On April 20, 2012, the Vice-president of Business at Comercializadora de Servicios Médicos (CSMC), Tomás Reinoso, met in Havana with the his counterpart at the Embassy of Brazil, Alexandre Ghisleni, seeking to offer the export of Cuban medical services to the South American country.
During the meeting, diplomatic cables in the hands of DIARIO DE CUBA reveal that Reinoso claimed that "all the revenues obtained from the sale of medical services abroad are transferred into the Cuban public health system."
Six years later, on November 20, 2018, with the flight of Cuban doctors from Brazil in full swing, the current Minister of Public Health, José Ángel Portal, reiterated the point about the reinvestment of revenues obtained from the sale of medical services abroad.
In an interview with the regime's Cubadebate, Portal declared that "the monies that reach Cuba as part of the medical cooperation project with Brazil contribute to financing the social services of 11 million Cubans, including the relatives of doctors abroad. The money does not go into anyone's personal account, or serve individual interests."
Data: National Office of Public Health Statistics and Yearbooks
In the yearbooks of the National Bureau of Statistics (ONEI), Havana does not break down the revenues from the export of professional services. It only indicates, through statements by officials, that most of this revenue comes from the sale of medical services. However, as recently as 2017, when the revenue from services came to over 11.37 billion dollars, only the equivalent of 428 million was channeled into public health and social assistance, according to data from the ONEI itself; this after more than a decade of cuts that would have increased the need for investment.
Study of the Public Health Yearbooks makes even more dubious the words of the CSMC's Vice-president of Business in 2012, and the Health Minister's in 2018.
DIARIO DE CUBA has analyzed said yearbooks and found that, according to the official figures, more than 20,000 beds and 120 hospitals have "disappeared" from the Cuban health system in the last 20 years.
The Government states that between 2010 and 2011 a process of reorganization of the country's medical services began, which included a "compacting" of structures, supposedly aimed at making them more efficient and saving resources to guarantee "sustainability".
The official data shows, however, that the cuts began much earlier, and sheds light on the disconnect between the official rhetoric, which describes the public health system on the Island as one equivalent to that of a developed country, and the growing complaints of Cubans about the deterioration of their health care.
1,000 fewer beds each year
In 1997 there were 66,948 hospital beds in Cuba. In 2000 there were 58,713 and, last year, 46,851. The country, however, has not seen a variation in its population that would justify this reduction, as the number of Cubans grew very slightly, from 11,008,659 in 1997 to 11,221,060 in 2017.
The availability of beds for medical care, meanwhile, went from 6.1 per thousand inhabitants in 1997 to 4.2 per thousand inhabitants in 2017.
The cutback has affected all the provinces. In the capital there are 6,539 fewer beds than in 2000, in Pinar del Río the number has dropped by 1,313, and in Granma it is down 900. In addition, 679 were eliminated in Camagüey, 480 in Matanzas, 469 in Sancti Spíritus, 457 in Santiago de Cuba, and 314 in Guantánamo.
As for hospitals, in 2000 there were 270 in the official figures, of which just 150 remained by 2017.
Of the facilities that are no longer in the Statistical Yearbooks, 29 were general hospitals, and seven were clinical/surgical facilities. Five were gynecological, 11 maternal, and four pediatric hospitals.
The most drastic reduction in hospital facilities was registered as of 2011, when the authorities announced the commencement of the "reordering" process, part of the so-called "updating of the economic model", approved by the Communist Party in that year, at its 6th Congress.
Figures that don’t add up
Despite the drastic cut in beds and hospital facilities, the Government reports that medical consultations went from 80,543,854 in 2000 to 96,361,152 in 2017; that is, from 7.2 to 8.6 per inhabitant. Also –say the statistical yearbooks– the number of operations has increased, from 953,372 in 2000 to 1,085,623 in 2017.
The variation in hospital admissions is, in contrast, small: from 11.9 to 12 per 100 inhabitants.
How can such figures be explained in light of the dismantling of so many health facilities, and the constant complaints of Cubans about the difficulties they encounter obtaining specialized consultations or operations?
In a survey carried out this year by the CubaData project, with support from DIARIO DE CUBA, 62.9% of those consulted said that Cuban public health is not good, calling it "fair" (33.3 %), "deficient" (18.9%) or "very deficient" (10.7%), while 61.7% reported that they have had to pay or give gifts at least once to be treated or to get a prompt answer to a question.
No rural hospitals
The dubiousness of the official figures grows if one takes into account that, in addition to the aforementioned facilities, the 62 rural hospitals that existed in 2000 in the country –some with beds– were progressively reduced, and by 2011 had been eliminated completely. Together with these centers, all the first aid stations were closed, of which there were 170 in 2002.
The Public Health Statistical Yearbook reported in 2005 that 22 rural hospitals became polyclinics with beds, which could indicate that it was part of a reorganization strategy. In fact, at least based on the cold data, the number of polyclinics rose from 440 in 2000 to 499 in 2008.
However, in a second stage, between 2008 and 2017, the number of polyclinics went from 499 to 450; in total, 49 less.
In an article published in 2016 by the Pan American Journal of Public Health, the authors, including the then Public Health Minister, Roberto Morales Ojeda, referred to the compaction of "46 polyclinics attending to towns of less than 5,000 inhabitants, redistributed to nearby health areas."
There are dramatic situations behind the figures: these towns are often in areas that are difficult to access, and suffer from poor transport services, which places their inhabitants in perilous situations, especially in the event of emergencies.
The situation gets even worse if we add the reduction in Family Doctor Offices across the country dedicated to primary care. Their numbers went from 14,671 in 2001 to 10,869 in 2017; that is, 3,802 fewer.
Since 2007, 438 offices have been eliminated from Pinar del Río, 325 from Sancti Spíritus, 257 from Villa Clara, 236 from Camagüey and 224 from Holguín, all provinces with large rural areas.
Propaganda vs. reality
The figures from the National Bureau of Statistics and the Public Health Yearbooks reflect a clear degrading of the health system in Cuba, and render dubious the assertions that everything obtained from the sale of medical services abroad is reinvested in the national health scheme.
The absence of independent control mechanisms to verify the Government's assertions, as well as the lack of statistical transparency, combine to cast doubts on a system that the official propaganda and organizations like the Pan American Health Organization continue to uphold as a model for the Americas.