Challenges and achievements of the health sector in Cuba during a complex and adverse 2024.

The year 2024 has presented a true challenge for the health sector in Cuba, facing multiple adversities that have tested the resilience of its professionals. The energy contingency, accompanied by the devastation caused by hurricanes Oscar and Rafael, as well as earthquakes in the eastern region, have created a complex context for medical care in the country. Additionally, the impact of the unilateral coercive measures imposed by the United States has hindered the necessary financing to ensure an adequate supply of medical supplies. Despite these difficulties, the commitment and dedication of over 400,000 health workers have allowed the vitality of medical services to be maintained. However, various dissatisfactions in the care of the population remain, resulting from both objective and subjective problems that persist in health institutions. There are reports of a systematic effort to raise the quality of care, although shortages are still palpable. A positive aspect amid adversity has been the Maternal and Child Care Program, which has managed to reduce the infant mortality rate to 7.0 per thousand live births, a figure that reflects a significant advance compared to the previous year. This achievement is a testament to the hard work and commitment of the medical staff, who, despite limitations, continue to provide quality care to the most vulnerable populations. In the realm of infectious diseases, a mortality rate of 0.9% and a prevalence of HIV/AIDS at 0.40% have been reported. The Cuban health system continues to provide antiretroviral treatments free of charge, as well as access to testing and pre-exposure prophylaxis services in 36 polyclinics. Health promotion campaigns have been key in informing the population about the proper use of condoms and the importance of seeking health services for any symptoms. Epidemiologically, the country has faced active transmission of arboviruses such as dengue and Oropouche, the latter being detected for the first time in May of this year. Health authorities have closely monitored the situation, recording a considerable number of hospitalized patients, some in serious condition. However, most suspected cases of Oropouche are receiving home treatment, indicating that not all patients present alarming clinical conditions. The vaccination schedule for 2024 has been updated to include new vaccines, such as the Pneumosil-10 pneumococcal vaccine, which protects children under one year of age. Additionally, vaccination against the human papillomavirus will begin in 2025 for girls aged nine, promising to be an important step in the prevention of cancers related to this infection. Primary health care has seen an increase in medical and dental consultations, as well as a rise in home visits. This is an indicator of the effectiveness of the Family Doctor and Nurse Program, which aims to bring health services closer to the population, especially in rural areas. The implemented strategies have improved service organization and strengthened the human capital of the system. The growing prevalence of chronic diseases has led authorities to emphasize the importance of prevention and timely diagnosis. A "silent epidemic of obesity" has been declared, and measures have been taken to actively seek out individuals with risk factors. Therapeutic education has become a priority, aiming for patients to understand their illnesses and commit to maintaining an adequate quality of life. Meanwhile, Cuban health collaborators continue their altruistic work abroad, with over 25,000 professionals working in 56 countries. This effort has been accompanied by international support in the form of medications and supplies, reflecting the solidarity that characterizes the international community towards Cuba amid its difficult economic situation. Mental health care has also been a priority this year, with the development of a wide network of psychiatric services in hospitals and polyclinics, specializing in various populations. The promotion of mental health, along with comprehensive care for the psychological needs of the population, has become a pillar of the Cuban health system. Finally, recognition of the efforts of health workers has been a central element in this year's agenda. From November 8 to January 15, 2025, various activities have been carried out to honor those who have dedicated their lives to the well-being of the people, highlighting their commitment and contribution to the development of medicine in Latin America. This recognition is not only a reflection of gratitude but also an impetus to continue striving for a more robust and equitable health system.