Cuba's health system, which has led to remarkable success in low infant mortality and long life expectancy, emphasizes prevention and primary care at the community level. Family doctors and polyclinics play a key role.
(click to enlarge) Treatment room at the polyclinic. Note the electrotherapy apparatus and the acupuncture maquette.
(click to enlarge) Physical therapists in the polyclinic
From CMAJ, the online journal of the Canadian Medical Association, Feb 3, 2009
Central to Cuba's approach to maternal health and early childhood development is the polyclinic. Currently, there are 498 polyclinics, which each serve an average of 22 000 rostered patients. Cuba also has 14 078 family doctors' offices that work under the auspices of the polyclinics. Over-all, this provides for 1 physician per 159 people and 1 nurse per 79.5 people.7
The role of the polyclinic is far more extensive than that of the typical Canadian medical clinic. The polyclinic's staff is multidisciplinary and includes a wide range of professionals. Currently, the average polyclinic offers 22 services, such as rehabilitation, radiography, ultrasonography, endoscopy, thrombolysis, emergency services, traumatology, clinical laboratory, family planning, emergency dentistry, immunization, dermatology, cardiology, family and internal medicine, pediatrics, and obstetrics and gynecology.8 Polyclinics also provide mental health care, maternal and child care, and care for diabetic and elderly patients.8 All of the staff at polyclinics are familiar with and responsible for every individual in the community. They focus on prevention and universal screening initiatives, and they encourage immunization through house calls, home visits and semiannual checkups. During the subcommittee's visit, we were told that diabetes can often be diagnosed long before the patient is aware of a problem. Similarly, staff at polyclinics work closely with early child development, preschool and elementary teachers so that the moment a problem is spotted in a child, he or she can be referred to the appropriate specialist.
The polyclinic is also a hub for medical and educational training. Students in medicine and nursing receive part of their training at a polyclinic, which is often where they will work after graduation. Polyclinics are also resources for data collection and scientific research, and they are conduits for scientific advances. The data collected are used by health authorities to evaluate the effectiveness of the polyclinic programs. Scientists are frequently appointed to polyclinics, where they undertake academic research and facilitate the transfer of knowledge to and from front-line staff. For example, between 2001 and 2003, a nationwide survey about the needs of people with disabilities was undertaken by scientists, university professors, professionals and specialists in cooperation with all polyclinics and primary care settings. The results of this survey led to the development of individualized education and rehabilitation programs and improved health and social services.9