Learn from Cuba's health system, (Australia) PM told

[Mika]

Learn from Cuba's health system, PM told
http://www.abc.net.au/news/stories/2010/03/15/2846597.htm?section=justin

A local GP has left the Prime Minister a little red-faced by suggesting he take a leaf out of Cuba's book when formulating the Federal Government's public health overhaul.

Kevin Rudd visited Queanbeyan Hospital in New South Wales on Monday to announce that the Government will spend an extra $632 million over the next 10 years to train a record number of doctors.

But the so-called picture opportunity didn't quite go to plan, with Dr Jeannie Ellis, the GP in charge of the hospital's emergency department, telling Mr Rudd to look to Cuba for a solution to Australia's ailing health system.

"Maybe Australia should take a leaf out of the Cuban healthcare system's book where they have something like $20,000 less per capita and they have exactly the same healthcare indicators as Australia," she said.

"I've lived in Cuba for a long time and I can tell you that they run a very, very good healthcare system and they get a lot of bang for their buck over there."

Mr Rudd says the extra funding announced today will mean the doubling of GP training positions available for medical graduates from 600 to 1,200 places a year by 2014.

The number of specialist training places will also go up from 360 to 900 positions. And there will be a doubling of GP work experience places for junior doctors up to 975 places a year by 2013.

The Prime Minister says the policy will target rural areas experiencing doctor shortages.

"This pattern across rural and regional Australia has not been getting better. It's probably been getting worse," he said.

"So what can you do about it? The first thing is to make sure your overall supply of trained GPs increases. This is a very big step forward. We're talking about 5,500 GPs.

"The second is that the distribution of both those GP training places and the distribution of the specialist training places will be very mindful of the needs of regional and rural Australia."

Mr Rudd says the plan will be fully off-set and the details associated with the funding will be outlined in the May budget.

Not enough
Dr Ellis says she welcomes the extra numbers announced by the Government but says it is not enough to fix the problem.

"You can't just put a whole bunch of new medical graduates out into rural areas and expect that you're going to have the same level of health care provided," she said.

"You need supervision. You need to maintain standards. So you need senior clinicians."

The Rural Doctors Association of Australia agrees, but the association's president, Dr Nola Maxfield, says the Government needs to pay bonuses to encourage doctors to regional areas otherwise, she says, the shortages will continue.

"We want to be able to show young doctors when they come out and they think about where they're going to work, what they're going to do in the longer term, that we are actually price competitive with other parts of the medical profession," Dr Maxfield said.

"Otherwise they may well choose to be emergency medicine specialists in the city and we won't get our rural GPs."

Dr Andrew Pesce, the president of the Australian Medical Association, says the states need to make sure they fulfil their part of the bargain.

"We now need the states and territories to come on board and make sure the funded positions are used for the purposes that is intended, and that is to make sure that we do train enough doctors in the future," Dr Pesce said.

"In the past, funding hasn't been translated to adequate training positions and now the states and territories have to come on board and make sure the junior have access to this training."

'Bullying game'
The new doctor numbers are part of the Government's carrot to tempt the states and territories into supporting its hospital overhaul ahead of next month's special leaders' meeting to discuss it.

Some premiers have deep reservations about the plan, with state and territory leaders scheduled to have a phone hook-up later this week.

Federal Opposition Leader Tony Abbott, who was the health minister for four years in the Howard government, says he is sceptical of Mr Rudd's plans.

"What we've seen from this Prime Minister over the last few weeks, in particular, is ending the blame game to be sure. It's been replaced by the bullying game," Mr Abbott said.

"Anyone who has been watching the footage of the Prime Minister and the state premiers would know that cooperation between them has all but broken down.

"That picture of the Prime Minister and Premier Keneally did not lie in the way that press releases can so easily be misleading."

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[Judi Lynn]

1. Kicking & rec.

:kick: :kick: :kick: :kick:

[protocol rv]

2. An excellent example

Showing it's possible to have a medical care system without medicines and equipment, yet people can survive it.

[Judi Lynn]

3. This reminded me immediately of what former World Bank President James Wolfensohn said:

Learn from Cuba, Says World Bank
By Jim Lobe, IPS, 1 May 2001

WASHINGTON, Apr 30 (IPS) - World Bank President James Wolfensohn Monday extolled the Communist government of President Fidel Castro for doing "a great job" in providing for the social welfare of the Cuban people.

His remarks followed Sunday's publication of the Bank's 2001 edition of 'World Development Indicators' (WDI), which showed Cuba as topping virtually all other poor countries in health and education statistics.

It also showed that Havana has actually improved its performance in both areas despite the continuation of the US trade embargo against it and the end of Soviet aid and subsidies for the Caribbean island more than ten years ago.

"Cuba has done a great job on education and health," Wolfensohn told reporters at the conclusion of the annual spring meetings of the Bank and the International Monetary Fund (IMF). "They have done a good job, and it does not embarrass me to admit it."

His remarks reflect a growing appreciation in the Bank for Cuba's social record, despite recognition that Havana's economic policies are virtually the antithesis of the "Washington Consensus", the neo-liberal orthodoxy that has dominated the Bank's policy advice and its controversial structural adjustment programmes (SAPs) for most of the last 20 years.

Some senior Bank officers, however, go so far as to suggest that other developing countries should take a very close look at Cuba's performance.

"It is in some sense almost an anti-model," according to Eric Swanson, the programme manager for the Bank's Development Data Group, which compiled the WDI, a tome of almost 400 pages covering scores of economic, social, and environmental indicators.

Indeed, Cuba is living proof in many ways that the Bank's dictum that economic growth is a precondition for improving the lives of the poor is over-stated, if not downright wrong. The Bank has insisted for the past decade that improving the lives of the poor was its core mission.

Besides North Korea, Cuba is the one developing country which, since 1960, has never received the slightest assistance, either in advice or in aid, from the Bank. It is not even a member, which means that Bank officers cannot travel to the island on official business.

The island's economy, which suffered devastating losses in production after the Soviet Union withdrew its aid, especially its oil supplies, a decade ago, has yet to fully recover. Annual economic growth, fuelled in part by a growing tourism industry and limited foreign investment, has been halting and, for the most part, anaemic.

Moreover, its economic policies are generally anathema to the Bank. The government controls virtually the entire economy, permitting private entrepreneurs the tiniest of spaces. It heavily subsidises virtually all staples and commodities; its currency is not convertible to anything. It retains tight control over all foreign investment, and often changes the rules abruptly and for political reasons.

At the same time, however, its record of social achievement has not only been sustained; it's been enhanced, according to the WDI.

It has reduced its infant mortality rate from 11 per 1,000 births in 1990 to seven in 1999, which places it firmly in the ranks of the western industrialised nations. It now stands at six, according to Jo Ritzen, the Bank's Vice President for Development Policy who visited Cuba privately several months ago to see for himself.

By comparison, the infant mortality rate for Argentina stood at 18 in 1999; Chile's was down to ten; and Costa Rica, 12. For the entire Latin American and Caribbean region as a whole, the average was 30 in 1999.

Similarly, the mortality rate for children under five in Cuba has fallen from 13 to eight per thousand over the decade. That figure is 50 percent lower than the rate in Chile, the Latin American country closest to Cuba's achievement. For the region as a whole, the average was 38 in 1999.

"Six for every 1,000 in infant mortality - the same level as Spain - is just unbelievable," according to Ritzen, a former education minister in the Netherlands. "You observe it, and so you see that Cuba has done exceedingly well in the human development area."

Indeed, in Ritzen's own field the figures tell much the same story. Net primary enrolment for both girls and boys reached 100 percent in 1997, up from 92 percent in 1990. That was as high as most developed nations, higher even than the US rate and well above 80-90 percent rates achieved by the most advanced Latin American countries.

"Even in education performance, Cuba's is very much in tune with the developed world, and much higher than schools in, say, Argentina, Brazil, or Chile."

It is no wonder, in some ways. Public spending on education in Cuba amounts to about 6.7 percent of gross national income, twice the proportion in other Latin America and Caribbean countries and even Singapore.

There were 12 primary pupils for every Cuban teacher in 1997, a ratio that ranked with Sweden, rather than any other developing country. The Latin American and East Asian average was twice as high at 25 to one.

The average youth (ages 15-24) illiteracy rate in Latin America and the Caribbean stands at seven percent. In Cuba, the rate is zero. In Latin America, where the average is seven percent, only Uruguay approaches that achievement, with one percent youth illiteracy.

"Cuba managed to reduce illiteracy from 40 percent to zero within ten years," said Ritzen. "If Cuba shows that it is possible, it shifts the burden of proof to those who say it's not possible."

Similarly, Cuba devoted 9.1 percent of its gross domestic product (GDP) during the 1990s to health care, roughly equivalent to Canada's rate. Its ratio of 5.3 doctors per 1,000 people was the highest in the world.

The question that these statistics pose, of course, is whether the Cuban experience can be replicated. The answer given here is probably not.

"What does it is the incredible dedication," according to Wayne Smith, who was head of the US Interests Section in Havana in the late 1970s and early 1980s and has travelled to the island many times since. "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated," he said.

More:
http://www.hartford-hwp.com/archives/43b/185.html