Cuba's health care system has long been the envy of much of Latin America and the Third World, with the government providing free primary care, as well as hospital services and dentistry, to 100 percent of the population. The success of the system is reflected in indicators such as life expectancy and infant mortality that are comparable to those in many developed countries.

But the end of aid and preferential trade from the Soviet bloc following the dismantling of the Soviet Union in 1989 has caused a major contraction in the economy. At the same time, Cuba's access to foreign currency has been "severely hindered" by the U.S. trade embargo, according to the Pan American Health Association (PAHO).

Although health care has continued to be a high government priority, with overall expenditure increasing 17 percent between 1989 and 1994, according to PAHO, the lack of foreign currency is reflected in sharp decreases in health care investment, a growing scarcity of drugs and the inability of the health care sector to easily obtain disposable medical supplies and replacement parts for aging, pre-revolution equipment made in the United States.

These shortages, while not affecting overall public health indicators, have resulted in increases of treatable conditions such as acute respiratory infections and intestinal infectious diseases, among others. Food intake in Cuba has fallen below nutritional requirements in recent years.

The Cuban government, and many Cubans, blame the shortages and general decline in the quality of health services on the embargo. While the sale of most pharmaceuticals and medical supplies are not prohibited under its terms, U.S. government procedures for selling drugs to Cuba are "difficult, discouraging and cumbersome," according to an Oxfam America study, and few companies participate. Many products are not available in other countries; the cost of those that are available is increased significantly by long-distance shipping costs.

Karen DeYoung—
Washington Post Staff Writer