Charting the Course to Universal Health in the Americas: Cristian Morales PhD, PAHO/WHO Representative in Cuba

[Transformations in the health system in Cuba and current strategies for its consolidation and sustainabilityTransformações no sistema de saúde em Cuba e estratégias atuais para sua consolidação e sustentabilidade]

In Cuba, universal access and health coverage rest on three key principles: health as a human right, equity and solidarity. Although many of the Cuban health indicators are among the best in the Region of the Americas, in 2011 it was decided to reorganize health services, in line with the process of updating the Cuban economic and social model that occurred in all sectors. For this purpose, an action-research project was designed, including a situation diagnosis, implementation of changes and evaluation of the results, in several stages. As a result, human resources were rationalized with a reduction of more than 150 000 posts not directly linked to patient care, management structures were reduced in 57 municipalities, 46 polyclinics were compacted, the Family Physician and Nurse Program was optimized with 20 specialties for the community care, teaching was reorganized, and the international medical cooperation programs were revisited. These changes have contributed to improving the sustaina-bility of the National Health System and its performance: increase in the number of consultations at the primary level (19.3%) and oral care visits (56.6%), reduction in the number of visits to emergency rooms (16.1%), increase in the number of patients surgically treated (12.1%), increase in the number of research projects (300%) and increase in the number of medical students (55.7%), among others. In Cuba, transformations in health is an ongoing project.