When Iraida, 69, tripped over the wheelchair of her 94-year-old mother while she was taking care of her, she did not calculate that her fall would mean that she would spend three weeks in the hospital. She was admitted to the Arnaldo Milián Castro Provincial University Hospital in Santa Clara, where the doctors indicated a hip replacement.
The prosthesis would have to arrive through an international family shipment or, otherwise, Iraida would have to join the list of older adults with a hip fracture who have been waiting, for six months, for a surgical intervention at said facility in Villa Clara.
Iraida’s emigrant relatives tried to buy it in the informal Cuban market to expedite the operation. A shipment from Europe, where they reside, could take time. However, they did not find it, not even for the 10,000 pesos that they were willing to pay.
Finally, after more than ten days of travel, the prosthesis arrived from Europe. With this, other essential materials for Iraida’s operation and of whose shortage the relatives in the hospital were alerted; such as gloves, trocars, antibiotics and sterile material for dressings.
The story, however, is not exclusive to Villa Clara. At the end of 2022, Minister of Public Health José Ángel Portal acknowledged before the Parliament’s Health and Sports Commission that throughout Cuba “the health system, in addition to presenting difficulties in the supply of medicines,” faced “limitations in basic lines of expendable material.” In the area, “69 lacking and 23 with low coverages” were then quantified.
Among the “critical resources” at the time, the minister highlighted “catheters, transfusion equipment, hip replacements, collectors, among others.” According to information obtained by this writer, other vital supplies that are lacking are syringes, ligatures to channel veins, anesthesia, and more.
In an attempt to distribute what is not enough and alleviate the situation, Portal reported that they were “making balances in the country, based on availability in the territories.” In addition, he reiterated “the commitment to continue seeking a solution to such a sensitive issue.”
Six months after his statements, the lack of resources, medical supplies and medicines, a problem that is not new, continues. In fact, the general perception is that it has gotten worse.
And time went by
The year 2021 marked the beginning of the most critical stage for Cuba in terms of scarcity of medical resources. In the Ministry of Public Health (MINSAP) balance report for that year recorded “the sustained increase in shortages and low coverage of medicines, diagnostics, expendables and other supplies for medical care.”
Luck was no different in 2022. The annual balance of the sector showed that “the sustained deficit of low or null coverage of medicines and medical supplies” was maintained.
This reality directly affected the quality of services, compliance with the main health indicators and “the satisfaction of the population’s demands,” according to official annual information.
In 2022, problems in the technological infrastructure due to obsolescence and breakage were added to the shortage of medicines and supplies. A “91% coefficient of technical availability in the equipment” was registered in both years, which shows a stagnation of the indicator in the year-on-year calculation.
It was in 2022, however, when the health authorities recognized surgical activity as “one of the most impacted by the shortage of medical supplies.” Not even the fact that the year was marked “by an increase in the reuse of medical devices” served as a palliative. The reuse of materials was not enough. A palliative to the absence of disposable supplies traditionally applied in Cuba has been the reuse of supplies, after their corresponding sterilization. In the country, mainly glass and stainless metal medical supplies are reused, such as syringes and aerosol nozzles, and other resources made of cloth that can be washed and sterilized for reuse. This is the case of cloths, gowns, hats, protective shoes and masks.
According to the authorities, the main cause of the sustained deficit is the lack of financing. The stability in the import and production of medicines and supplies in Cuba also depends on the solution of “the financial tensions that the health system has based on debts with suppliers, for having had to negotiate the shipment of some resources without the possibility of payment thereof.”
But, precisely, “the lack of foreign currency income,” in the words of Prime Minister Manuel Marrero, continues to be the essential obstacle “in the search for solutions to the most complex problems that we face as a country,” among which is “the acquisition of resources that guarantee the health demands of our population.”
In essence, the debts must be paid, but the available currencies are not enough to do so. In the health sector, the allocation of financing to medicines, medical supplies, spare parts and reagents is based on the income of the sector itself and the budget assigned by the State. The official figures reveal only amounts of conjugated allocations, dedicated to more than one sector.
In 2021, 6.741 billion was allocated for Public Health and Social Assistance. In 2022, 123 billion were allocated to Public Health, Education and Social Assistance; and in 2023, 251.222 billion was the allocation for Public Health, Education, Culture, Sports and Social Assistance.
After the first five months of 2023, and although it had been assured that this would be “a different year,” the problem and its causes are still valid.
Last May, the authorities again included among the main public health challenges the “shortage of medicines” and “inputs for fundamental services” in the sector.
A mitigation, at least temporary, comes from the hand of the recently announced extension of non-commercial imports, without limits on their value and exempt from payment of customs duties, of medicines, food and cleaning products.
From July 1 to December 31, 2023, the extension will include the import of supplies, from medical equipment to accessories for bedridden or disabled people. The detailed list of goods of this nature that will be able to enter the country without cost or limit has not yet been officially published.
Although, in the midst of such a prolonged crisis, the high demand and the very low supply encourage individuals to import medicines with the sole purpose of reselling them at prices well above the state prices, the expansion of this facility is welcome. Meanwhile, medicines, even with money, reach the hands of someone who needs them. Of the fair and definitive solution to the problem, however, there are no signs.
You don’t live on medicines alone
The lack of medicines is possibly one of the most sensitive issues of the current crisis in Cuba. The trend of national production has been downward for more than five years, both for intra-hospital and for those that are sold in the country’s pharmacy network. Its critical point began in 2021 and is lived to date.
At the end of 2022, official information reported “219 drug shortages in the country and 197 drugs with coverage for less than 30 days (73 are imported and 146 are domestically produced).”
In the case of medicines and vaccines, the basic table is made up of 627 medicines and vaccines in general, of which 60% (369) are supplied by BioCubaFarma and created in centers of the Cuban biotechnological and pharmaceutical sector.
However, there are no drugs. Not even those of national production. The causes? Financing again. To produce drugs in Cuba, raw materials must be imported. And, according to statements by the president of BioCubaFarma, Dr. C. Eduardo Martínez, these cannot be purchased because “the necessary and timely financing to acquire them does not exist,” and because of “problems for payment to suppliers, due to the refusal of banks to work with Cuba.”
The lack of raw materials generates 94% of the shortages. The other percentage is due to stoppages at production plants due to breakdowns or maintenance. In 2022, the stability of five blood pressure drugs, two diuretics, one anticoagulant, metformin for diabetes, isosorbide dinitrate for heart failure, and two aerosols for asthma were affected: salbutamol and fluticasone, among the most widely used drugs. Similarly, prenatal tablets (with 14 components) and folic acid for pregnant women, the latter due to a lack of vitamin C (ascorbic acid), according to Ms.C. Tania Urquiza Rodríguez, vice president of BioCubaFarma.
As a result of the very financial straits that the country is facing, not only have fewer medicines been produced, but also fewer have been purchased abroad.
Investments in finished medicines purchased abroad in 2020 and 2021 showed a decrease compared to 2017 and 2019. While in 2020 and 2021 Cuba invested around 85 and 89 million dollars, respectively, between 2017 and 2019 it exceeded 100 million.
The final link in the deficit chain are and will be the needy. Those who depend on the solidarity of those who have and want to share, of relatives who pay for shipments from abroad or, in the worst case, of what is available in the informal market at prices that do not know ceilings.
Public health cannot depend on any of these factors. Cuba is a country marked by a rapid population aging, a trend that brings with it an increase in the demand for health services and drugs. A delay of six months or more for an elderly patient to undergo surgery to fix a fracture cannot become a reality that ends up being tolerable after being so daily. This, just to mention a sector of the population.