1. HTM Seminar June 2015 Country Presentations CUBA Ing. Jorge Castro Medina jcastro@infomed.sld.cu Clinical Eng. Dep. Manager National Hospital for Physical Rehabilitación La Habana, Cuba Presented by

2. La Habana, Cuba June 7, 2015ACCE ACEW Program Review, Atlanta, GA, USA 2

3. Geographic data June 7, 2015ACCE ACEW Program Review, Atlanta, GA, USA 3 Surface = 109.886 km² (1/91 Canada surface)km² Total of Provinces = 16 Widest part = 191 km Narrowest point only 31 km

4. June 7, 2015 in Brief Population (Tomado del Anuario estadístico de salud 2014) It composed of 11,224,190 inhabitants, distributed in 15 provinces and 168 municipalities. The sex ratio is 994 males per 1 000 women, in absolute numbers, 33 432 more women than men. There is a discreet but continuous trend of feminization population since 2012. Life Expectancy at Birth (Tomado del Anuario estadístico de salud 2014) At the close of the triennium 2011-2013, life expectancy at birth of the Cuban population in general came to 78.45. Cuba placed among the 25 nations in the most advantaged in this important indicator for human progress of a world society. Women show an expectation of 80.45 and men 76.50. Infant Mortality Rate (Conveción de Salud 2015, Ministro de Salud Pública de Cuba) 4.2 x 1,000 live births at the end of 2014 In the decade of the 60s was 34.8. In the decade of the 70s was 19.4. In the 80s of 11.1. In the decade of the 90, 6.5. In the 2000s, 4.7 HTM Seminar, Denver, CO, USA4 Total Expenditure on Health as % of GDP The budget allocated to public health and social assistance is 22% of the state budget and constitutes 9.7% of gross domestic product.

5. June 7, 2015HTM Seminar, Denver, CO, USA5 The Constitution of the Republic of Cuba, 1976, Article 50 states: "The Constitution of the Republic of Cuba, 1976, Article 50 states: "Everyone has the right to take care and protect their health. The State guarantees this right”. Health care is universal, public and free at all levels. The universal health coverage in Cuba is based on the primary health care strategy. Primary care in Cuba is based on the model of Family Medicine and its gateway is the “family doctor and nurses”. A total of 500 294 health workers, 325 000 have served in 158 countries. Country’s Health System Profile

6. Situation in 1959, (Victory of the Revolution):  Illiteracy reached 40% of the population.  There were only 3 universities and only 1 medical school.  6 286 doctors concentrated in large cities, over 50% of whom emigrated, mainly to the United States.  Infant mortality higher than 60 per thousand live births.  Life expectancy less than 60 years. Current status (2014): o 35 Universities, 15 medical school. o 86 340 doctors (14 times more) o A doctor every 130 inhabitants. o A dentist every 671. o A nurse every 123. o Physician density is 7.7 per thousand inhabitants. June 7, 2015HTM Seminar, Denver, CO, USA6

7. The health sector has: o 500 294 workers. o 10 741 family clinics; o 451 polyclinics; o 151 hospitals with 45 462 beds; o 13 medical research institutes. o 1215 dental services, with 5 252 dental sets; o 138 maternity homes with 3 589 beds; o 247 grandparents houses; o 143 nursing homes with 13 533 beds. June 7, 2015ACCE ACEW Program Review, Atlanta, GA, USA 7 Country’s Health System Profile

8. Country's Health Technology Support Program History o On October 3, 1963, it is considered the beginning of Electro Service. On this date, several companies were nationalized and technical staff went to the Ministry of Public Health. o In 1982 the National Network of Electro is created on the initiative of Fidel. Structure o 1 National Center of Electromedicine (CNE). Regulatory, Methodological and Rector functions. Supervise the Electromedicine activities across the country. o 16 Provincial Centers. Perform installation, calibration, maintenance, repair, etc. of medical equipment in all health institutions of the National Health System who need these services. o 21 Regional Centers. Subordinated to the PCs, which perform the same functions of the PCs but in greater geographical complexity territories within the province. o 137 Municipalities (Electro Technical Groups). o 150 Technical Groups in Hospitals

9. June 7, 2015HTM Seminar, Denver, CO, USA9 National Center of Electromedicine & Clinical Engineering 16 Provincial Centers 21 Regional Centers 137 Municipalities (Technical Groups) 150 Technical Groups in Hospitals 13 Health Research Institutes

10. June 7, 2015HTM Seminar, Denver, CO, USA10 Country's Health Technology Support Program Engineers 520 Licensed 718 Técnicos 708 Workmens 170 Total (*)2116 (*) Datos cortesía de la Dirección Nacional de Electromedicina

11. Medical Equipments (2013)* No. ProvinceTotal of ME % 1 Pinar del Rio5301 4,4% 2 Artemisa2.657 2,2% 3 La Habana27.603 22,9% 4 Mayabeque2.810 2,3% 5 Matanzas8322 6,9% 6 Cienfuegos4.046 3,4% 7 Villa Clara8497 7,1% 8 Sancti Espíritus5.581 4,6% 9 Ciego de Ávila5.446 4,5% 10 Camagüey 6.6195,5% 11 Las Tunas4.636 3,9% 12 Holguín 8.6747,2% 13 Granma6.461 5,4% 14 Santiago de Cuba9.981 8,3% 15 Guantánamo4.685 3,9% 16 Isla de la juventud1448 1,2% 17 Unidades de Subordinación Nacional7.535 6,3% Total120.302 100 (*) Datos cortesía de la Dirección Nacional de Electromedicina

12. June 7, 2015HTM Seminar, Denver, CO, USA12