Cuba and the Philippines have something in common: they were former colonies of Spain and later the United States. These former colonies, however, gained their independence differently.
BY ARTHUR L. ALLAD-IW
Northern Dispatch
Posted by Bulatlat
Vol. VII, No. 48, January 13-19, 2008
Cuba and the Philippines have something in common: they were former colonies of Spain and later the United States.
These former colonies, however, gained their independence differently: Cuba, by armed revolution, toppled the U.S.-backed dictatorship of Fulgencio Batista on Jan. 1, 1959; while the Philippines was ‘granted’ in a silver platter its independence by the American colonizer on July 4, 1946, after World War II, and this was only after U.S. interests were incorporated in the fundamental laws of the Philippines and through their “puppet administrations.”
The two countries have adopted contrasting government systems since their independence. Cuba, through its revolutionary leaders headed by Fidel Castro, established a socialist state and continuously asserted its sovereignty even against the U.S. embargo imposed since 1959.
On the other hand, the Philippines has been a satellite of the U.S. and subservient to its neocolonial policies since 1946.
The contrasting political and economic systems of Cuba and the Philippines are manifested in their government health care system. The visit of Cuban Ambassador Jorge Rey Jimenez in Baguio City gave me the opportunity to learn more about the health care system of Cuba and try to compare their health care system to the Philippines’.
Cuban health care system
Jimenez cited the policy of Cuba as contained in the Cuban Constitution, which provides that everyone has the right to health protection and care. The State guarantees this health right by providing free medical and hospital care through the installation of a rural medical service network, polyclinics, hospitals, preventive and specialize treatment centers; by providing free dental care; by promoting health’s publicity campaign health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of diseases. All the population cooperates in these activities and plans through social and mass organizations.
This health policy of Cuba is realized through a total welfare health care system by the government where health institutions, including pharmaceutical centers, are government-owned and all health services are government-provided and -funded.
Jimenez claims that the doctor-patient ratio of Cuba in 2006 was 1:158, a great improvement from 9.2:10,000 in 1958. Today, it has 71,489 doctors and a population of more than 11 million.
The infant mortality rate of Cuba has been drastically reduced. Today it has an infant mortality rate of 5.3 per 1,000 live births. Jimenez said that Cuba has the lowest infant mortality rate in the world. In 1950, the mortality rate was 60 per 1,000 live births.
Cuba’s Granma newspaper recently reported that the infant mortality rate of 5.3 per 1,000 live births is the lowest in their history and after Canada, the second lowest in all of the Americas. Citing the 2007 UNICEF (United Nations Children’s Fund) report, I added that the worldwide mortality rate is 52 per 1,000 live births – with 26 per 1,000 live births in Latin America, and 108:1,000 in West Africa.
Data from the World Health Organization (WHO) data confirms Cuba’s claim to an infant mortality rate of 5 deaths per 1,000 while showing that in the U.S., the infant mortality rate is 7 deaths per 1,000. It claimed that the doctor to inhabitant ratio in the US is 2.56 to 1,000 inhabitants. Cuba has the second highest doctor-to-patient ratio in the world after Italy, added the WHO report.
Jimenez explained that the base of their health care system is the Family Medical Office where 99.7 percent of their population have access to the services of family doctors (who comprise 47.4 percent of the 71,489 doctors) scattered in the whole Cuban territory. The family doctors are tasked to assist the population and ensure the four fundamental aspects of health: prevention, promotion, attention and rehabilitation of the population. One family doctor and a nurse each care for about 500 to 600 inhabitants.
“We are developing a Universal National System of Health that is accessible and free to all citizens up to the provinces and municipalities,” explained Jimenez. This system is being developed despite the economic blockade that has been imposed by U.S. and its allies against Cuba since 1959.
Cuba has 243 hospitals and 473 clinics which are all government-run. It has 21 medical schools (they had only one before 1959); one International Medical School where they train professionals from Latin America and in the world and one medical school for the Pacific Islands. Its Latin American School of Medicine in Havana has graduated 4500 physicians from other countries, added Jimenez, where the graduates exemplify “high scientific, humanist preparation and ethics that will allow them to act professionally and to be to of service to the neediest sectors in their nations.”
Cuba has been notable for its international health missions. While doctors from former colonies and developing nations are moving to industrialized countries due to very low salaries as well as the absence of benefits and professional development, Cuba has been able to send 100,000 health workers to more than 100 countries since 1963. Jimenez said these international missions constitute “a human feat that the U.S. and Europe could never accomplish as they lack the human capital to demonstrate which human rights they are really defending.”
Philippine health care system
The Philippine government has been reiterating its policy to protect and promote the rights of its people on health. It however remains as lip service with the existing realities and manifestations through different indicators of its health situation.
National Statistics Office (NSO) data as of 1999 show that the infant mortality rate is 54 deaths per 1,000 live births. The doctor-patient ratio is estimated by the Community Health Education, Services and Training in the Cordillera Region (Chestcore) at 1:10,000 to 26,000.
Like the budget on social services, the health budget is a least priority of the government. It is but two percent of the national annual budget which if translated it is only thirty five centavos per day per Filipino. The biggest piece of the national budget – nearly 40 percent annually – has been automatically and systematically appropriated by the national government for debt servicing, depriving Filipinos of funds for social services like health.
The national government passed on its responsibility for health services to the local government units by decentralizing health services. This policy of decentralization was imposed by the International Monetary Fund-World Bank (IMF-WB) as part of its structural adjustment program for Third World countries.
As a result, this policy has pushed local government units to adopt “revenue enhancement schemes” like imposing fees on patients in government owned hospitals. Poorer LGUs (local government units) are left suffering as they do not have the capacity to fund their health services.
Since 1995, when the Philippines acquired membership in the World Trade Organization (WTO) following the Senate ratification of the Uruguay Round of the General Agreement on Tariffs and Trade (GATT) – of which then Sen. Gloria Macapagal-Arroyo was a leading proponent – the Philippine government has embarked on a systematized privatization of most government-owned and -controlled corporations, including health institutions. The move denationalizes state-controlled industries, aggravating the ratio of government to private hospitals which now stands at 1:2.
Among the government’s target for privatization are specialized health institutions like the Lung Center of the Philippines, National Kidney and Transplant Institute, Philippine Heart Center, National Center for Mental Health, Philippine Orthopedic Hospital and National Children’s Hospital. The privatization of these institutions hands on to private owners the “right” to dictate the prices for health services, further commercializing health care services and denying indigent clients the much-needed help.
The privatization strengthens foreign corporations’ control on our economy.Chestcore said that 72 percent of our drug industry is controlled by foreign multi-national corporations while only 28 percent is controlled by local corporations – 23 percent of which is controlled by the United Laboratories (Unilab).
As a consequence, prices can be dictated by those who control the industry, Chestcore claimed citing that a brand of Amoxicillin 500 mg has a manufacturing cost of P1.49 ($0.04 at the Jan. exchange rate of $1:P40.60) per tablet but is retailed at P22 ($0.54) or even more.
The patenting of medicinal plant species is another issue strengthening foreign control on the pharmaceutical industry. Chestcore said that foreign corporations have already patented Philippine species like the banaba (cure for diabetes), sambong (for its anti-tumor agent), and lagundi (for hair-growth and for curing coughs).
The exodus of health workers, abetted by the government’s labor-export policy, worsens the state of our health care system. Due to lack of employment opportunities in the country and very low salaries, there is an exodus of Filipino health workers abroad. It is approximated that 85 percent of Filipino nurses are now abroad. The Philippines is among the top exporter of doctors, next to India. Reportedly, 80 percent of public health physicians have taken up or enrolled in nursing schools, geared toward jobs as nurses abroad.
Welfare system vs. privatization
Even the WB appreciated Cuba’s achievement not only in health, but also in education. In the WB’s World Development Indicators, particularly in 2001, Cuba topped all poor countries in the field of health and education statistics.
This development has been achieved despite the 49-year trade embargo imposed by the U.S. Cuba’s experience shows that they are on the right track. Cuba was never a member of the IMF-World Bank but it has survived through its nationalized economy.
In contrast, the Philippines, which had swallowed all the neocolonial policies of the U.S., is now among the poorest countries of the world. Its economy is loan-oriented and dependent on the IMF-WB and since World War II the Philippines has allotted the biggest part of its budget to the servicing of debts (mostly IMF-WB loans). Foreign control over the national economy is strengthened due to the government’s policies of trade liberalization, deregulation, and privatization – of which Arroyo was a major proponent as a senator during the Ramos administration.
Comparing the systems of Cuba and the Philippines, the system that Cuba asserted shows that their fundamental human rights are respected – as exemplified by its health care, their low infant mortality rate; their economic and political system.
On the other hand, the Philippines needs to learn from Cuba’s experience and must move away from the path of de-nationalization of its economy if it wants to improve its conditions and fully respect the fundamental human rights of its people. Northern Dispatch / Posted by Bulatlat
