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Healthcare in Cuba: Sustainability Challenges in an Ageing System

Published online by Cambridge University Press:  22 January 2021

Carmelo Mesa-Lago  and
Sergio Díaz-Briquets
Carmelo Mesa-Lago*
Affiliation:
Carmelo Mesa-Lago is a distinguished service professor emeritus of economics and Latin American studies at the University of Pittsburgh
Sergio Díaz-Briquets
Affiliation:
Sergio Díaz-Briquets is an independent consultant who has written extensively on the demography of Cuba.
*
*Corresponding author. Email: [email protected].
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Abstract

This article assumes a balanced position between two contrasting views regarding the accessibility, quality, efficiency and financial sustainability of the Cuban healthcare system. It evaluates those issues in the 2006–20 period by identifying strengths and weaknesses based on a comprehensive statistical compilation of health indicators, physical infrastructure trends, availability of physicians and other elements to assess the system's long-term financial sustainability. Finally, it examines the likely consequences of population ageing on healthcare, including potential policies.

Spanish abstract

Spanish abstract

Este artículo asume una posición equilibrada entre dos puntos de vista contrastantes en relación al acceso, calidad, eficiencia y sostenibilidad financiera del sistema de salud cubano. Lo anterior es evaluado durante el periodo de 2006–20 mediante la identificación de fortalezas y debilidades basadas en una recopilación estadística exhaustiva de indicadores de salud, tendencias de la infraestructura física, disponibilidad de médicos y otros elementos para valorar la sostenibilidad a largo plazo del sistema. Finalmente, se examinan las consecuencias posibles del envejecimiento de la población en el sistema de salud, incluyendo políticas potenciales.

Portuguese abstract

Portuguese abstract

Este artigo assume uma posição balanceada entre duas perspectivas contrastantes sobre a acessibilidade, qualidade, eficiência e sustentabilidade financeira do sistema de saúde cubano. Entre o período de 2016 e 2020, analisa tais questões através da identificação de pontos fortes e fracos baseados em uma extensiva compilação estatística de indicadores de saúde, tendências de infraestrutura, disponibilidade de médicos e outros elementos para avaliar a sustentabilidade financeira do sistema no longo prazo. Por fim, o artigo examina as possíveis consequências do envelhecimento da população no sistema de saúde, incluindo políticas potenciais.

Keywords

Cubahealthcare policies and indicatorsaccessquality and efficiencyfinancial sustainabilitypopulation ageingCubapolíticas de salud e indicadoresaccesocalidad y eficienciasostenibilidad financieraenvejecimiento de la poblaciónCubapolíticas de saúde e indicadoresacessoqualidade e eficiênciasustentabilidade financeiraenvelhecimento da população
Type
Research Article
Information
Journal of Latin American Studies , Volume 53 , Issue 1 , February 2021 , pp. 133 - 159
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

1 A comprehensive analysis of the literature on Cuba's healthcare system is beyond this article's scope and space. Instead, we provide representative cases to illustrate each of the three perspectives.

2 Danielson, Ross, Cuban Medicine (New Brunswick, NJ: Transaction, 1979), p. 224Google Scholar. This book was published a decade before the 1990s crisis, when Cuba's healthcare system was in an ascending trend.

3 Feinsilver, Julie Margot, Healing the Masses: Cuban Health Politics at Home and Abroad (Berkeley, CA: University of California Press, 1993), p. 91CrossRefGoogle Scholar.

4 Ibid. The two phrases cited, in particular, are underlying themes throughout the book.

5 Ibid., p. 91. Feinsilver credits Sergio Díaz-Briquets for his conclusion in his book The Health Revolution in Cuba (Austin, TX: University of Texas Press, 1983) that more equitable healthcare access was a causative determinant behind Cuba's life-expectancy gains under the Revolution.

6 Whiteford, Linda and Branch, Laurence G., Primary Health Care in Cuba: The Other Revolution (Boulder, CO: Rowman and Littlefield, 2009)Google Scholar.

7 Gómez-Dantés, Octavio, ‘The Dark Side of Cuba's Health System: Free Speech, Rights of Patients, and Labor Rights of Physicians’, Health Systems and Reforms, 4: 3 (2018), p. 2Google ScholarPubMed.

8 Ibid., pp. 175–82.

9 Hirschfeld, Katherine, Health, Politics and Revolution in Cuba since 1898 (New Brunswick, NJ: Transaction, 2007)Google Scholar. See the outstanding review of the healthcare literature in this book.

10 Kath, Elizabeth, Social Relations and the Cuban Health Miracle (New Brunswick, NJ: Transaction, 2010)Google Scholar. The phrases cited run throughout the book.

11 Ibid., pp. 16–22. These issues are discussed throughout these pages.

12 Ibid., pp. 119–24. These linked phrases recapitulate elements of a broad discussion covered in these pages. Kath quotes and supports Carmelo Mesa-Lago's analysis of the problems faced when conducting field research in Cuba (p. 17).

13 This article is based on 83 different sources, mostly Cuban statistical institutions, followed by official newspapers, magazines and blogs; Cuban and foreign scholars; NGO reports, independent blogs and foreign news; and international organisations.

14 Ross, Ciro Bianchi, ‘Derecho a la vida’, Cuba Internacional, 16: 176 (1984), pp. 36–43Google Scholar; González, Roberto M., ‘Infant Mortality in Cuba: Myth and Reality’, Cuban Studies, 43: 1 (2015), pp. 19–39CrossRefGoogle Scholar; Roberto González, M. and Gilleskie, Donna, ‘Infant Mortality Rate as a Measure of a Country's Health: A Robust Method to Improve Reliability and Comparability’, Demography, 54: 2 (2017), pp. 701–20CrossRefGoogle ScholarPubMed.

15 Ministerio de Salud Pública (MINSAP), Anuario estadístico de salud (2018). In addition, tens of thousands of ‘menstrual regulations’ – an early form of medical fertility control – are performed annually.

16 González, ‘Infant Mortality in Cuba’, pp. 21, 29–30, 34; González and Gilleskie, ‘Infant Mortality Rate as a Measure of a Country's Health’, pp. 715–18; Berdine, Gilbert, Geloso, Vincent and Powell, Benjamin, ‘Cuban Infant Mortality and Longevity’, Health Policy and Planning, 33: 6 (2018), pp. 755–7CrossRefGoogle ScholarPubMed.

17 Cuba does not seem to be an outlier in this regard as by 2015–20 life-expectancy levels were reportedly higher in Costa Rica and Chile than in Cuba. See United Nations Department of Economic and Social Affairs (UNDESA), Population Division, ‘World Population Prospects 2019’, file MORT/7-1.

18 Institute for Health Metrics and Evaluation (IHME), ‘Cuba: Country Profile, 2018’, available at www.healthdata.org/cuba, last access 28 Sept. 2020. See also Pan American Health Organization (PAHO), ‘Health Situation in the Americas – Core Indicators, 2018’, available at www.paho.org/data/index.php/en/indicators.htm, last access 28 Sept. 2020.

19 Juan Carlos Albizu-Campos and Patricia Varona Pérez, ‘La mortalidad materna en Cuba. El color cuenta’ (Centro de Estudios de la Economía Cubana, Universidad de la Habana and Instituto Nacional de Higiene, Epidemiología y Microbiología, MINSAP, 2020).

20 Albizu-Campos, Juan Carlos and Fazito, Dimitri, ‘Dinámica demográfica cubana: Antecedentes para un análisis’, Novedades de Población, 9: 18 (2013), pp. 1–35Google Scholar.

21 Mesa-Lago, Carmelo, Market, Socialist and Mixed Economies: Comparative Policies and Performance – Chile, Cuba and Costa Rica (Baltimore, MD: Johns Hopkins University Press, 2000), p. 72Google Scholar; Mesa-Lago, Carmelo and Pérez-López, Jorge, Cuba under Raúl Castro: Assessing the Reforms (Boulder, CO: Lynne Rienner, 2013), p. 83Google Scholar.

22 Oficina Nacional de Estadística e Información (ONEI), Anuarios estadísticos de Cuba (2007–18).

23 ‘Cinco provincias de Cuba presentan dengue, según ministro de salud pública’, Cubanet, 18 Dec. 2018, available at www.cubanet.org/noticias/cuba-dengue-provincias/, last access 7 Oct. 2020; Hirschfeld, Health, Politics and Revolution.

24 Carl Zimmer, ‘Cuba Had Zika Outbreak in 2017, After a Global Emergency Had Ended’, New York Times, 23 Aug. 2019.

25 Arlin A. Loforte, ‘El rastro de la basura’, Granma, 11 Dec. 2014.

26 JEMA, ‘Health Alert: Cholera in Cuba’, 27 May 2015, available at https://jemaclinic.com/cholera-in-cuba, last access 28 Sept. 2020.

27 ‘Cuba: Nationwide Haemorrhagic Conjunctivitis Outbreaks’, GardaWorld, 2 Aug. 2017, available at www.garda.com/crisis24/news-alerts/68026/cuba-nationwide, last access 28 Sept. 2020.

28 Ng, Marie et al. , ‘Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980–2012’, Journal of the American Medical Association, 311: 2 (2014), pp. 183–92CrossRefGoogle ScholarPubMed.

29 IHME, ‘Cuba: Country Profile, 2018’.

30 Lisandra Fariñas, ‘Alzheimer: En busca de tratamientos más efectivos’, Granma, 14 May 2017; Quiñones, Rolando García, ‘Cuba: Envejecimiento, dinámica familiar y cuidados’, Novedades de Población, 29: 1 (2019), p. 133Google Scholar.

31 For a recent review of some of these issues, see Marieta Cabrera and Caridad Carrobello, ‘Higiene ambiental: ¿Atrapados y sin salida?’, Bohemia, 16 May 2016.

32 Paulino Alfonso, ‘¿En qué pararon las escuelas en el campo?’, Cubanet, 2 July 2015, available at www.cubanet,org/actualidad-destacados/en-que-pararon-las-, last access 6 Oct. 2020.

33 Home assistance for the needy shrank by 69 per cent from 2007 to 2018. See ONEI, Anuarios estadísticos de Cuba (2007–18). Adult day-care homes (casas de abuelos), with only 13,504 places, can only serve 0.6 per cent of the elderly, whereas permanent homes, with 11,726 places, can accommodate a further 0.5 per cent.

34 Mirta A. Fernández and Pablo Díaz Espí, ‘23,000 médicos, un pésimo negocio para los cubanos’, Diario de Cuba, 9 Nov. 2018.

35 The training of foreign doctors in Cuba is beyond the purview of this article.

36 Carmelo Mesa-Lago and Pavel Vidal, ‘El impacto en la economía cubana de la crisis venezolana y de las políticas de Trump’, Documento de Trabajo, Real Instituto Elcano de Estudios Internacionales, Madrid, 30 May 2019, p. 18.

37 Based on Comité Estatal de Estadísticas (CEE), Anuarios estadísticos de Cuba (1989, 1991); ONEI, Anuarios estadísticos de Cuba (2000–18).

38 José Luis Rodríguez, ‘La economía cubana 2016–2017: Valoración preliminar’, Cubadebate, 1 Jan. 2017, available at www.cubadebate.cu/opinion/2017/01/01/la-economia-cubana-2016-2017-valoracion-preliminar-i/#.X37W3ouSmM8, last access 7 Oct. 2020.

39 Ciara Nugent, ‘How Doctors Became Cuba's Biggest Export’, Time, 30 Nov. 2018, available at https://time.com/5467742/cuba-doctors-export-brazil/, last access 28 Sept. 2020. The United Nations raised an inquiry with the government of Cuba regarding the possible violation of internationally accepted human and labour rights, which remains unanswered (see Susana Gaviña, ‘La ONU califica de “trabajo forzoso” las misiones de médicos cubanos en el exterior’, Hoy, 10 Jan. 2020).

40 United Nations, ‘Mandatos de la Relatora Especial sobre las formas contemporáneas de la esclavitud, incluidas sus causas y consecuencias; y de la Relatora Especial sobre la trata de personas, especialmente mujeres y niños’, UN Doc. AL CUB6/2019, 6 Nov. 2019.

41 See Dresang, Lee T. et al. , ‘Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine’, Journal of the American Board of Family Practice, 18: 4 (2005), pp. 297–303CrossRefGoogle ScholarPubMed; Whiteford and Branch, Primary Health Care in Cuba; Keck, William and Reed, Gail A., ‘The Curious Case of Cuba’, American Journal of Public Health, 102: 8 (2012)CrossRefGoogle ScholarPubMed, published online 11 July 2012, available at https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2012.300822, last access 6 Oct. 2020.

42 Central Intelligence Agency (CIA), ‘The World Factbook: Physician Density’, 2018, available at www.cia.gov/library/publications/the-world-factbook/fields/359.html, last access 6 Oct. 2020.

43 PAHO, ‘Health Situation in the Americas – Core Indicators, 2018’.

44 ONEI, Anuario estadístico de Cuba (2018).

45 MINSAP, Anuarios estadísticos de salud (2007–17).

46 For a review of issues affecting the healthcare system and complaints by the public, see Jessica Castro and Marieta Cabrera, ‘Salud: Enderezar el camino’, Bohemia, 22 March 2018; ‘Salud: Anclajes necesarios’, Bohemia, 23 March 2018.

47 Cuban physicians abroad receive a fraction of the salary paid to the Cuban government by the host country but they still earn much more than their colleagues in Cuba; an unknown number of physicians abroad have deserted in order to become independent and earn more.

48 ONEI, Anuario estadístico de Cuba (2018). Two currencies circulate in Cuba: the national peso (CUP) and the convertible peso (CUC); in 2020 the latter was equal to the US dollar and was officially exchanged for 24 CUP.

49 The overall state mean salary in 2019 was 1,067 CUP, or 46 per cent of the basket; the healthcare personnel salary should have been higher but still below the basket cost (data from Betsy Díaz, Cuban minister of commerce, ‘Entrevista a Ministra de Comercio Interior’, Havana TV, June 2020).

50 ONEI, Anuario estadístico de Cuba (2018).

51 Shasta Darlington, ‘Cuba Is Pulling Doctors from Brazil after “Derogatory” Comments by Bolsonaro’, New York Times, 14 Nov. 2018.

52 ‘Díaz-Canel reconoce que 836 médicos cubanos no han regresado de Brasil’, Cubanet, 21 Dec. 2018, available at www.cubanet.org/noticias/cuba-diaz-canel-medicos-brasil-regreso/, last access 7 Oct. 2020. There are no statistics on the total number of Cuban doctors in international missions that have deserted or on those that returned to Cuba to work on the island.

53 ‘Gobierno cubano envía 500 nuevos médicos a Venezuela’, Cubanet, 12 Nov. 2018, available at www.cubanet.org/noticias/gobierno-cubano-envia-500-medicos-a-venezuela/, last access 7 Oct. 2020.

54 Ginés González, Ministro de Salud de Argentina, Antes de mañana, Canal América TV, 20 April 2020.

55 ONEI, Anuario estadístico de Cuba (2018).

56 Marieta Cabrera, Igor Guilarte Fong and Toni Pradas, ‘Medicamentos: Remedios para un dolor de cabeza’, Bohemia, 17 May 2017.

57 Ibid.

58 Roberto Rodríguez Cardona, ‘Los hospitales cubanos no escapan el “reciclaje” de los productos’, Granma, 31 May 2017.

59 ONEI, Anuario demográfico de Cuba (2018); MINSAP, Anuario estadístico de salud (2018).

60 World Bank, ‘Labor Force, Female (% of Total Labor Force)’, available at https://data.worldbank.org/indicator/SL.TFL.TOTL.FE.ZS, last access 6 Oct. 2020.

61 Aja, Antonio and Hernández, William, ‘Dinámica de la población y sus interrelaciones en Cuba y sus territorios: Recomendaciones para la acción’, Novedades en Población, 15: 29 (2019), pp. 56–74Google Scholar; Díaz-Briquets, Sergio, ‘Accounting for Recent Fertility Swings in Cuba’, Population and Development Review, 40: 4 (2014), pp. 677–93CrossRefGoogle Scholar.

62 ONEI, Anuario demográfico de Cuba (2018) and Anuario estadístico de Cuba (2018); projection for 2050 by the under-director of ONEI, Juan Carlos Alfonso, Granma, 6 Feb. 2019. See also Sergio Díaz-Briquets, ‘Major Problems, Few Solutions: Cuba's Demographic Outlook’, Cuban Studies, 43 (July 2015), pp. 3–18.

63 The labour force decreased by 10.7 per cent from 2014 to 2018. ONEI, Anuario estadístico de Cuba (2018).

64 Oficina Nacional de Estadística e Información and Centro de Estudios de Población y Desarrollo (National Office of Statistics and Information – Centre for the Study of Population and Development, ONEI–CEPDE), Encuesta nacional de envejecimiento de la población (2017).

65 Prieto, Mayra Espina, Políticas de atención a la pobreza y la desigualdad: Examinando el rol del Estado en la experiencia cubana (Buenos Aires: CLACSO, 2008)Google Scholar.

66 Cotlear, Daniel and Tornarolli, Leopoldo, ‘Poverty, the Aging, and the Life Cycle in Latin America’, in Cotlear, Daniel (ed.), Population Aging: Is Latin America Ready? (Washington, DC: World Bank, 2011), pp. 79–134Google Scholar.

67 González, Elaine Acosta, Risso, Florencia Picasso and González, Valentina Perrotta, Cuidados en la vejez en América Latina: Los casos de Chile, Cuba y Uruguay (Santiago: Konrad Adenauer Stiftung, 2018), p. 140Google Scholar.

68 García Quiñones, ‘Cuba: Envejecimiento, dinámica familiar y cuidados’, pp. 129–40.

69 For an analysis of this problem see Mesa-Lago, Carmelo, ‘The Cuban Welfare State System: With Special Reference to Universalism’, in Aspalter, Christian (ed.), The Routledge International Handbook to Welfare State Systems (London: Routledge, 2017), pp. 106–21Google Scholar.

70 CEE, Anuario estadístico de Cuba (1989); ONEI, Anuario estadístico de Cuba (2000); Mesa-Lago, Market, Socialist and Mixed Economies.

71 Mesa-Lago and Vidal, ‘El impacto en la economía cubana’.

72 From 1960 to 1990, the Soviet Union granted Cuba US$65 billion (three times the amount that the Alliance for Progress provided to Latin America), out of which 60 per cent was in non-reimbursable subsidies. See Mesa-Lago, Market, Socialist and Mixed Economies, p. 378.

73 Carmelo Mesa-Lago, ‘Assessing the Conundrums in the Cuban Economy under the Revolution, 1959–2019’, St Petersburg University Journal of Economic Studies, 3 (Nov. 2020).

74 Ibid.

75 ECLAC, Estudio económico de América Latina y el Caribe, 2018 (Santiago: ECLAC, 2019).

76 ECLAC, Enfrentar los efectos cada vez mayores del COVID-19 para una reactivación con igualdad, Informe Especial Covid-19, No. 5, Santiago, 15 July 2020, p. 9.

77 Raúl Castro, ‘Discurso en conmemoración del asalto al Cuartel Moncada’, Granma, 26 July 2009.

78 Health expenditures in constant prices are not available from Cuban statistical publications.

79 MINSAP, Anuario estadístico de salud (2017); ONEI, Anuarios estadísticos de Cuba (2007–18).

80 Two scientists have reported that interferon may make the virus even more virulent. See Peter Dockrill, ‘Scientists May Have Found the Human Cell Types Most Vulnerable to the New Coronavirus’, ScienceAlert, 23 April 2020, available at www.sciencealert.com/the-cell-types-most-vulnerable-to-infection-by-coronavirus-may-have-been-identified, last access 7 Oct. 2020.

81 ‘Cuba informa nuevas medidas para enfrentar el virus’, Granma, 23 March 2020; Yadira Serrano Díaz, ‘Escasez de alimentos e insalubridad: Las brechas del nuevo coronavirus en Cuba’, interview with Dr Roberto Serrano, Cubanet, 3 April 2020, available at www.cubanet.org/destacados/escasez-de-alimentos-e-insalubridad-las-brechas-del-nuevo-coronavirus-en-cuba/, last access 7 Oct. 2020.

82 Based on MINSAP data, 26 April 2020, available at http://covid19cubadata.github.io/index.htm#cuba, last access 7 Oct. 2020.

83 ‘Cubans Celebrate No Local Transmission of Covid-19 for Four Months’, Reuters, 19 July 2020, available at www.reuters.com/article/us-health-coronavirus-cuba-recovery-idUSKCN24K0JL, last access 7 Oct. 2020; ‘Ministerio de Salud Pública: Cuba confirma 37 nuevos casos de Covid-19’, Granma, 27 July 2020.

84 Amilcar Pérez Riverol, ‘The Cuban Strategy for Combatting the Covid-19 Pandemic’, Journal of Latin American Cultural Studies, published online, 7 July 2020, available at https://medium.com/@j_lacs/the-cuban-strategy-for-combatting-the-covid-19-pandemic-266b62cd721c, last access 7 Oct. 2020.

85 ‘Informe Especial. COVID: Coronavirus, opacidad, violencia, impunidad, desinformación’, Article 19, 9 July 2020, available at https://articulo19.org/wp-content/uploads/2020/07/Book-A19_InformeCovid_2020-V03.pdf, last access 7 Oct. 2020, p. 86.

86 Data sourced from ‘Covid-19: Country/Region Entry Restrictions’, Trip.com, available at www.trip.com/travel-restrictions-covid-19/, last access 7 Oct. 2020.

87 ONEI–CEPDE, Encuesta nacional de envejecimiento (2019); Elaine Acosta González, ‘El gobierno cubano no puede solo con el coronavirus’, 14ymedio, 22 March 2020, available at www.14ymedio.com/nacional/Gobierno-cubano-puede-solo-coronavirus_0_2843115661.html, last access 7 Oct. 2020; Marc Frank, ‘Cubans Cast Aside Coronavirus Fears to Search for Scarcer Food’, Reuters, 8 April 2020, available at www.reuters.com/article/us-health-coronavirus-cuba-economy-featu-idUSKCN21Q2C6, last access 7 Oct. 2020; Pavel Vidal, ‘Analysis: Coronavirus to Deliver Blow to Cuban Tourism’, Cuba Standard, 16 March 2020.

88 Juan Carlos Albizu-Campos, as cited by Sara Más in ‘Cuba: Desafíos demográficos a la vista’, Progreso Semanal, 6 Nov. 2017, available at https://progresosemanal.us/20171107/cuba-desafios-demograficos-la-vista/, last access 7 Oct. 2020.

89 In 2018, out of all taxes, 52 per cent were indirect (mostly from sales taxes) and 41 per cent were direct (ONEI, Anuarios estadísticos de Cuba (2017, 2018)). On income inequality see Omar Everleny, ‘Desigualdad y población en riesgo de pobreza en Cuba’, Cuba y la Economía, 15 Aug. 2019, available at https://cubayeconomia.blogspot.com/2019/08/desigualdad-y-poblacion-en-riesgo-de.html, last access 7 Oct. 2020; Carmelo Mesa-Lago, ‘La desigualdad del ingreso y la experiencia de América Latina’, Temas, 84 (Oct.–Dec. 2015), pp. 35–43

90 Under President Obama's programme of five-year visas with multiple entries, many Cubans were working on their own in adult care in Florida, but such visas were cancelled by President Trump in 2019. These informal working arrangements were in violation of US immigration and labour laws.

91 Sergio Díaz-Briquets, ‘Medicare: A Potential Income-Generating Activity for Cuba in the Future’, Cuba in Transition, 11 (Nov. 2001), pp. 185–94.

92 The number of doctors currently being sent to Argentina, Mexico and even some developed countries, prompted by Covid-19, is lower than the losses cited.

93 Ricardo Torres, ‘Mirando a través de las ventas de servicios médicos’, Progreso Semanal, 12 Dec. 2018, available at https://progresosemanal.us/20181129/mirando-a-traves-de-las-ventas-de-servicios-medicos/, last access 7 Oct. 2020; correspondence with Ricardo Torres, Havana, 23 April 2020.

94 Aja and Hernández, ‘Dinámica de la población y sus interrelaciones en Cuba’, pp. 69, 72–3.

95 Alejandra García, ‘Nuevas normas jurídicas aumentan la protección a la maternidad en Cuba’, Granma, 11 Feb. 2017.

96 Yenia Silva, ‘Retos de un país que peina canas’, Granma, 9 July 2019; ONEI, Anuario demográfico de Cuba (2018). The government does not publish overall housing expenditure allocations.

97 ONEI, Anuario demográfico de Cuba (2018); ‘Al gobierno ya no le salen los números: Sube la mortalidad infantil, se desploma la natalidad’, Diario de Cuba, 3 Jan. 2020.

98 ‘La bondad neoliberal de los entusiastas consejeros’, Granma, 6 May 2020; ‘Consejo de Ministros: Salvar vidas y estimular el desarrollo económico’, Granma, 8 May 2020.