The Global Forum for Health Research “Forum 2009: Innovating for the Health of All” takes place this week in Havana, Cuba from 16-20 November. This is the first of a series of posts from the conference. Because of challenges to getting and staying online here, posts will be in dispatch format. That means delayed, linkless, medialess, error-prone, and far from comprehensive.

The meeting opened Monday with a plenary featuring:

• Gill Samuels, Chair of the Foundation Council, Global Forum for Health Research
• José Ramón Balaguer Cabrera, Minister of Public Health, Republic of Cuba
• José Ramón Fernández Álvarez, Vice President of the Council of Ministers of the Republic of Cuba

Dr. Samuels stated that a goal of planning this meeting was to better involve the private sector, specifically biotechnology and pharmaceutical companies from low-, middle-, and high-income countries. The goal was based on a sentiment that the private sector was “poorly represented” at last year’s meeting, coinciding with the Global Ministerial Forum on Health, in Bamako.

I believe conference venues are selected well in advance of conference themes, but much of the discussions have centered around tying the theme (innovation) to the place (the Cuban health system). That doesn’t really include private sector, but it does include the Cuban biotech industry.

Observations on Cuban innovations presented by the Cubans in the plenary session, most from Minister Balaguer’s “brief” one hour history of the Cuban public health system:

1. Social determinants of health. Balaguer began with a story about Comrade Fidel carrying out an attack on barracks. While this seems unrelated, he said, it is in fact very relevant because of the “social situation”. Throughout his speech, he emphasized the social determinants of health and the Cuban’s holistic response.
2. Quoting Fidel. Not really an innovation, but I have to mention this. Balaguer continued by reading a passage from Fidel Castro’s “History Will Absolve Me”, relevant to health through a discussion of child malnutrition in the context of poverty, unemployment, and corruption. Common to all Cuban presentations – I’ve seen eight at this conference, so I’m making an inference – is the practice of quoting Fidel Castro. In one case José Martí. And in another case Margaret Chan and Fidel both quoted on the same slide.
3. Human solidarity. In describing the successes of Cuba, and noting “we are not a wealthy country”, Balaguer talked of the “deepness of human solidarity” as a key factor. A gentleman from the BMJ at a later session asked a panel of Cuban health leaders if they thought the successes of the health system were transferrable or if they were tied to the political system. The question was averted, the answer was acknowledged as averted by the same, and the eventual response was no. The same issue came up in a Tuesday session on social entrepreneurship. Thulasiraj (Thulsi) Ravilla, Executive Director of the Aravind Eye Care System, spoke of how compassion led to “owning the problem”. This also helped explain the sacrifices the founders made in starting up and growing the system without donor funding.
4. Healthcare for all. They have aimed to provide care that is universal, accessible, and affordable. Cuba is known for universal provision of education and healthcare. He emphasized, as did other Cuban colleagues later, that there is no discrimination based on gender, race, religion, or political affiliation. I assume that where this happens the processes tend to be implicit (structural).
5. Shifting to practical training. In 1976, the Cubans undertook a change in the system of training physicians to be more aligned with the realities of their eventual work. They introduced more practical experience earlier in the educational process. The old system, common around the world, involved two years of class/lab work before practical training. Based on this experience, the Ministry of Higher Education learned that such practical experience would be good for engineers and architects, too. Perhaps some additional lessons for engineering education.
6. African brain drain. In response to the massive brain drain in the African health sector, Fernandez described, Cuba has helped build nine medical schools in Africa, though some have disappeared due to conflict.
7. Investing in health in tough times. As with the republics of the former Soviet Union, the Eastern Bloc, and a small handful of other countries like Mongolia, the fall of the Soviet Union was a big blow to Cuba. Still, they maintained health spending, and invested heavily in the development of the biotech sector.
8. South-South assistance. Aside from building medical schools, Cuba has engaged in many other health assistance activities, most involving the deployment of physicians to other countries. According to a speaker from Tuesday, there are Cuban doctors serving in 76 countries around the world right now.