The birth of the Cuban polyclinic
Date Written: 28/06/2018
Year Published: 2018
Resource Type: Article
Cx Number: CX22881
During the 1960s, Cuban medicine experienced changes as tumultuous as the civil rights and antiwar protests in the United States. While activists, workers, and students in western Europe and the United States confronted existing institutions of capitalism and imperialism, Cuba faced the even greater challenge of building a new society.
The Policlínico Integral
When the revolutionary government took power in 1959, millions of Cubans were without medical care. The revolution put enormous energy into building new facilities and expanding services. Nowhere was the crisis more severe than among the rural and black population of the island.
The revolution had inherited a patchwork of unintegrated, overlapping medical structures, including private fee-for-service practices, public assistance for the poor, a few large medical plans, and many small plans.3 These rarely offered preventive medicine and never a complete range of treatment, requiring patients to go from one provider to another (if another was even available). Though the second half-decade of the revolution continued to expand care, it focused on reorganizing the disjointed medical system it had inherited.
Accounts of Cuban medicine during the 1960s can be confusing. Some emphasize the increase in the number of polyclinics without noting their metamorphosis in the middle of the decade. The term "polyclinic" (policlínico) generally refers to a medical facility offering outpatient services. José Ruíz Hernández clarifies what happened in the Cuban system of policlínicos: in August 1961, the Ministry of Public Health (MINSAP) began a study in Marianao (a town of 45,000) that sought to unify preventive and curative medicine. In May 1964, it became the first policlínico integral in Cuba. The next year, MINSAP began to spread the policlínico integral model throughout Cuba, making it "the point of departure for all health planning."
How did the policlínico integral differ from earlier policlínicos, and why was it so central to creating the new medicine? MINSAP's plan addressed existing shortcomings by consolidating services. Staff at the new polyclinics would include at least a general practice physician, nurse, pediatrician, OB/GYN, and social worker. Dentistry was also brought under the umbrella, and nurses and social workers made house calls. Staff extended services to workplaces, schools, and communities. Outreach included health campaigns such as mass vaccination programs and efforts to control malaria and dengue.
Vaccination began shortly after the revolution, but the policlínico integral structure vastly increased its effectiveness. In 1962, 80 percent of all Cuban children under fifteen were vaccinated against polio in eleven days. In 1970, it took just one day for the same national effort. Malaria was eradicated in 1967, as was diphtheria by 1971.10
Clinic staff coordinated primary care programs (maternal and child care, adult medical care, and dentistry) as well as public health, including control of infectious diseases, environmental services, food safety, school health, and occupational and labor medicine. The policlínicos integrales were designed to integrate medical services in multiple ways. In addition to combining preventive and curative medicine, they provided a full range of services at a single location, coordinated community campaigns, and offered social as well as medical services. Most importantly, they provided a single point of entry into the system, allowing for a complete record of patients' medical histories and making them key to the transformation of health care.
It cannot be overemphasized that these advances in medical care could only have succeeded through the massive changes throughout Cuban society that began immediately after the revolution and continued during the ensuing decade. The best known was the literacy campaign of 1961, but other programs addressed racial discrimination, land reform, agricultural salaries, farming methods, improved diet, pensions, new roads, new classrooms, housing, piped water, and urbanrural differences. The redesign of medical services was thus hardly an isolated process it was an essential component of remaking Cuba.