Can the Cuban Health Care System Offer Lessons in Leadership?

Leadership is the art of influencing and directing others to create results that would not have otherwise happened.  In health care, strong leadership is crucial to the health and well-of populations served. Health care leaders must ensure that every member of the team work together to provide the highest level of care that is necessary to achieve the best health outcomes. Leaders also mentor employees while providing them with the advice and guidance they need to fulfill their roles with confidence.  In the United States (US), more than ever health care is changing.   A leader must embrace a global mindset, where relationships are developed from different contexts, situations are viewed from a variety of perspectives, and diversity is valued and appreciated, thus paving the way for successful partnerships and collaboration.

Seventeen professionals were selected to attend a leadership conference in Cuba in March 2016.  This nine day trip was composed of faculty and staff members that included professors (in nursing, communication, health education, language literature and culture, and nutrition), lawyers, and business administrators.  This trip was arranged through California State University, Chico. The US has not had diplomatic relations with Cuba since the1960’s, so travel to Cuba has been restricted to selected individuals.  Fortunately, this group was allowed special permission visas for this professional exchange.  The group visited Cuba and met with Cuban leaders in higher education, cultural and scientific institutions and to exchange and examine best practices in Cuban leadership.  The group followed a Cuban approved itinerary which was rigorous and included three cities, Havana, Santiago de Cuba and Camaguey. Through this exchange professional relationships were established.

Despite limited resources, the Cuban health care system is recognized worldwide for its excellence and efficiency.  Due to the US embargo, and economic sanctions, Cuban leaders have developed problem solving strategies that ensure adequate health care access for all segments of the population with health outcomes similar to those in developed nations. The efforts of the Cuban leadership in making health a priority and health care a right for all Cuban citizens is commendable.  This is also a testimony to leaders in the global community that despite limited financial resources positive health outcomes can be achieved.

According to the World Health Organization, Cuba spent $503 per capita on healthcare in 2009, whereas the U.S. spent almost 15 times that sum.  In fact, the US spent $421 per person just on the administration of the private healthcare insurance system, almost enough to fund the Cuban system. Despite dramatically lower costs, Cuba has some of the best health statistics and health indicators of any country around the world. Cuba’s health indicators are more like those of the “first world” in the U.S. than its neighbors in the “third world.”  In Cuba, the average life expectancy is 77.5 years, compared to 78.1 years in the United States.  Infant and child mortality rate in Cuba is highly comparable to the US.  Cuba leads the world with the lowest patient to doctor ratio, 155:1, the U.S. trails way behind at 396:1.

Cuba leadership shuns the inefficient and more expensive, curative model and embraces a prevention-based system. There is more focus on personalized, community-based care where doctors and nurses work as a team and live in the communities they serve. The reality of health care in Cuba is a nationalized system, with an emphasis on disease prevention, access to care, and education and training of health professionals.  Research and development is also closely linked to the health care system.  Clearly, this innovation has improved the health of the Cuban population especially the most vulnerable.

Cuba also supports the health of people in third world countries through medical diplomacy.  This is achieved by dispatching doctors and other health care workers to treat the poor in areas of Caribbean and Africa.  Per capita, Cuba graduates roughly three times the number of doctors as the United States. Cuba also supports the medical training of international students that otherwise could not afford this type of education in their native country.  This group was fortunate to participate in an exchange with a medical student from Angola who is enrolled in a medical school operated by the Cuban government that will fully train him to become a general surgeon.  This school is called Latin American School of Medicine which is officially recognized by the Educational Commission for Foreign Medical Graduates and the World Health Organization. It is also fully accredited by the Medical Board of California, which has the strictest US standards.

Examination of the health care in Cuba reveals a system with leaders that embraces financial and quality stewardships. Cuban leaders also possess a sense of health care globalization, curiosity and risk taking combined with a spirit of innovation and creativity that champions health care in the global arena.  With the dawning of warmer relationships with Cuba and the US, it is hope that health care leaders can collaborate and learn from each other to improve the health of populations