The problem with medicines in Cuba is, as in many other areas of economic life, structural. Cubans have access to free universal health care (as in other countries around the world), generously paid for through work and collective effort, but when it comes to medicines, problems abound.
Several recent reports from the island indicate that Cubans are particularly concerned about the lack of medicines at pharmacies. Doctors complain about difficulties treating patients with chronic diseases through periodic treatments that, likewise, are lacking at pharmacies.
This lack of medicine in Cuba is no easy problem to solve. It is nothing new, either. And it calls for understanding, in detail, how the Castro regime administrates the production of medicines in Cuba, because most of the difficulties observed can be traced to this management.
The production of medicine in Cuba is handle by a monopoly: the pharmaceutical giant BioCubaFarma, the Biotechnological and Pharmaceutical Industries Business Group, created in 2012 and owned, run and controlled by the State.
This group is just one more example of the absurd concentration of economic power in the Cuban economy. For its creation, two entities were combined that had been operating in a relatively independent manner: Quimefa and the Polo Científico in the west of the capital, which, despite being in the same business, were subject to different regulatory frameworks, and possessed different sets of business knowledge and levels of scientific/technical development.
In order to strengthen the Group the authorities imposed greater economic, financial and accounting discipline, based on the establishment of procedures, policies and rules for the management of the new organization’s processes. These actions are hardly reproachable. After all, this is what every well-run company must do if it wants to survive. The problem is that its State ownership remained a millstone, and attention to the consumers of its medicines has never been a real priority for the group.
Despite this potential, the island continually reports a lack of medicines at pharmacies, sometimes affecting up to 150 products out of a total of some 760 forming what the regime calls the country's "basic list."
The situation has recently been aggravated because the missing from pharmacies are identified by the Ministry of Public Health as "top-priority" ones, related to treatments for gout, cardiovascular diseases, epilepsy and Parkinson's.
In addition, the shortage of medicines depends on the area; apparently in the east of Cuba the shortages at pharmacies are much worse than in the contiguous provinces. People who cannot freely buy medicines notice these differences, which only increases their indignation and irritation.
What does BioCubaFarma management say to justify this situation?
Of course, the "blockade" is always cited, although in this case the argument has little credibility. They also mention "problems supplying the population with medicines caused by internal inefficiencies, instability in the operation of several production lines, due to a lack of spare parts, and not having the raw materials required for production, due to financial difficulties." And, of course, "the serious liquidity crisis that the Cuban Government faces, and even the corruption of employees at pharmacies and stores, which feeds the black market in the midst of the current crisis," which has led to demands to print medical prescriptions, for more information, and the tracking of patients and medications, in order to prevent illicit sales.
In response to these problems, of course, "the country's top leadership took the appropriate actions to minimize their repercussions, in addition to permanent follow-up on the issue, with the participation of the Ministry of Economy and Planning, the Ministry of Public Health, and other entities."
That is, in Cuba when companies face business and management problems, the "country's top leadership" steps in to solve the problems.
This is something unheard of, as companies need to solve their problems, autonomously, and competently, and only when they are very serious should the State ever intervene, playing a subsidiary role, which is the standard practice in the mixed economy model prevailing all over the world. In any case, "the country's top leadership" does not seem to be troubled by the fact that Cubans cannot find the products they need to take care of their health at their pharmacies. Its priorities lie elsewhere.
Rare is the country where governments entrust the production, marketing and sale of medicines to a monopoly. It is economically inefficient and a source of problems, above all when the monopoly acts as the government's transmission belt. Fidel Castro also got this one wrong, if he really was the architect of this sector of Cuban science, as stated in a report on this matter in the newspaperGranma.
The result has been a waste of State resources on a monopoly that barely delivers the raw materials needed, mismanages the reception of spare parts, and does not allow plants to operate in a stable manner, all while recognizing that the shortages of some products will mean that they may be hard to find at pharmacies. In Cuba, it is a pity that ordinary business management problems, easy to solve, end up becoming State projects that divert resources from other activities. And that is why things are the way they are.
Obliging BioCubaFarma to deliver 62% of the basic drug list to the national health system is as irresponsible as keeping this group a state monopoly. The whole organization is an absurdity, a fountain of problems, uncertainties and structural weaknesses, despite the struggle to reduce imports. And, while it may be true that the figure of 2,400 patents has been reached in the Biotechnology and Pharmaceutical industry in Cuba and the world, it is no less true that these exports are scarce, and that they have never made a major contribution to the trade balance. Data from 2013, the latest available for this category, indicate that drug exports barely accounted for 12.5% of the total external trade of goods, despite the fact that BioCubaFarma products are sent to 40 countries. Where is the "blockade" then?
As with any such over-reaching project, the group boasts that between 2013 and 2017 it made 56% more investments than that allocated to the industry during the previous five-year period. Not surprisingly, the Group maintains one of the most notable investments in the Mariel Special Development Zone, with the construction of a biotechnological complex, "conceived for a wide range of products already obtained and validated, and others that are in their final development phase." The question is: is this really what BioCubaFarma needs to guarantee all Cubans the medicines they need?