Cuba’s Health Programmes in Africa as South-South Development Cooperation

1. Cuba’s Health Programmes in Africa as South-South Development Cooperation Margaret Blunden International Institute for the Study of Cuba, London Metropolitan University

2. To what extent can Cuba’s international health programmes in Africa be considered as development aid? • How far do they meet the criteria for successful South-South development cooperation?

3. Distinctive characteristics • Focused heavily on capacity building within the health sector, rather than infrastructural projects • Located within a distinctive discourse of South-South solidarity officially repudiating the self-interest and power imbalances usually implicit in donor-recipient relations • Explicitly free from political conditionality • Emphasizing prevention and health living conditions, rather than curative medicine, as in the colonial legacy • Early contribution to the concept of South-South development cooperation

4. Scope of Cuba’s Health Aid to Africa • Dates back almost to beginning of military intervention in the 1960s • Medical assistance achieving equal priority to military assistance in the 1970s • Expansion after end of Cold War • 1995 Cooperation Agreement with post-apartheid South Africa • Integral Health Programme 1998 for rural areas involved sending of medical and auxiliary staff to 13 African countries • 2000 Group of 77 meeting, richer African states agreed to provide finances for an extra 3000 doctors on the African continent • 2000 Gambia Medical School in Banjul and Bata School of Medicine in Equatorial Guinea set up on Cuban model; medical academics already teaching elsewhere • By 2000 there was said to be 40,000 African graduates of Cuban universities, many of them doctors, working in Africa • In 2005 there were 777 students from sub-Saharan Africa studying in medical schools in Cuba

5. Prevailing African Approaches to Health Policy • Most post-colonial governments, except for Tanzania and recently South Africa, focussing on medical treatment rather than a healthy environment • Resources devoted to curative rather than preventive medicine, and spent disproportionately on hospitals, imported technology and drugs • Little or no consideration for health in other government policies • Priority on the needs of urban elites • Little progress towards meeting the Millennium Development Goals

6. Global Health Watch, 2005 “The dominant development paradigm is one which focuses on the delivery of Medical technologies and pre-determined packages of interventions without considering adequately the process of health development, and without considering how health interventions can simultaneously change the political and social landscape in which are constituted the fundamental social and economic determinants of health” Global Health Watch, “Mobilising civil society around an alternative health report” Global Health Watch Update, 10 June 2005

7. Alubo and Vivekananda “The poorer African countries have tended to copy the philosophy and development priorities of the developed world even though the problems and population structures are different. In following the health delivery trends of technologically sophisticated societies, African countries have so far failed to make their health systems effective, let alone sufficient.” S. Ogoh Alubo and Franklin Vivekananda, Beyond the illusion of primary health care in an African society, Bethany Books, Stockholm, 1995

8. Criteria for successful South-South Development Cooperation • Responds to need articulated on the basis of special national and local analysis • Have contexts or relate to issues that have some commonality or complementarity • Involve exchange of knowledge and expertise in both directions • Bring mutual benefits on a reasonably equitable basis • Provide good value for money compared with alternative modes of operation • Prevention as part of the policy mind-set • Involvement and consent of an empowered civil society

9. Cuban medical aid to Angola, 1960s “The MPLA were keen to employ Cubans as opposed to western doctors for several reasons, not least because the average Cuban cost a quarter of a similarly qualified doctor from the World Health Organization. But Cubans were also willing to endorse more basic living conditions – medical teams often shared apartments and were happy to eat meals as a group – and were more sociable, easy-going and more racially tolerant than their Soviet and East European comrades. The Cubans had an ability to improvise where equipment or supplies were lacking, a skill they had had to acquire in Cuba.” Edward George, The Cuban Intervention in Angola, 1965-1991: from Che Guevara to Cuito Carnavale, Cass Military Studies Series, Routledge, Abingdon, 2005

10. Mutual benefits ( leaving aside diplomatic or economic issues) • International experience intended to reinforce the revolutionary ethos and help politicize Cuban youth • Valuable professional development for Cuban health workers: “They are faced with a different reality; they learn many things, in particular about interpersonal relationships; and they return home with a more comprehensive and solid formation. And this benefits us all. These people work in other countries for two or three years, but then they return home and work here for 20, 30 or 50 years. So, we’re not only giving, we are receiving benefits as well.” Francisco Rojas Ochoa, Interview in Medicc Review, volume VII no 9, November/December 2005

11. The Case of South Africa • Collaboration intended to meet specific needs and shortages in the transition process • Targeting of specific problem areas, eg Walter Sisulu University medical school in the Transkei • Apparent consistency of philosophy, as Government of National Unity opted for a new focus on primary care, and the incorporation of traditional African medicine BUT many South African health officials and doctors seeing the importation of Cuban doctors as a temporary stop gap. • Cuban doctors’ major frustration was the persistence of a heavy bias towards curative medicine Does the heavy Cuban emphasis on non-interference in domestic policies limit its potential for effective south-south development collaboration?

12. The Official Cuban Position “Cuba did not come here to change any system. The people of South Africa and the government of South Africa have to make the change. We are only here to render services, not to colonize. That is a principle we have always respected because we believe that each country should select its own methods of organization, its own systems. Cuba has always upheld this principle with pride at all international meetings.” Jaime David, “South Africa’s need for doctors: why turn to Cuba?” Unisa Center for Latin American Studies, volume 15, no 1

13. Tentative Conclusion • Much of Cuban medical aid to Africa risks being a temporary stopgap, rather than promoting the transformation of health systems which Africa needs. • The best prospects for transformational progress lie in the long term effects of medical training of Africans on the Cuban model and in the Cuban philosophy of health.