - YEAR LL.B,
CAREER COLLEGE OF LAW, BHOPAL
Introduction
“The enjoyment of the highest attainable standard of health is one
of the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition" -WHO
Health
is wealth. The quality and efficiency of the health care system in a
country showcase the prospectus of prosperity in that society. The health of a
nation relies upon how the system can cater the needs of their subjects and by
enabling them all the basic amenities to lead a life of dignity. Consequently,
a healthcare system extends beyond the framework of publicly owned institutions
that offer individual health services, encompassing the organizations,
individuals, and assets engaged in delivering healthcare to individuals. An
individual's overall physical, social, and mental health status, as well as
their quality of life, are greatly impacted by their ability to access
healthcare. Low healthcare access can result in inadequate management of
chronic conditions, an increased burden of preventable illnesses and
disability, and premature death. Healthcare services are of utmost importance
as it promote good health of an individual. It also helps in the prevention of
several diseases. Health care is only one of such factors that determine
health. There are several factors that include individual behaviours,
environmental factors, social factors, education, income, and genetics. But in
this article, we are focusing primarily on Health care and will provide an analysis
of health care in India and Cuba.
Why Chosen Cuba?
Cuba
being a free and independent nation follows a socialist political system. The total
population of Cuba is about 11 million and a 0.14% global share, the island
nation in the Caribbean with an upper middle class income has an annual GDP of
$107.40 billion. The nation's principal budget is for health care, accounting
for 27.5% of the total national budget, which is over 6% of GDP. Cuba has prioritized
health since 1959, by establishing a public, universal, and free health system.
It has prioritized public health over economic concerns, allocating the
majority of its yearly budget to this area. Cuba is one of the five Latin
American and Caribbean nations where Cuba being the socialist country dedicated
6% of its GDP to health care.
Healthcare Infrastructure of Cuba
Established
in 1961, the health care system of Cuba comes under the ambit
of its ministry that manages public health. This entire healthcare system
is built upon seven core principles, one of which emphasizes the state's
responsibility for the well-being of the population. Cuban health care system
derives its basis from a model which traces back to 1984 and is popularly known
as the "Family doctor and nurse" Model. Placing family units at its core
this model adopts a holistic approach encompassing clinical, epidemiological, and
social aspects of health issues. The healthcare infrastructure consists of
community polyclinics and consultation centres that are distributed throughout
the country. The health care system of Cuba is based on preventive measures
rather than curing methods. Preventive measures include focusing on the physical fitness
of an individual, hygiene, nutrition, and mitigation of risk factors. Prevention
stands as a central pillar of the Cuban healthcare framework. Consequently,
every Cuban family, regardless of their health status, receives regular visits
from their designated doctor, often referred to as "the guardian of
health." This model has demonstrated remarkable effectiveness, particularly
in the domains of epidemiological surveillance and the control of epidemic
diseases. For instance, if an area has a notable prevalence of allergies, the
polyclinic will establish specialized services to address this issue.
Similarly, if a significant portion of a community is affected by hypertension,
the healthcare institutions will take requisite measures to adapt to this
reality. Cuba has also made substantial investments in the biotechnology
sector, resulting in the establishment of a leading industry. This industry has
enabled Cuba to produce nearly 65% of the pharmaceuticals required for its
population's healthcare needs. Furthermore, it has successfully developed
thirteen vaccines with efficacy recognized by WHO, including those for diseases
like diabetes and hepatitis B. Notably, Cuba stands as the only country with a
healthcare system that is closely intertwined with research and development in
a closed cycle.
Healthcare
Infrastructure of India: Disparities and Challenges
India possesses a diverse healthcare system,
comprising both public and private healthcare service providers that offer a
wide array of medical services to its vast population of 1.4 billion people,
contributing to a 17.76% global share. However, the majority of private
healthcare providers are concentrated in urban areas, primarily offering tier 2
and tier 3 level healthcare services. India's annual GDP stands at $3.732
trillion, with healthcare sector expenditures accounting for a modest 2.1% of
the total budget. According to NITI Aayog, India is grappling with a shortage
of 600,000 doctors, 2 million nurses, and 200,000 dental surgeons. While the
standard recommendation states that a doctor-to-patient ratio must be 1:1000, In
rural India, this ratio is a staggering 1:11,082, and in certain states like
Bihar, it plunges to an alarming 1:28,391. In 1983, India introduced its
inaugural National Health Policy (NHP), which adopted a comprehensive approach,
particularly focused on primary healthcare, to ensure health for all (HEA).
This entailed the establishment of Primary and community health centres,
sub-centres, district/civil hospitals, and medical institutions. A sub-centre
serves as a communication bridge between the local community and the primary
healthcare system. It is usually established in an area that has a population of around 5000.
On the other hand, the primary health centre is
an initial contact point between the people of the village and healthcare experts. These
units serve areas with a population of around 30,000. Furthermore, the state
government supervises community health centres and these centres serve an area
with a population of around 120,000. India's healthcare landscape is evolving
with a growing emphasis on digital healthcare, which is reshaping how
healthcare services are delivered, especially in remote regions. The use of
ultra-modern technologies like telemedicine, digital health records, mobile
health applications, etc. is enhancing the quality and efficiency of healthcare
services.
Health
Indicators
|
Indicators |
India |
Cuba |
|
Life Expectancy |
72.0 yrs. |
78.3 yrs. |
|
Total Fertility Rate |
2.0 |
1.5 |
|
Infant Mortality |
24.5 |
3.9 |
|
Deaths under Age 5 |
30.5 |
4.9 |
|
Population Density |
481 people per sq. km |
105 people per sq. km |
|
Hospital Beds (per 1000 people) |
0.5 |
5.3 |
|
Physicians (per 1000
people) |
0.7 |
8.4 |
|
Diabetes |
10.4 % |
9.6 % |
|
Tuberculosis cure rate |
85.0 % |
79.0 % |
|
Death Rate (per 1000 people) |
2.1 |
14.65 |
Key Programs, Policies and Initiatives
of both countries
Cuba
-The healthcare system of Cuba forms its basis on the model named as “Family
doctor and nurse.” This model not only focuses on the interaction between
patient and doctor but also includes family members of patients. This model recognizes the family as the functional unit of society considering not only medical
conditions but also the social context, family culture, and environment. The
national health care system of Cuba is characterized by a dual framework of
horizontal coordination and hierarchical control. While the public health
ministry of Cuba (Ministerio de Salud Pública - MINSAP) assumes primary
responsibility for hierarchical control, INFOMED, functioning as an information
portal and network, fosters horizontal communication and coordination across
the healthcare system. Currently, INFORMED is tasked with the mission of
creating an integrated telecommunications network to facilitate the access and
management of information and knowledge, with a specific focus on enhancing
clinical care, training, research, and healthcare management systems. In 1999, the Public Health Ministry initiated the Virtual University project, aimed at improving
ongoing postgraduate medical education for more than one hundred thousand Cuban
healthcare professionals and establishing an international center for
postgraduate education in the fields of medicine and related disciplines.
In India, in 2013, a Health mission for
the entire nation was introduced; one for rural health and the other for urban
health. The primary objective of the NHM is to reinforce the infrastructure and
services of primary healthcare by upgrading existing facilities, constructing
new ones, and enhancing the supplies of medical equipment as well as their
availability. It also focuses on augmenting the healthcare workforce by
providing training and recruitment opportunities for doctors, nurses, and
paramedical staff, with particular attention to rural areas. Additionally, the
NHM seeks to enhance maternal, neonatal, and child health by expanding access
to essential services like antenatal care, skilled birth attendance, and
immunization programs. In 2018, another noteworthy healthcare initiative was
launched named Ayushman Bharat. This program offers financial protection and
healthcare coverage to India's vulnerable populations. The major of the scheme
PMJAY (Pradhan Mantri Jan Arogya Yojana) is implemented and several wellness
centres are established under this initiative. The latest data shows that
approx. 117,000 wellness and Ayushman
Bharat centres are distributed across India. These wellness centres provide basic
Medicare facilities along with diagnostic centres at no cost. These centres are
designed to offer extensive healthcare services in rural as well as urban areas,
encompassing preventive, promotive, and curative care.
Way Forward
Looking
ahead for India, the Cuban healthcare model stands as an exemplary path,
offering valuable insights for the rest of the world. As one of the most efficient
and distinctive healthcare systems globally, it underscores the pivotal role of
community-based polyclinics as a fundamental pillar. The primary care system
has consistently delivered impressive outcomes and is well-prepared to address
emerging challenges. The remarkable health indicators achieved by Cuba in the past
several years can be attributed to the unwavering emphasis placed on primary
healthcare. India can draw inspiration from this model, striving to strengthen
its primary healthcare infrastructure and services. By recognizing the
significance of community-based healthcare, India can aim to enhance its health
indicators and better meet the evolving healthcare needs of its population. The
Cuban example serves as a beacon for India's healthcare future, emphasizing the
critical role of comprehensive primary healthcare.
References
1) https://www.worldometers.info/world-population/india-population/
2) https://www.worldometers.info/demographics/india-demographics/#life-exp
3) https://data.worldbank.org/indicator/SH.MED.BEDS.ZS
6) https://www.worlddata.info/country-comparison.php?country1=CUB&country2=IND
7) Julie Feinsilver, “Cuba’s Health Politics at Home
and Abroad”
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