It is widely recognised that healthcare in Cuba is at a high level and that child health, in particular, is excellent.1 This is illustrated by data from the World Health Organization (WHO) in its report World Health Statistics 20072 and UNICEF in its report The State of the World’s Children 2008.3 Table 1 shows mortality rates for neonates, infants and children under the age of 5 (U5MR) for Cuba and three of its nearest neighbours, who all have a higher standard of living, as well as showing the United Kingdom and the United States. The U5MR is considered by UNICEF as the single most important indicator of the state of a nation’s children.3 It is used as a marker of whether countries are successfully reducing child mortality.

Cuba has both the lowest U5MR and the greatest reduction in U5MR (between 1990 and 2003) in Latin America and the Caribbean.4 The U5MR in Cuba is considerably lower than that of wealthier neighbouring countries and in between that of the U5MR of the United Kingdom and the United States. The United Kingdom and the United States are in the top 10 richest countries in the world, whereas Cuba is ranked as the 120th wealthiest country. At a time when many countries are following the American model of privatising health care, it is useful to look at how Cuba has managed to reduce its mortality rates for children with a free publically funded healthcare system.

PRIMARY HEALTHCARE

One of the strengths of the Cuban health system is its primary healthcare. This is based on the family doctor.5 Almost half of Cuban doctors are family doctors and they are based in a small primary care centre (consultorio). Attached to each consultorio is a nurse and both the family doctor and …