Community Medical Care in Cuba and Venezuela: A Model in Extinction

Thinking against the State requires to consider some aspects that are less clear-cut than the repressive and/or neoliberal apparatuses—the most important of these aspects being public health. In post-revolution Cuba, bank headquarters are turned into hospitals and access to public health for all becomes a reality. Four decades later, when Venezuela begins to be presided by Hugo Chávez, many exchanges between the two countries—in particular around health—are implemented. In the following text, Lisbeth Moya González observes the crumbling of these state health systems under US sanctions and bureaucratic corruption, and insists on the importance of the community health paradigm as an alternative.

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After the triumph of the Revolution, people in Cuba used to go to the doctor even for a common cold. The family doctor became almost like another friend, because doctors in the country were not distant, untouchable figures shut inside an office: they were people who spent much of their time visiting patients directly in their homes.

Medical follow-ups were so frequent that they could feel overwhelming, since each family doctor closely monitored older adults, children, pregnant women, and people with chronic diseases living in the households assigned to their clinic.

I write all this in the past tense, and that is regrettable. The benefits of community medical care no longer exist in Cuba. On the other side of the Caribbean Sea, in Venezuela, the situation is similar, with the difference that the model never reached the same level of national consolidation that it did in the Cuban case.

To speak about health is to speak about the State. It is not only about hospitals, programs, or statistics, but about how a country decides to care for its people—or abandon them. Every policy, every budgetary priority reveals which lives are considered worthy of protection and which lives are left exposed. In this sense, health systems function like a mirror: they reflect the State’s promises, but also its limits and contradictions, especially when public administration ends up managing scarcity instead of guaranteeing rights.

Community health care raises an uncomfortable question: can the State, on its own, sustain collective well-being?

These models remind us that health is not born only in clinics, but in neighborhoods, in homes, and in everyday relationships—in the capacity of communities to organize themselves. When the State supports and strengthens these dynamics, care becomes closer and more democratic. But when centralization, bureaucracy, and distance from daily life prevail, even the best-designed projects begin to fracture.

With these questions in mind, looking at Cuba and Venezuela is illustrative in many ways. Both countries, born out of social revolutionary processes at different historical moments, invested in health models with a strong community vocation, backed by states that saw themselves as guarantors of social welfare. For years, these policies expanded access, brought doctors into neighborhoods, and challenged the idea that health should be a privilege. However, the very structures that made those advances possible also exposed their vulnerabilities: centralization, political dependency, prolonged economic crises, and accumulated attrition that eventually reached everyday life. What follows is not just a timeline of decline, but an open question about what happens when a state that once cared for its own people stops doing so—whether due to lack of political will or a collapsed economy.
Within this framework, the role of the US blockade and sanctions has been a key factor in the erosion of both health systems. According to the report of the UN Special Rapporteur on Human Rights, Alena Douhan, following her 2025 visit to Cuba, presented before the UN Human Rights Council, unilateral sanctions have seriously affected access to medicines and medical technologies, limiting financial and operational resources, resulting in the inaccessibility of approximately 69% of the medications needed by the Cuban population, including treatments for cancer and heart disease, as well as basic diagnostic tests.

In parallel, the coercive measures imposed on Venezuela since the mid-2010s—such as the freezing of state assets and financial pressure on banks that prevents regular international trade—have had direct consequences on the purchase of basic supplies, vaccines, and medical equipment, obstructing the provision of essential health services. A report by the Office of the UN High Commissioner for Human Rights, published in Geneva on August 28, 2025 during the 59th session of the UN Human Rights Council, notes that these sanctions have disproportionately harmed vulnerable groups by limiting access to economic resources needed to guarantee fundamental rights such as health and life.

State Health or Community Health? ///
Community medical care understands health as a collective matter, encompassing not only epidemiological problems but also the well-being of every member of society. It is based on communities identifying their needs and participating in decision-making, prioritizing prevention and equity. In contrast, state or institutional medical care refers to services organized by governments within a formal public system.

The differences between both approaches are clear. The first and most essential is that State systems focus on individuals and reproduce a biomedical logic, while community care works with broader social groups and not only in hierarchical spaces such as hospitals or clinics. Their modes of intervention also differ: community care prioritizes prevention over treatment and understands illness in relation to environmental conditions, whereas State systems tend to focus on diagnosis, treatment, and control. Community models turn the community into an active, co-responsible actor, while institutional systems usually maintain more vertical structures.

Community Health in Cuba and Venezuela ///
In 1959, when the Revolution triumphed, Cuba had only about 6,200 doctors, mostly concentrated in large cities, and most of them practiced privately. Infant mortality was 60 per 1,000 live births, and life expectancy did not reach 60 years. There was only one medical school in the entire country.

From that starting point, a deliberate process of change began: the Cuban State placed health at the center of the political project, nationalized much of the existing infrastructure, and redirected resources toward territories that had never had services.

Hospitals, polyclinics, and clinics became part of a single public network, while health planning was organized from the national level down to the neighborhood. This transition—from a fragmented and privatized system to a centralized and free one—was gradual but sustained.

By the year 2000, Cuba had more than 70,000 doctors. Infant mortality had dropped to 4.2 per 1,000 live births, and life expectancy had risen to 77 years. The country also had an immunization program covering 13 diseases, along with 14 medical universities, 2 faculties, and 27 university branches.

Primary Health Care in Cuba has its origins in the Rural Medical Service, established after the revolutionary triumph as mandatory social service for medical graduates. In 1964, a unified national system was created, with comprehensive centers aligned with a State model.
In practice, doctors ceased to be figures concentrated in cities and began to be tied to specific territories: first through rural missions and later through increasingly complex community structures. The reorganization of the system not only expanded coverage but also transformed the relationship between doctors, the State, and the community. By 1974, Community Polyclinics emerged, integrating neighborhood representatives into their activities. After the Alma-Ata conference in 1978, community plans expanded and the Family Doctor and Nurse Program was designed. Cuba met the Alma-Ata goals in 1985 and even incorporated medical teaching into university polyclinics starting in 2005.

The process was neither linear nor spontaneous: it combined expansion of training, administrative centralization, and a strong emphasis on prevention, building a network that functioned both as a health structure and as a political project. Beginning in 2003, Cuba attempted to export this model to Venezuela through the Barrio Adentro Mission promoted by Hugo Chávez: a set of public policies aimed at guaranteeing free access to health care in poor neighborhoods and rural areas, with strong emphasis on primary care and territorial presence. Barrio Adentro was structured in levels: community clinics; Comprehensive Diagnostic Centers; and, in its second phase, hospitals and higher-complexity clinics. It also incorporated Community Health Agents and mechanisms for local participation. This health structure depended largely on Cuban medical personnel, which allowed a rapid consolidation of a care network in previously underserved areas. The training of Venezuelan students in Cuban medical schools was also part of the cooperation.

What Happened to Community Health? ///
Barrio Adentro expanded access, carried out preventive campaigns, and reduced inequalities in its early years. However, recent interviews reveal sustainability problems: dependence on Cuban personnel, administrative weaknesses, deteriorating infrastructure, and shortages of supplies. The Venezuelan national media describe a system in crisis, with massive migration of professionals, lack of diagnostic equipment, deteriorated hospitals, shortages of medicines, and territorial gaps. The lack of integration of clinical data, according to the CENDES-UCV report “Misión Barrio Adentro: Fractured Care and Health in Crisis” (2018) hinders epidemiological control and health planning.
When speaking with her, Sofía, a 30-year-old Venezuelan woman, recounts: “My father has been waiting more than five years for cataract surgery… The day I gave birth I went to three hospitals and none could attend me due to lack of personnel or supplies.” Nonetheless, within that same context another community logic coexists: Cecosesola, a cooperative network created by residents of the Barquisimeto region. It was founded over 50 years ago and today coordinates agricultural production, consumer fairs, funeral services, savings programs and, above all, an autonomous health network. According to the report “Cecosesola: A possible world in Venezuela through cooperativism,” published in La Web de la Salud, it operates without formal bosses, with task rotation and collective decision-making. With their own resources, residents built the Cooperative Integral Health Center, which includes operating rooms and more than 30 specialties. Linked to five community centers, Cecosesola’s hospital serves up to 230,000 people a year, often at prices 50% lower than private facilities. Rather than opposing the public system, Cecosesola’s example complements it and shows that, in contexts of crisis, communities can organize accessible, supportive, and sustainable care networks.

Cuba: An Old Structure and a Collapsed System ///
Mirta, a 50-year-old woman living in the city of Santa Clara, in central Cuba, tells me that after the pandemic the clinic in her neighborhood closed and doctors stopped visiting her home. The pandemic, US sanctions, and State management of the epidemiological process triggered a gradual collapse. María, a resident of Havana explains: “Health care is free, but to have surgery you have to pay for supplies or ask family members living outside Cuba to send them.”

The pandemic changed everything in terms of health for Cubans, but even amid that deterioration, Cuban doctors continued their internationalist work. A text published in the outlet Resumen Latinoamericano in April 2025, titled “What has been the global impact of Cuban medical collaboration?”, explains that Cuba’s response to the pandemic was the continuation of an internationalist trajectory that began in 1963, when the first brigade left for newly independent Algeria. Since then, Cuban doctors have treated more than 2.3 billion people, performed nearly 17 million surgeries, attended 5 million births, and are estimated to have helped preserve around 12 million lives. During the COVID-19 pandemic, that experience enabled brigades to be sent quickly to neighboring countries and to critical epicenters such as Lombardy, Italy. By 2022 there were already Cuban doctors in more than 40 countries. Even in later crises—such as the earthquakes in Turkey and Syria in 2023—cooperation was reactivated almost immediately.

In that same context, in July 2022, the Cuban company Biocubafarma told the press that it was withdrawing 142 of the 369 medications it had previously guaranteed in Cuban pharmacies, due to lack of inputs and raw materials and because some foreign manufacturers had stopped producing essential components. In an article published in the independent Cuban outlet La Joven Cuba, titled “Medicines in Cuba: subsidy or free market?” (2023), I analyze how, in the face of scarcity, an informal market for the sale of medicines emerges through social networks, in an environment shaped by the capitalist logic of supply and demand. Rubén, a 30-year-old resident of the Playa municipality in Havana, tells me a different experience from that of other interviewees: his family doctor still visits them, and their clinic continues functioning normally; but his case is an exception. The migration of professionals, low salaries, and the economic crisis have eroded the foundation of a health system that maintains the structure of primary care in theory, but lacks the supplies and human capital necessary to sustain it.

In Venezuela’s case, any analysis of public health today must consider another decisive factor: the country is living under an economic, diplomatic, and military offensive led by the United States.

Sanctions, pressure on exports, and the attempt to financially isolate the State have eroded its ability to purchase medical supplies, affected hospital logistics, and reduced the room for maneuver to sustain universal public policies. It is not only an internal crisis: it is a model of strangulation that strikes first at the bodies of ordinary people.

And then a troubling question arises: what will happen to healthcare in a Venezuela invaded by a US so-called “intervention?” I’m indeed finalizing this text a couple of days after US bombings in Caracas and the abduction of Nicolás Maduro and Cilia Flores. Recent world experience offers painful clues. The US invasion of Iraq or NATO operations in Libya, ended up destroying health infrastructures, fragmenting care systems, and leaving populations dependent on private networks, unstable NGOs, or informal medicine markets. War turns health into spoils, into business, and into a space of territorial control. Imagining that horizon for Venezuela is not rhetorical: it implies envisioning hospitals turned into barracks, professionals working only in private systems due to the decapitalization of the public sector, and communities forced to survive outside any public framework.

In that sense, the defense of a health system—however imperfect, worn-out, or contradictory it may be—cannot be separated from people’s sovereignty. Without sovereignty, what remains is usually a “reconstruction” under external tutelage, where life is administered from outside and rights become provisional. Venezuela today is crossed by that crossroads: resisting US invasion without losing the capacity to care for its people.

In the end, what is dying in both countries is not the idea that health can be collective: what is disappearing is the political will and the institutional and economic capacity to sustain it.

Cuba and Venezuela showed that bringing doctors into neighborhoods, prioritizing prevention, and linking medicine with everyday life could radically transform access to care. Those achievements were real. But community health cannot survive indefinitely on exhausted budgets, US blockades, fragmented management, and permanent crises. Nor can it be sustained only on moral narratives of sacrifice while professionals emigrate, hospitals deteriorate, and families learn to survive alone amid scarcity. The tragedy is not only that these systems collapsed: it is that they collapsed after showing us that another way of caring was possible.

What remains now is an ethical and political contradiction. If community care proved capable of saving millions of lives, why was its erosion allowed? Blaming external pressures alone obscures the responsibility of States that did not reform, did not decentralize, and did not democratize their decisions when there was still time. But abandoning the model entirely would mean accepting systems where care once again becomes a market privilege. The future of health in Cuba, Venezuela, and the broader Caribbean region will depend on whether we are able to recover the spirit of those projects, learning from their limits: less verticalism, more transparency, and communities not as passive recipients, but as true co-architects of their own well-being. ■