1964 and after: Cuba Creates ‘Polyclinics’

Cuba transforms its health centers into “polyclinics.” Each of the polyclinics administers health services to a specific geographical region comprised of between 25,000 and 30,000 people and serves as the point-of-entry for most patients. [Feinsilver, 1993, pp. 35] In addition to treating patients, the clinics educate patients by holding daily lectures on health care in clinics’ waiting rooms. [Feinsilver, 1993, pp. 67] The region served by a polyclinic is further divided into health sectors. Within these sectors, all people are seen by the same medical teams, which after 1976 are mostly comprised of a physician and nurse trained in the same specialty. So for example, within a health sector, all children have the same pediatrician and all women have the same gynecologist. The polyclinic medical teams operate according to a paradigm known as “medicine in the community” which aims to treat patients as a biopsycho-social being in their respective unique environments. The medicine-in-the-community model is also designed to focus on disease prevention by identifying risks present in the environment before they become health problems. By the 1980s, it is apparent that something more needs to be done to achieve these objectives. The polyclinic medical teams fail to establish close relationships with their patients and have little time for prevention. This shortcoming leads to the creation of Cuba’s Family Doctor Program in 1984 (see 1984). [Feinsilver, 1993, pp. 35-40]