CMSA Today - Issue 6, 2011 - (Page 14)
Community-Oriented Health Care
had the great fortune to join the March 2011 National Association of Social Work’s Delegation to Havana, Cuba to study services for the aging. Being a ﬁrst generation Cuban-American, this was a wonderful opportunity for me to directly connect with my parents’ homeland for the ﬁrst time, and I was awed and amazed at how much the experience impacted me personally. This aspect alone made the delegation trip worthwhile, but the professional experience and learning that I gained from the trip, and my subsequent readings about social work and health care in Cuba, also has provided much inspiration for my professional journey. It is the latter that I wish to share with you in this article.
From Cuba to Milwaukee:
BY CARLOS M. ESTRADA, MSW, CAPSW
THE CUBAN HEALTH CARE SYSTEM
Our delegation’s focus was to study services for the aging, but much of what we were shown highlighted the successes of the Cuban health care system, which impacts not only older adults, but all Cubans alike. Cuban health care is free, universal, and community-oriented. Free medical care and preventing illness is viewed as a basic human right and a responsibility of the state. Structurally speaking, at the national level the Ministry of Public Health oversees three tiers within the health system: hospitals (provincial level), polyclinics (municipal level), and family doctor/nurse teams (community level). It is at this community level that you most clearly see the preventive and persistent aspects of health care provision. With Cuba having one of the highest numbers of doctors per capita in the world, doctor/ nurse teams, and subsequently health care, is available to the smallest communities. Each community’s doctor/ nurse team strives to have a “case” on everyone in that community. If a person cannot visit the doctor’s oﬃce for a check-up, then the doctor and nurse make a home visit. While in the home, the medical team not only examines the identiﬁed patient, but will also examine other members within the household, as well as the condition of the home for the purposes of preventing illness and disease. This persistent and aggressive provision of health care has been critiqued by some to be excessive medicalization or even a form of social control. Political and ideological discussions aside, it does appear that this community-oriented, prevention-focused health care has paid dividends toward the overall health of Cubans as seen in measurements often used to determine a country’s health.
CUBAN HEALTH BY THE NUMBERS
In looking at the numbers, one can see that not only does Cuba score high on some of the basic indicators of health as compared to other low-income nations, but it also scores well as compared to middle- to high-income nations
Overlooking the Bay of Havana and the skyline of Old Havana.
Issue 6 • 2011
Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2011
PRESIDENT’S LETTER CASE MANAGEMENT WITHOUT BORDERS: Promoting a Global View and a Universal Understanding
Canadian Perspective A Systems Level Approach to Safe and Effective Care
South African Perspective Hospital to Home – Comparative View of Transitions of Care
Cuban Perspective From Cuba to Milwaukee: Community-Oriented Health Care
VIEW FROM CAPITOL HILL PPC’s Busy Schedule Equates to Changes on the Health Care Front
ETHICS CASEBOOK Advocacy in Case Management: What Are the Limits?
MENTORING MATTERS Improving the Mentorship Role through Feedback This Is a Marathon – Not a Sprint
CASE MANAGEMENT AND THE LAW Deploying Case Management Programs to Reduce Legal Risks
CMSA Today - Issue 6, 2011