Primary care in Cuba
Since the beginning of the revolutionary period in Cuba, the Polyclinic was established, defined as the basic unit of the National Health System, including all health actions to understand the contours territorial allocation (the “health area”). At the same time, the link was established clinic with other levels of care in the National Health System and was given impetus to the involvement of the community through the mass organizations.
At the turn of the decade of the 60s “in Cuba extends the coverage of medical services throughout the country through a network of polyclinics. By 1962, they totaled 61 in 1968 there were 260, while for 1980 reach the figure of 386, according Escalona [1]
The process of consolidation of system of polyclinics was accompanied by changes in the epidemiological profiles. In the decade of the 70 “were shown these changes in health status of the Cuban population from a dominance of diseases and a high rate of infant mortality, is now a situation in which chronic diseases are prevalent noncommunicable and reducing child mortality, according to Ramos [2] This is expressed in terms of health, the more specific needs of the Cuban State to strengthen a single national health system pursued since then, the idea of turning Cuba into a medical power at the international level.
In 1982, the Commander in Chief Fidel Castro raised the need for a general practitioner may provide services in different locations: a sugar mill, a boat, a school, an international mission, as well as in urban areas. The new proposal was based on the description of a doctor and a nurse to take charge of attention of a number of families (between six and about seven hundred people) living in a town or neighborhood. These professionals work in harmony in the community, the hospital and a clinic, and should integrate into their practice the knowledge of the basic specialties (internal medicine, obstetrics, gynecology and pediatrics). The primary idea of family doctors that would gradually deepen, had to do, besides having a “full and thorough knowledge of the environment and the conditions under which people live,” according to Ramos [3]
According to Rodriguez [4] In September 1983 a document entitled “Considerations on the linkage of the health team to the block,” stated the need for subdivision to the population adapted to the political-administrative division of the country. Two key objectives were pursued:
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Target more quickly and effectively with the problems of epidemiology and environmental health.
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Facilitate and promote the participation of mass organizations in the work of health workers to boost the role of local government bodies, improved attachment of the doctor “generalist” to organized groups of families in the community.
So the MINSAP selected 10 doctors to implement the pilot scheme. Was chosen Policlinico “Lawton” in the October 10 County, City of Havana, on the one hand, depending on the actual performance of the doctors at that site, and secondly, due to its geographical location and characteristics of its population, because it was primarily a neighborhood worker.
The pilot project lasted three months, during which a group of nurses worked in the adequacy of the different sectors to the political-administrative division, and the file block from the medical records according to the Committees for the Defense of Revolution (CDR) and districts. In this way, it was restructured the basic unit of community health. ”
In November 1983, MINSAP up another document on the “doctor of the 120 families.” Here are some general considerations about the profile of that doctor, who referred to the ideas expressed by Che Guevara at the beginning of a course at the Ministry of Public Health, August 1960: