The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children’s growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children.
Cuba’s infant mortality rate has remained <5 deaths per 1000 live births for 10 consecutive years, and in 2017 reached 4 per 1000, the lowest rate to date. The mortality rate for children aged <5 years in 2017 was 5.5 per 1000 live births, with a survival rate of 99.5%; low birth weight was 5.1% and vaccination coverage >95%. Among children aged 1 year in Cuba’s Educate Your Child program in 2014, >90% met age-specific indicators in all four developmental domains (intellectual, motor, socioaffective and language). Cuba has universal coverage for antenatal care and, in 2017, 99.9% of births occurred in health institutions. All working mothers receive paid antenatal leave from 34 weeks of gestation, continued through the child’s first year, to facilitate breastfeeding and child care. In 2018, the Cuban government allocated 27% of its national budget to health and social welfare and 21% to education.
KEYWORDS Growth and development, child development, child health services, preventive health services, primary health care, pregnant women, children, child rearing, intersectoral collaboration, Cuba
El notable incremento de las tasas de supervivencia de los niños cubanos ha conducido a nuevos desafíos en la búsqueda continua de mejorar su bienestar y calidad de vida. Solamente se pueden alcanzar estos avances en la medida en que también se mejoren la atención preventiva y la promoción de salud. Este artículo describe el diseño de una estrategia para la atención integral de niños y adolescentes que tiene como base mejorar la calidad de las consultas, definir sus componentes, las actividades específicas según la edad y brindar las pautas para el seguimiento en función de los hallazgos de las consultas. Como complemento a la estrategia, se identifican los indicadores y estándares para la evaluación sistemática de la calidad de la consulta, lo que permite recoger información objetiva y específica de cada consulta individual y la evaluación de las tendencias en el tiempo. Esto, a su vez, permitirá mejorar aún más esta estrategia a largo plazo.
PALABRAS CLAVE Servicios de salud infantil, servicios preventivos de salud, atención primaria de salud, mortalidad infantil, supervivencia, niños, adolescentes, Cuba
The notable rise in survival rates of Cuban children has presented new challenges in the search for continued improvement of their welfare and quality of life. These advances can be achieved only to the extent that preventive care and health promotion are also improved. This article describes the design of a strategy for comprehensive care of children and adolescents based on better quality of well child visits, defining visit components, age-specific activities for each visit, and guidelines for followup based on visit findings. Complementary to the strategy, indicators and standards are identified for systematic evaluation of visit quality, enabling collection of objective and specific information about individual visits and assessment of trends over time, which in turn facilitates further improvements in this strategy over the long term.
KEYWORDS Child health services, preventive health services, primary health care, infant mortality, survival, children, adolescents, Cuba
