Medical training for universal health coverage: a review of Cuba-South Africa collaboration.

Achieving improvements in Universal Health Coverage will require a re-orientation of medical education towards a stronger focus on primary health care. Innovative medical curricula have been implemented in some countries, but in many low- and middle-income countries (LMICs), the emphasis remains focused on hospital and speciality services. Cuba has a long history of supporting LMICs and has made major contributions to African health care and medical training. A scheme for training South African students in Cuba was established 20 years ago and expanded more recently, with around 700 Cuban-trained graduates returning to South Africa each year from 2018 to 2022. The current strategy is to re-orientate and re-train these graduates in South African medical schools for up to 3 years as they are perceived to have inadequate skills. This negative narrative on Cuban-trained doctors in South Africa could be changed dramatically. They have highly appropriate skills in primary care and prevention and could provide much needed services to rural and urban under-served populations whilst gaining an orientation to the health problems of South Africa and strengthening their skills. Bilateral arrangements between South Africa and the United Kingdom are providing mechanisms to support such schemes. The Cuban approach to medical education may have lessons for many countries attempting to meet the challenges of Universal Health Coverage.

Cuban medical training for South African students: a mixed methods study.

BACKGROUND: Achieving universal health care coverage will require greater investment in primary health care, particularly in rural and underserved populations in low and middle-income countries. South Africa has invested in training black students from disadvantaged backgrounds in Cuba and large numbers of these Cuban-trained students are now returning for final year and internship training in South Africa. There is controversy about the scheme, the quality and relevance of training received and the place of Cuban-trained doctors in the health care system. Exploring the experiences of Cuban- and South African-trained students, recent graduates and medical school faculty may help understand and resolve the current controversy. METHODS: Using a mixed methods approach, in-depth interviews and a focus group discussion were held with deans of medical schools, senior faculty, and Cuban-trained and South African-trained students and recent graduates. An online structured questionnaire, adapted from the USA medical student survey, was developed and administered to Cuban- and South African-trained students and recent graduates. RESULTS: South African students trained in Cuba have had beneficial experiences which orientate them towards primary health care and prevention. Their subsequent training in South Africa is intended to fill skill gaps related to TB, HIV and major trauma. However this training is ad hoc and variable in duration and demoralizing for some students. Cuban-trained students have stronger aspirations than those trained in South Africa to work in rural and underserved communities from which many of them are drawn. CONCLUSION: Attempts to assimilate returning Cuban-trained students will require a reframing of the current negative narrative by focusing on positive aspects of their training, orientation towards primary care and public health, and their aspirations to work in rural and under-served urban areas. Cuban-trained doctors could be part of the solution to South Africa's health workforce problems.

Public participation in decision-making on the coverage of new antivirals for hepatitis C.

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.