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Fidel Castro & His Relevance to India A look at Cuban Health & Education Policies

J. Shriyan

All leaders the world over, have their share of admirers and those who despise them including those who hate them. These are human feelings and therefore it will be multi dimensional, like degree of likes, dislikes, hatred, etc. There is no exception to this aspect of public life. All leaders, who can be truly regarded as those who have left indelible footprints on the sands of time, surely for varieties of reasons, from Abraham Lincoln to Mahatma Gandhi to the latest victim of time Fidel Castro, there will be loads of positives as well as portions of negatives. None will be fully without criticism, since despite their superior contribution to the time they lived, they too are humans and therefore could have been victims of some human failings. But it is the larger picture that truly matters. In that sense, Fidel Castro, who passed away some weeks ago, was a towering personality who lived for his people and died for his people. It is quite likely, in the process of doing good to his people, he could have stamped on some achilles foot. Of course according to the available details in public space, he was ruthless with his opponents. His record of human rights is supposedly pathetic. UNDP report informs that he had over 500 people jailed for every 100,000, which is among the highest. Be that as it may, his record in health sector and education to his countrymen are being seen as models in socio-political governance.
Born in comforts to a plantation owner father, young Fidel was witness to the socio-economic inequity prevailing in their own backyard. His playmates were children of his father’s impoverished workers living in thatched huts with dirt floors. The economic injustice and deprivation he witnessed in his childhood inspired his lifelong sympathy for the poor. This sympathy spurred his political life of communism. He managed to overthrow the then Cuban dictator Fulgencio Batista in 1959 and established himself into the national life of Cuba. Most of Latin American despots were U.S stooges and they were aided and funded by them for their own socio-economic & political reasons. In the bargain ordinary people immensely suffered. Fidel Castro detested this scenario and had visions of U.S-free Cuba from early days. From 1959 to 2008 he strode the Cuban landscape like a colossus. During those almost five decades, he defied every president- some 10 of them- of United States of America. The missile crisis of 1962, brought the world to the brink of possible nuclear war between the then USSR and U.S.A, but was averted in time. The leadership in Moscow helped him establish his socialistic pattern of government with huge physical and financial aid.
At the time of his initial political life, the U.S influence was all over Latin America, and young Fidel wanted it ended. He was out and out anti- U.S, all for the sake of his country. There were umpteen U.S inspired attempts on his life, but he managed to survive them all, for almost all the five decades of public life. Born in Aug 1926, he died in Nov. 2016. After the missile crisis of 1962, the U.S imposed trade sanctions against Cuba, which greatly hurt the socio/economic life of Cuba.
It is true, his experiments in socialistic pattern of governance, did throw-up enough opponents and created a lot of enemies within the Cuban society who left the country and kept campaigning against him.
But the strides he has made in both health sector and in spreading the quality education is a model to many countries in the third world as well as European countries. The government of Fidel Castro was operating the national health system at its own cost and responsibility for the health care of all its citizens. There is no private hospital or clinics, and health services are government owned and operated. It spends 10% of the Gross Domestic Product, which is almost 3 times that of India. When Castro took over the reins of government in Havana in 1959, Cuba had 9.2 doctors for every 10000 citizens, by 1999 it was 58.2 per 10000, which  is almost 6 times jump, and increased to 67.2 in 2014, where as in India, it is 6.5 per every 10,000 citizens, a poor less than 1/10th. Universal health care in Cuba was a priority in state planning. In 1976, Cuba’s health care programme was enshrined in Article 50 of the revised Cuban constitution which reads “Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installation of the rural medical service network, polyclinics, hospitals, preventive and specialized treatment centres; by providing free dental care, by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population co-operates in these activities and plans through the social and mass organizations.”
Thus, unlike India, for Cuba, the health of its citizens certainly constituted an integral part of its developmental paradigm. In India, not only the health sector is poorly funded, private enterprises have been allowed free run with hardly any drug price control regime. That is how in Cuba, out of pocket expenditure of individuals is only 5.3% of the total health expenditure, whereas in India it is a whopping 59%. So one can imagine the devastation caused by the exploitation of private drug industry, allowed by a system of governance that has remained immune and distant to the needs of its citizens. (See table)
The commitment of the politica

l class to the universal health under Fidel Castro in Cuba has been of such order that as of 2012, the infant mortality rate in Cuba had fallen to 4.83 deaths per 1000 live births, which is better than even the United States of America at 6.0 per 1000 live births. This infant mortality rate came down further to 4 per 1000 in 2014 and those under 5 years it is 6. Whereas comparative figures of India are rather dismal. The infant mortality rate of India was a staggering 44 for every 1000 births and those under 5 years of age were 56 for every 1000 births.
According to Wikipedia, in 2007, Cuba announced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and Medical images. Cuba is the second country with such a product, preceded only by France. Cuba is preparing a Computerized Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research development projects. An important link in wiring process is to guarantee access to Cuba’s Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health system.
Wikipedia also informs that ‘Cuba had 128 physicians and dentists per 100,000 people in 1957. This was comparable to the levels in many European countries and supposedly the highest in Latin America. However in 2005, Cuba had 627 physicians and 94 dentists per 100,000 population, while USA had 225 physicians and 54 dentists per 100,000 populations.
Writing further, it says “While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by patients. Items which are paid by patients, who can afford it, are: drugs prescribed on an outpatient basis, hearing, dental and orthopedic processes, wheel chairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on low income, these items are free of charge.
In 2000, former Secretary General of UNO, Kofi Annan had stated “Cuba should be the envy of many other nations” adding that achievements in social development are impressive given the size of its per capita gross domestic product. “Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities- health, education and literacy” the UN Secretary General had concluded. A former President of the World Bank James Wolfensohn had, in 2001, remarked at the annual meeting of IMF “Cuba has done a great job on education and health.”
What is admirable and therefore worthy of reflection is, despite the poor pay to doctors, mostly outdated and poor state of repairs & maintenance of its hospital buildings, lack of adequate equipment, absence of freedom of choice, “the success of the Cuban health care system is based on its strong emphasis on disease prevention and commitment to the practice of medicine in a community”, stated Health Select Committee of U.K House of Commons which travelled to Cuba in 2001 and reported back to their parliament.
There are any number of accolades which describes Cuba “as a shining example of power of public health and transformation of the health of an entire country by a commitment to prevention and by careful management of its scarce medical resources”.
India also needs to learn from Cuba’s holistic approach to health. Economic constraints and restrictions have forced the Cuban health system to incorporate alternative and herbal solutions to health care issues which are accessible and affordable to a larger section of the population. In 1990 itself, Cuban Ministry of Public Health formally recognized natural and traditional medicine and began its integration into the already well established western medicine model. Options included flower essence, neural and hydromineral therapies, homeopathy, traditional Chinese medicine, natural dietary supplements, Yoga, electromagnetic and laser devises.
According to available reports, children in primary school begin studying the multiple uses of medicinal plants, learning to grow and tend their own plots of aloe, chamomile and mint and conduct scientific studies about their uses. Cuban biochemists have produced a number of new alternative medicines which are used in the state health system.
Medical research is another area of strength in the Cuban health scenario. This is despite all kinds of sanctions and embargo by the mighty United States. Their scientists have done well to produce pharmaceutical preparations in the treatment of cancer, meningitis B, polio and many other have been the products of this Cuban research efforts.
Of course this is not to say, there is no criticism of the system. But what is important is at the end of the day, Cuba as a country, despite huge disadvantages of lack of democracy, limited resources, political sanctions leading to trade embargos by the U.S, has managed to give its people an exemplary health service, acclaimed all over the world. A government of the people, for the people and by the people should at least guarantee a semblance of good health to its people. Admittedly, Fidel Castro of Cuba has come out with flying colours.
Coming to Education, reportedly in Cuba, education continues to receive high priority with 10% allocation in the national budget, compared to 4% in the UK and just 2% in the United States, according to UNESCO. However, in 2014, the Cuban expenditure on education was 13% of the GDP and in India it was a mere 3.3%.
Although Cuba always had better levels of education, early on, as compared to their Spanish colonial masters, it was not accessible to poor rural folks. But post Cuban revolution led by Fidel Castro, the new government placed the reorganization of the education system as a top priority. Following the restructuring, the new government focused on literacy problem. As soon as Fidel Castro took over, in 1959, close to 1000 literacy centres were opened and youth were sent all over the country-side to teach their fellow Cubans, how to read. Reportedly, this Literacy Campaign served two purposes: first to educate every Cuban and teach them to read, then to give those in the city a chance to experience the rural living, so also to improve communication between the countryside and cities. By 1961, all private schools, colleges and Universities were nationalized. The changes that the new government brought about spurred literacy rate among age 15-24 to almost 100% at 97% by 2000. Leaders of the new government recognized that to be strong and for citizens to be active participants in society, they must be educated. Literacy provided poor uneducated Cubans a better standing in the country and the world.
The new government of Fidel Castro made a huge difference to the women of Cuba. Besides agriculture, most women were reportedly engaged in prostitution. Fidel Castro changed it all. He made prostitution illegal in 1961, and opened up schools and institutes for job training for rural women in multiple vocations. This gave the women folks a big opportunity to rebuild their lives. The new government believed in the human dignity of women, and hence provided them, besides schooling and higher education, skills to build confidence and pride.
Thus, gender equality was given the prominence it deserved. The new government wanted women to take their rightful place in nation building.
A study carried out by UNESCO in 1998, showed a high level of educational achievement among Cuban students. Cuba is supposedly one of the poorest countries in Latin America, and was reeling under U.S trade embargo, which severely restricted its economic development. Yet Cubans turned out very good with their third and fourth graders scoring 350 points, a clear 100 points above the regional average in basic mathematics skills and language. Hence, it was very clear that Fidel Castro gave high importance to education. The figures available on record confirm it. In Cuba, the student-teacher ratio was 12 to 1, in early years, when Latin American average was double at 25 to 1. But by 2014 it got still improved to 9 to 1. Reportedly the youth illiteracy rate in Cuba is almost zero, a figure unmatched by any in Latin America. Wikipedia informs “Cuban schools are closely integrated with the community. Teachers are very active in the communities of the children that attend their schools, and build strong relationship with their parents and families to enhance the learning process. It has been demonstrated that there is a strong commitment to the educational sector on the part of the government. Equal opportunity for a high quality education for all students is one of the key factors that explains that Cuban educational success is not a miracle or an accident, but the result of many years of concerted efforts and commitments, by the government to its people.”
Coming to India, its performance in education sector is clearly disappointing. With its budget at 3.3% of GDP, compared to Cuba @ 13%. India’s students to teacher ratio is 35 to 1. Population with at least secondary education is 39% as compared Cuba’s 77% and university education 23% as against the Cuba’s 62%.
According Annual Survey of Education Report (ASER), year after year, learning outcomes were woefully short. ASER of 2014 found that half the kids in class five could not read class two text book. Maths and reading skills achievements routinely fall very short. “A hundred million children have gone through the schools in the last decade without basic reading and math skills” was the stark comment in the 2014 ASER report. Isn’t this a terrible waste of national resources? No wonder Deputy PM of Singapore had observed during his recent visit to India the biggest gap between India and East Asia was the state of education.
We do not have to over emphasis that education is what empowers all communities, more so, backward communities, with tools to move ahead.
Without quality basic education, the weak are eventually rendered weaker, left fit only to do menial jobs. The real remover of backwardness in society is good quality school education. Skill development comes in later. Good basic education helps backward communities march forward and challenge stratified conventional established classes.
As we end, it is worth quoting the observation of Haoliang Xu, Director of UNDP’s Regional Bureau for Asia and Pacific. He had remarked “The availability and quality of work are keys for human development in Asia and the Pacific, a region that is home to 2/3rd of the world’s working age population. In order to ensure that the work force is capable of adapting to rapidly changing demand, the government needs to make strategic investments into education and health care.”
Power that be in India need to appreciate and understand, that ‘investment in and accumulation of human capital is the best marker of development’. Economist Ajit Ranade writes “If a nation’s stock of capital (which determines its future growth), is broken into human and non-human capital, then in developed economies the share of human capital is more than 75%. That share for India is likely to be less than 30%.” That’s the bottom line. Do you hearken, the power that be!