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Acknowledgements

Cuba’s process of social development has been at the center
of the ongoing debate about the merits, the failures and
the challenges of the Cuban socialist experiment of the last
four decades. In writing this piece, that powerful history of
documentation and struggle by scholars and policy makers
in and out of the island was a presence, and my first
appreciation is for their work. For the possibility of exploring
this topic I thank, first of all, Oxfam America and its Cuba
Program Officer Minor Sinclair. Sinclair, I and our families
shared many times in Cuba during “the special period”
and, thankfully, his perspective is present in this document.
Most special thanks go also to Georgina Chabau, Jesus
Ramos, Gina Rey and Rosa Oliveras who provided material
and helped arrange interviews in Cuba. David Diaz
Carbo, Lorena Barberia, Rafael Betancourt, Rosa Oliveras,
Mario Coyula and Alfredo Prieto read the manuscript or
commented on presentations of the material. I thank them
for their input. Thanks also go to Jim O’ Brien and Lori
Anne Saslav who edited the manuscript; Izakun Gaviria, Jeff
Deutsch, Jennifer Wilder, Kevin Pepper, and Martha Thompson
of Oxfam America who brought the publication process to
the end.

Oxfam America gratefully acknowledges The Ford Foundation
for the funding of this report.

Cover illustration: Isabel Gimeno

INTRODUCTION

From the beginning of the Cuban revolution in 1959, the model of social development
has underscored equity across society and universal access. Full responsibility rests on
government to fund and deliver social entitlements. These values have framed the
development and implementation of social policy during the last 40 years. During this
time Cuba has instituted free and universally accessible health care and education and has
built on its formerly weak pension system to develop a universal and government-sponsored
one. Cuba’s safety net of benefits includes protection of workers’ employment and housing,
food subsidies, utilities and other necessities, and mechanisms to assist vulnerable families
without stigma. The results have been quite positive. Adult literacy is nearly 96%, and
schooling rates have risen dramatically. Infant mortality has decreased, drug use and
crime are subdued compared with other countries, and youth violence is minimal.
Cubans feel these effects in their daily lives, and for many these transformations mean
that the revolution is working for them.

In 1990, Cuba spent 20.08% of its gross domestic product on social benefits including
social security, health, and education

; an amount greater than that spent by Japan,

Australia, and the United States

(Latin American countries averaged 10.4%

). Suddenly,

in 1989 the collapse of socialism in Europe, and particularly in the Soviet Union,
fundamentally altered the Cuban economy most particularly through the loss of Cuba’s
import capacity, which plunged by 75%. As Cuba attempted to cope with the crisis,
Washington tightened its embargo and curtailed trade even further. These two events
together had the force of an earthquake on the economy. In the countryside, agricultural
production practically stopped, causing serious food shortages. In the cities, public
transportation almost disappeared, as did gasoline for private cars. Throughout the
island, electricity was closely rationed. As Cuba weathered the economic crisis of the
1990s, many questioned whether continued financial commitment to the values of
universality and government responsibility for social benefits would be possible and
whether the wide range of benefits they had spawned would survive under such a deep
and all-encompassing crisis.

The answer, thus far, has been yes. The system has held, though somewhat battered and
facing even more challenging problems. When the ground stopped shaking, it became
evident that there was strong political will to maintain Cuba’s safety net. Cuban television
announcers often exclaimed, “Not one hospital has been closed, not one teacher has lost
a job,” and that has been true.

Throughout the 1990s, the share of Cuba’s gross domestic product spent on social
programs increased by 34%. But despite this level of funding, the system strained in the
face of higher demands and decreased buying power of these resources. Today, delayed
maintenance of hospitals and schools is a major problem. Shortages of medicines, medical
equipment, and schoolbooks limit health care and education. Nutrition levels remain
far below what they were in 1989. Most critically, the last decade has brought complex
social changes that challenge Cuba’s commitment to equity. Rapid changes in income

INTRODUCTION

Despite the economic crisis, people have
found ways to adapt with few resources
available. Here school children play
handball on a Havana street.

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CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

distribution have brought new wealth and a growing set of economically vulnerable
families, who have placed additional demands on an already strained system.

In today’s Cuban economy, even a strong political will has to come to grips with economic
imperatives in ways that Cubans have seldom experienced. And it has to do so in an envi-
ronment where social differences are far more prevalent than they were just a decade ago.

Up to now, Cuba has achieved positive
social outcomes by spending large
amounts of money on services. Now, they
must find new ways to achieve such
results. Cuba does not possess infinite
resources, and it faces an escalating set of
demands. The new economic environment
requires efficiency as well as effectiveness.

Strong indicators signal that leaders will
not seek efficiencies either by reducing
services or by privatizing them. Cuba is
choosing instead to take the harder road,
that of transforming the framework and
the delivery of services. As Cuba develops
effectiveness that does not rely solely on
the massive deployment of resources, it
will need to use its great reservoir of
experience in approaching problems
preventively. But it will also need to

develop the mechanisms to identify local needs, focus resources, and respond agilely
with appropriate services.

There are indications that the system, although strongly relying in its universal reach,
is slowly introducing new and more differentiated initiatives. Cuba has always attended to
the needs of specific populations – women, children, and the disabled, for example.
But what is new is the growing recognition that universal policies and centralized initiatives
alone, as successful as they had been in addressing social problems in the past, may miss
the particular needs of specific areas and of new vulnerable populations in this more
difficult environment.

As new complex problems challenge the social system, solutions are being developed with
more collaborative and integrated approaches, especially at the level of service delivery.

Finally, the experience of the local community development movement of the last decade
offers an emerging model of small-scale, place-based, participatory planning and
monitoring of services, which could greatly complement the reach and effectiveness of
current models of service delivery. The experiences at the community level have developed
useful methods that include:

These women participate in a community
based housing rehabilitation project in
the Havana municipality of Marianao.
Over half of Havana’s housing is in need of
repair or replacement. Self-help housing
repair brigades are one of the community-
based responses to this challenge.

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• A close focus on families and communities;

• Horizontal collaboration and coordination of activities between local entities;

• Connecting families and communities to enhanced community networks;

• Developing the capacity of residents and local government to participate in local policy

development and in the monitoring of local services.

Cuba faces these challenges armed with a considerable accumulation of strengths. First
of all, Cubans know how to take care of their own. In a relatively short period of time,
they drastically improved and maintained the health status of the nation, virtually
eradicated illiteracy, and developed one of the most educated workforces in the hemisphere.

With this extraordinarily high level of education, Cubans have proven to have a high capacity
for innovation and transformation that should not be underestimated. This has been
demonstrated over the past 40 years, but certainly never more than since the beginning
of the Special Period. Through major endeavors, such as the transformation of the
economy, the urban agriculture movement and development of environmentally sound
agricultural practices, and the application of alternative energy sources, Cubans have
proven capable of adaptation and invention in the face of adversity.

Finally, the values of equity and responsibility that have framed the development of social
policy in the past, and the practice of constructing a humane and equitable society, will
continue to serve Cubans well as they face the challenges of the future.

This Report

Chapters One, Two, and Three of this report offer an analysis of Cuban social policy
and its outcomes during the last 40 years. This analysis examines the impact of the crisis
of the 1990s on Cuban society, as well as the social benefits of economic measures
instituted to address the crisis.

This analysis, and draws on existing data from sources including the World Bank and
the United Nations, Cuban statistics, and the writings of social policy analysts both
inside Cuba and abroad.

Chapter Four analyzes the “different way of working” that has begun to emerge in the
delivery of Cuban social services. This section draws on the work of Cuban social policy
analysts and researchers working on community development, as well as from the
author’s own research on community development processes on the island.

INTRODUCTION

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

1. “THE RIGHT PRIORITIES: HEALTH,

EDUCATION, AND LITERACY”

When Cuba’s revolution came to power in 1959, its model of development aimed to
link economic growth with advances in social justice. From the start, transforming
economic changes were accompanied by equally transforming social initiatives. For example,
in 1959, Cuba carried out a profound agrarian reform which ended

latifundia

in the

island and distributed land to thousands of formerly landless small farmers. Alongside
this fundamental reform were programs directed at providing health care and education
to the farmers and their families. A national health system and its rural health services
were introduced in 1959; only 8% of the rural population had access to health care at that
time.

The National Literacy Campaign of 1961, recognized as one of the most successful

initiatives of its kind, mobilized teachers, workers, and secondary school students to
teach more than 700,000 persons how to read. This campaign reduced the illiteracy rate
from 23% to 4% in the space of one year.

Initiatives in the cities were no less ambitious. Urban reform brought a halving of rents for
Cuban tenants,

opportunities for tenants to own their housing, and an ambitious

program of housing construction for those living in marginal shantytowns. New housing,
along with the implementation of measures to create jobs and reduce unemployment,
especially among women, rapidly transformed the former shantytowns.

The swift pace of change of the early years gave way to more measured advances, but
the values that framed those initiatives have greatly influenced the body of social policy
in Cuba. Cuban social policy is characterized by its emphasis on

universal coverage

and

reach for all programs and for all educational, health, and social benefits. These are seen
as part of a “social wage” that workers accrue in addition to their monetary wage.

Social policy has also favored the development of

equity

across society, including the

equitable distribution of benefits across all sectors of the population, sometimes favoring
the most vulnerable. In the last 40 years Cubans have greatly reduced differences in
income between the lowest and the highest paid persons.

Women have benefited

significantly from the revolution as they have educated themselves and entered the
labor force in large numbers.

The differences among Cubans of different races have also

been reduced.

Cuban social policy is also characterized by

the exclusive participation of the

public sector

in its development and execution. The government assumes responsibility

for financing social programs and for providing all social benefits.

The programs and subsidies that make up Cuba’s safety net cover its citizens from cradle
to grave. They have led the island to outcomes that, especially in health and education,
are almost universally recognized as positive. The 1999 Human Development Index
(HDI)

, which measures basic dimensions of human development – longevity, knowledge,

and a decent standard of living – ranked Cuba 58 out of 174 countries. Primary

“Cuba’s achievements in social

development are impressive

given the size of its gross

domestic product per capita.

As the human development

index of the United Nations

makes clear year after year,

Cuba should be the envy of

many other nations, ostensibly

far richer. [Cuba] demonstrates

how much nations can do with

the resources they have if they

focus on

the right priorities –

health, education, and literacy.”

Kofi Annan,

Secretary General

of the United Nations – April 11, 2000

Women in Cuba are integrated into all levels
of the workforce. These women are members
of the “Soy Brigade” in Palma Soriano, in
the province of Santiago de Cuba.

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CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

indicators for Cuba were: life expectancy at birth (75.7 years), adult literacy rate
(95.9%), combined enrollment in school (72%), and per capita income (est. $3100).

The Human Poverty Index for Developing Countries ranked Cuba 5th out of the 90
developing nations considered in the analysis in 1997. For Cuba the indicators included
the percentage of people not expected to live to age 40 (4.5%), the adult illiteracy rate
(4.1%), the percentage of people without access to safe water (7%), the percentage
without access to health services (0%), and the percentage of underweight children
under 5 (9%).

TABLE 1

Summary of key policies and benefits in
the areas of education, health, social
security, and social assistance, 2000

Sources: (a) Centro de Investigaciones de la
Economía Mundial, 2000, pp. 79; Lutjens,
2000, p.56-57; (b) Centro de Investigaciones
de la Economía Mundial, 2000, p. 98; (c) Centro
de Investigaciones de la Economía Mundial,
2000, pp. 69 and 73; Mesa-Lago, 1997, p. 505;
(d) Centro de Investigaciones de la Economía
Mundial, 2000, p. 74; (e) Centro de Investiga-
ciones de la Economía Mundial, 2000; Segre,
Coyula, and Scarpacci, 1997; Ferriol, 2001.

POLICIES

Education is a right of Cuban citizens.

Education is delivered free at every level, including post-secondary and
graduate education.

There is universal access to primary education and secondary technical or
pre-university education, including special education for those who need it.

Access to programs of study at the university and post-graduate levels takes
place through competition. Availability of slots is closely linked to economic
priorities and needs.

The delivery of education is the sole responsibility of the state, which is
charged with assuring the access of all citizens to the educational system
and developing and maintaining a network of educational institutions of all
levels across the island. Every level is guided by a national program.

There is an emphasis on the educational value of work, and students are
encouraged to participate in study-work experiences, which usually take
place in the countryside.

Health is a right of Cuban citizens and is delivered free of charge at all levels.

The delivery of health care is the sole responsibility of the state, which is
charged with assuring the access of all citizens to primary, secondary, and
tertiary care as well as with developing and maintaining quality health care
services at all levels across the island.

Strong commitment to primary prevention and to a decentralized delivery of
health services.

State backed universal retirement pension program; employers pay 10% con-
tribution. Retirement age is 55 for women and 60 for men.

Disability benefits encompass coverage for work-related disability, accidents,
and illness as well as common accidents and illnesses for all workers; cover-
age for temporary disability.

Encompasses means-tested cash subsidies and services for families without
economic support.

Universal food subsidies through a ration card that in 2000 covered about
65% of the nutritional needs of the population. Special “diets” are available
for children, pregnant women, the elderly, and those with illnesses requiring
special nutrition.

Caps on rent at 10% of the income for housing; subsidies for mortgages.

Subsidies on utilities including water, electricity, gas, telephone.

AREA

Education

Health

Social Security
and Disability

Social Assistance

Subsidies

In the following section we review the benefits available to Cubans and the outcomes
that these benefits have afforded them. In the area of health and education, where com-
parative data is readily available, comparisons are presented along several indicators
between Cuba and other countries in the hemisphere.

The analysis compares Cuban

indicators with those of Canada and the United States, both developed nations in the
Americas; with Costa Rica, one of the Latin American nations with the highest level of
human development; and with the Dominican Republic, one of Cuba’s closest neighbors
in the Caribbean.

Health Care

Health care is considered a right of Cuban citizens and is provided free of charge. Health
care was nationalized in Cuba in 1961, although some physicians continued
to operate privately and a very small number still do so today.

When, in 1959, Cuba

began the process of transforming the health status of its population, it faced some
important challenges. First of all, most health care was concentrated in urban areas,
and was offered through a network of private clinics and a weak public system that was
generally regarded as deficient. Second, in the first years after the revolution, about
one-half of the physicians left the country, many in the wake of the socialization of
medicine. Cuba was left with the burden of caring for its people with greatly diminished
resources and the need to train almost all its medical personnel. But it was also left with
the opportunity to develop a health care system from the ground up. And it developed
a system that has attracted the attention of the world for its reach, its access, and its
orientation to prevention. Health outcomes worsened during the first decade of the
revolution as the system was put in place, but outcomes recovered by 1970 and have
continued to improve to this day.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

1960

1970

1980

1990

2000

1960

1970

1980

1990

2000

FIGURE 1

Infant mortality rate, 1960 to 2000
(out of 1000 live births)

Source: World Bank, 2001.

FIGURE 2

Mortality for children under 5 years,
1960 to 2000
(out of 1000 live births)

Source: World Bank, 2001.

Right:

A family doctor checks an infant

in a well baby clinic in Havana.

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CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

The Ministry of Public Health directs the activities of the health system, which includes
specialized medical research and treatment institutions as well as a highly decentralized
system of health care.

Its greatest strengths lie in its universality, accessibility, and

orientation to primary care and primary prevention. The entry to the health care system
was traditionally the community polyclinic located in every neighborhood, with a
mission of providing accessible primary health care akin to that of a public community
health center in the United States. From the polyclinic, Cubans, depending on their
need, had access to specialists and highly sophisticated treatment.

Beginning in 1983, primary care was transformed by the arrival of the “family doctor,” a
primary care physician who lives and works in the community. The doctor is provided
with a home, an equipped medical office, and the assistance of a nurse. He or she
attends to about 250 families. Family doctors provide primary care in their offices and
conduct home visits, following closely all pregnant women and newborns, children,
those with chronic illnesses, the elderly, and those recently released from the hospital.
Family doctors are linked to neighborhood polyclinics, which provide more sophisticated
care and access to specialists. Family doctors conduct primary care and primary prevention
activities in rural and urban areas and today cover most of the island.

Selected Health Outcomes

Infant mortality is an internationally recognized indicator of human well-being because
it taps both the quality of health care available to mothers and newborns, and the many
variables – such as poverty and access to food – that affect the health status of mothers
and babies. In the 1950, infant mortality stood at 35 deaths for every 1,000 live births
in Cuba. After rising slightly in 1970, infant mortality rates have declined dramatically
(see Figure 1). Even during the 1990s, when Cuba suffered through a very serious
economic crisis, the infant mortality rate continued to decline. In 1999, Cuba reported
an infant mortality rate of 7.2 deaths per 1,000 babies born alive. This rate is comparable
only to that of the United States and Canada in this hemisphere (see Table 2).

CUBA

CANADA

COSTA DOM U.S.

RICA

REP

Per capita gross domestic product

2,208

20,822

2,942

2,091

32,778

Infant mortality rate (per 1K children)

7.0

Under 5 mortality rate (per 1K children)

8.0

Life expectancy at birth (in years)

75.7

70.6

76.7

Adults living w/ HIV/AIDS (% of 19-49)

0.03

0.3

0.5

2.8

0.6

Physicians (per 1K persons)

5.18

2.1

.85

1.5

2.6

TABLE 2

National comparison of selected
health indicators, 1999

Source: United Nations Development
Program, 2001.

100

1980

1990

2000

DPT

Measles

FIGURE 3

Immunization for DPT and measles
(%) 1980 to 2000

Source: World Bank, 2001.

1960

1970

1980

1990

2000

FIGURE 4

Life expectancy at birth, (yrs)
1960 to 2000

Source: World Bank, 2001.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Other health indicators are equally improved. Mortality for children under five years was
54 deaths per 1000 children in 1960 and only 8 deaths in 1999. Child deaths are often
due to infectious diseases, many of which have been eradicated in Cuba through
immunization campaigns, country wide control of vectors, and widespread health
education. By 1990, Cuba had eradicated measles, rubella, typhus fever, and diphtheria,
and had significantly lowered the incidence of tetanus and tuberculosis.

Children are

vaccinated for diphtheria and measles before they are a year old at rates that rival those
of Canada and the United States.

The life expectancy of Cubans has increased and today stands one percentage point
lower than that of the far more wealthy United States. Life expectancy for Cubans is
slightly lower than that of Costa Rica and higher than that of the Dominican Republic.

Today Cubans die of the types of diseases that cause the death of persons in developed
nations: heart disease, cancer, and strokes, leaving behind the infectious diseases that are
the most prevalent causes of death across the Third World, and were the third and
fourth causes of death for Cubans before 1959, according to Cuban statistics (see
Table 3).

Education

Education is also considered a right of every citizen and is provided free of charge at every
level. The Cuban educational system includes pre-primary, primary (1 to 6), secondary
(7 to 9), and pre-university or technical/professional education (10 to 12). University
education is also available. The evolution in this area is similar. In 1959, the educational
attainment of Cubans stood at third grade. Forty-five percent of primary school children did
not attend school, and 23% of the population over 10 years old was illiterate. The National
Literacy Campaign reduced the illiteracy rate to 4% in 1961; the illiteracy rate in Cuba
has remained under 10% and today stands at 6.8% of the population (see Figure 5).
According to the United Nations, the rate of literacy among people 15 and older in
Cuba was 97%, compared to 99% in Canada and the United States, 96% in Costa Rica,
and 83% in the Dominican Republic (see Table 4).

In the 1960s and 1970s, schools were constructed, and a system of scholarships was
instituted that assured that all children, regardless of where they lived or the economic
situation of the family, would be able to attend school. The number of children in the
labor force, low even in 1960 when compared to Latin America as a whole,

first

decreased and then dropped to zero (see Figure 6) as the availability of schools led to

FIGURE 5

Illiteracy rate (%), 1958 to 2000

Source: World Bank, 2001.

1958

1970

1980

1990

2000

1958

2000

Heart Disease

Malignant Tumors

Diarrheic Illnesses

Cerebrovascular Diseases

Childhood Diseases

Accidents

Cerebrovascular Diseases

Influenza and Pneumonia

TABLE 3

Most prevalent causes of death
in Cuba, 1958 and 2000

Sources: (a) Centro de Investigaciones de la
Economía Mundial, 2000, p. 104; (b) Oficina
Nacional de Estadísticas, 2001, p. 65.

The government assigns children a liter
of milk a day up to age five. In a rural
community in La Florencia, in the province
of Ciego de Avila, a woman holds her child
while waiting to receive their milk.

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CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

dramatic increases in the rates of enrollment in primary, secondary (high school), and
tertiary (university or professional school) education.

Pre-primary school enrollments increased from 52% in 1970 to 94% in 1995. In 1980,
98.8% of the children 6-11 were attending primary schools.

Enrollments in secondary

education also climbed from 14% in 1960 to a high of 90% in 1990 (see Figure 7).
In the 1990s, during the economic crisis, these rates fell somewhat, due primarily to higher
dropout rates particularly in the technical schools. The dropout rate for all pre-university
and technical schools is 8%.

Today, educational attainment for Cubans stands at the

ninth grade.

The educational system from pre-primary to grade 12 is administered by the Ministry
of Education. Curriculum is guided by a national program; this has provided a uniform
set of guidelines and has resulted in a pretty homogenous level of preparation across the
country. This was meant to offset the differences in the quality of education available
for children in different areas, especially between urban and rural schools and between
historically more and less affluent urban neighborhoods.

Total enrollments at all levels of education – primary, secondary, and pre-university or
technical professional – stand at 76% of the population of appropriate age. Compared
to the other countries selected for comparison, Cuban rates fall between the high
enrollments found in Canada and the United States (97% and 95%, respectively) and
the much lower ones found in Costa Rica (67%) and the Dominican Republic (72%).

TABLE 4

Comparison of selected education
indicators, 1999

Notes and sources: (a and d) United Nations
Development Program, 2001; (b) United
Nations, Statistics Division, 2001; No data is
available for United States and Canada;
(c) World Bank, 2001; (e) Combined enrollment
ratio includes gross primary, secondary, and ter-
tiary enrollments.

CUBA

CANADA

COSTA DOM U.S.

RICA

REP

Per capita gross domestic product

2208

20822

2942

2091

32778

Adult literacy rate (15% and above)a

Youth illiteracy rate (15%-24%) b

—

1.7

8.9

—

Children 10%-14% in the labor force c

4.13

13.22

Combined Enrollment Ratio (%) d, e

97%

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1960

1970

1980

1990

2000

FIGURE 6

Children under 14 in the labor force
(%), 1960 to 2000

Source: World Bank, 2001.

1960

1970

1980

1990

1996

100

FIGURE 7

Enrollment in secondary education,
1960 to 2000 (%)

Source: World Bank, 2001

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Enrollment in Cuban universities is highly competitive. Access to programs of study at
the university and post-graduate levels is granted through competition. Availability of
slots is closely linked to economic priorities and may not always respond to students’
choices. Enrollments in higher education increased from a low of 7% in 1970 to a high
of 21% in 1990. These enrollments were strongly affected by the economic crisis of the
1990s, dropping to 12% in 1996.

Nevertheless, the educational attainment of Cubans has translated into a highly educated
workforce: of all Cuban workers, 14% have a university degree.

There were 37 insti-

tutions of higher education in Cuba, including general, technological, and pedagogical
universities, all under the direction of the Ministry of Higher Education.

Social Security, Retirement Benefits, and Disability

Cuba’s social security entitlement consists of a state-backed old age and disability pensions
and survivors insurance that is accessible to all Cuban workers, including agricultural
workers. Pensions are proportional to salary and time worked, and minimum and
maximum pensions maintain significant equity among beneficiaries. At a retirement age

CULTURE FOR ALL

Another area that strongly reflects the uni-
versality present in Cuban social policy is
arts and culture. As early as 1959, several
new cultural institutions were founded in
Cuba that would become important to the
development of art and culture across Latin
America: Casa de las Americas, the Cuban
Institute of Cinematographic Arts and
Industry (ICAIC), the National Theatre, the
National Ballet, the National Symphonic
Orchestra, and the National Folkloric Group.
The literacy campaign also raised Cuban
capacity to fully engage in the arts and cul-
ture. These developments alone would have
enhanced the life of the Cuban people. But
what has most characterized the process of
cultural development in Cuba is the massive
participation and access to arts and culture
that is available to the Cuban people.

Cuba has made significant investments in
the development of a system dedicated to
training in the arts, to the development of
artistic and cultural expression, and to the
enabling of Cubans to both participate and

enjoy arts and culture. A critical premise has
been that culture in Cuba has not been as
highly commercial as we experience it
elsewhere in the world. Movies and concerts
are still easily affordable, for example,
although the increase of tourism on the
island has created affordability barriers to
some cultural venues.

But the most important vehicle for popular
participation in the arts is the national system
of art education that operates free of charge
through primary and secondary schools,
specialized art schools and high schools,
university-level art education, and the Casa
de la Cultura, which is an art institution
present in every municipality. The Casa de la
Cultura offers free and low-cost art lessons
for children and adults and provides space
for exhibitions and performances. Cuba has
a strong movement of

aficionados

that

promotes and organizes artistic expres-
sion from all sectors of population, but
especially youth.

Cubans have created a vibrant identity
through music, dance and art. Here the
lead singer of Anacaona, the first Afro-
Cuban all women salsa band, rehearses
for their new CD.

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CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

of 55 years for women and 60 years for men, 1,352,200 Cubans were receiving pensions
in 1995, about 12.3% of the population. A minimum pension is 94.61 pesos a month,
close to the 100 pesos of minimum salary and about 49% of the median salary for
Cuban workers.

Both coverage and distribution have improved significantly since the revolution. With
a pension system since the 1930s, Cuba was one of the first Latin American countries
to establish one.

It consisted of independent pension funds and by 1959 covered about

63% of workers,

but the system varied greatly in terms of benefits and relied almost

exclusively on workers' contributions. Since 1959, the program has been funded
completely by the government. In 1958, about 63% of the labor force was covered for
old age, disability, and survivors insurance; today, the coverage is universal.

Social security is a major concern in a country whose population is aging very rapidly.
Ten percent of Cuba’s population was over 65 years of age in 2000, just slightly under
the 12.7% that are over that age in the United States.

A longer life expectancy and the

over-representation of the young among emigrants are contributing factors. Projections
from the World Bank show that by 2040, Cuba’s population 65 years and over will
account for 26% of the population, the fastest-growing group within the cohort being
those persons over 75 (see Figure 8) . By comparison, those over 65 in the United States
will account for only 20.4% of the American population.

Social Assistance Benefits for Persons of Low Income

For families without economic support, the government provides social assistance
through cash subsidies and special services. In order to become eligible, families have to
demonstrate that they are not capable of generating enough income to maintain their
families. Beneficiaries include single mothers with young children who cannot obtain
adequate child care; families of deceased workers who are eligible for death benefits; and
elderly workers who retire without having met the minimal time required for a social
security pension.

If a family needs additional services, such as special schools for at-risk adolescents or
special services for the elderly, these are provided preferentially by the municipal entities
charged with those services. Other benefits offered include meals and laundry services
for poor elderly and job training for mothers without a source of income. The latter also
receive preference in obtaining day care and scholarships for their children.

Universal Subsidies

In addition, Cubans are covered by several subsidies that are also universally available
and provided by the central government. These include subsidized food available to all
through the ration card (see

La Libreta:

The Cuban Ration Card); subsidized meals at

schools and work places; subsidies in the cost of water, gas, and electricity; subsidized

2000

2010

2020

2030

2040

65-74

over 75

FIGURE 8

Projected growth of Cuban population
65 to 74 years and over 75 years,
2000-2040. (%)

Source: World Bank, 2001

slots in day care for children of working mothers, and subsidies to rents and mortgages
(see Housing Policies: A Closer Look, above). These subsidies add significant strength
to the Cuban “safety net.”

The Role of Government

During the early 1960s, the process of nationalization brought all areas of health care
delivery and education under the control of Cuba’s central government. Over the last 40
years, the system has developed along a socialized model funded completely by the
central government.

During the economic crises of the 1980s and 1990s, many national governments
underwent processes of decentralization and devolution. Responsibility for social policy

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

HOUSING POLICIES: A CLOSER LOOK

A continuing challenge for Cuba has been
to provide sufficient and adequate housing
for its growing population. Although there
have been improvements in the cost of
housing and in its distribution across the
island, the housing deficit is significant.

Housing in Cuba is not a commodity that
is bought and sold privately in the market;
it is a benefit, although not an entitlement.
One of the revolution’s first initiatives was
to reduce the rents of tenants and to
provide the means by which renters could
become home owners. Rents are capped at
10% of a family’s income, except in the
case of the elderly or those who are sick,
who pay somewhat less. Today fewer than
10% of families are renters; most Cubans
own or are buying their own home.

Housing is largely the responsibility of the
government, which is supposed to build it
and maintain it. But this is an area in which
there has been considerable delegation of
responsibility to lower levels of govern-
ment. Construction micro-brigades, made
up of workers from specific work centers
volunteered to construct very simple
housing that was then distributed to
families of the workers, constructed a
significant amount of housing across the
country in the 1970s and 1980s. Currently,

social micro-brigades, made up of both
professional and volunteer construction
workers, construct housing for municipali-
ties, which are then charged with their
distribution. But beginning in the 1980s,
families themselves became the most
active sector in construction as they
began to build, expand, and renovate their
own housing.

Policy has tended to favor the construction
of government housing away from the
capital and in the countryside. Nevertheless,
throughout the island, but especially in
urban areas and most critically in Havana,
housing remains a serious deficit. Many
households are greatly expanded with
family members who are unable to obtain
independent shelter. In Havana, more than
16% of the households had more than six
persons in 1995 and about 3% of the
homes housed more than one household.
“In the City of Havana,” writes demographer
Maria Elena Benitez Perez, “are concen-
trated – and in very large numbers – all the
problems we face in the area of housing: it
has the largest concentration of tenements,
the largest number of marginal neighbor-
hoods, and a very large amount of housing
in bad condition.”

has in some cases been passed on to lower levels of government and in others to private
entities outside of the central government’s direct control. Although Cuba has resorted
to some decentralization of its economic activity, there is no noticeable effort in this
direction in the arena of social policy. Cuba’s central government remains firmly in control
of social policy, and the delivery of service remains firmly in the public sector.

In fact,

most Cubans are quite proud of the public control of social policy and service delivery;
health, education, and social security are seen as some of the most important accom-
plishments of the last four decades.

Cuba’s government is organized as a three tier system – national, provincial, and munic-
ipal – and at all levels there are policy making and legislative structures as well as
administrative ones. But power is heavily centralized. At the national level, the National
Assembly of Popular Power, the highest legislative body, meets twice a year. In between
sessions the Council of State represents the Assembly and carries out the decisions taken.
The Council of Ministers is the highest level of the executive and administrative branches.
The Assembly (and the Council of State) and the Council of Ministers compose the
chief policy making bodies in the central government.

At the provincial level, the Provincial Assembly of Popular Power is the deliberative
body. Its administrative counterpart is the Provincial Administrative Council (CAP),
which administers the resources available to the province. There are 14 provinces (and
the special municipality of the Isle of Youth). Finally, each of the 169 municipalities has

CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

LA LIBRETA:

THE CUBAN RATION CARD

State rationing of food was established in
1961 as a way to ensure that everyone has
access to at a least a minimum of food at
highly subsidized prices. Each household
has a booklet,

la libreta,

that lists household

members and documents what they have
been provided each month.

La libreta

includes food items as well as items such as
toiletries and cooking fuel, and in the past
has included clothes and shoes. Historically,
the ration card has guaranteed everyone,
regardless of income, access to a basic set
of foodstuffs.

Through the 1990s the amounts of food-
stuffs available through the

libreta

were

deeply reduced. Nevertheless, every person
received most months at least the following:
5 lbs of rice at 24 cents a pound; 1.25 lbs
of black beans at 30 cents a pound; 2 lbs of
split peas at 11 cents a pound, 3 lbs of white
sugar and a similar amount of dark sugar at

14 cents a pound; 12 eggs at about 19
cents each and half a pound of coffee at 12
cents per two ounce package. Children
under 7 received a liter of milk per day for
25 cents, and those between 8 and 14
received a soy yogurt for a similarly low price.
Chicken, fresh fish, meat, hot dogs, spam,
and other sources of protein were available
sporadically at subsidized prices.

At this time, the ration card provides food
supplies for about two weeks out of the
month.30 Families must buy additional food
in the peso farmers markets or from the
black market at prices close to 10 times
those of the libreta, from the urban gardens
(which sell vegetables for reasonable prices
in pesos), and from the dollar stores, where
purchases can be made only in hard curren-
cy. Sinclair and Thompson report that “food
purchases can take up 66% of the average
Cuban salary.”

Iris, the president of the neighborhood
popular council, listens to residents in a
community meeting in Vedado, Havana.

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CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

SOCIAL POLICIES AFFECTING CHILDREN

“Children are born to be happy” is a
refrain that captures Cubans’ attitudes
toward children. In comparison with the
poverty and violence felt by children in so
many parts of the world, the experience
of children in Cuba is privileged. There
are no children in Cuba who live in the
streets, and the overwhelming percent-
age of students finish high school. Drug
use among children and youth is almost
non-existent, and there is little violence
by and toward youth to speak of in
Cuban cities.

Attention to the needs of children begins
before they are born. Free health care
means that their mothers receive prenatal
care in community clinics. Women faced
with at-risk pregnancies receive care in one
of the specialty hospitals. Chances are that
the child will be born with normal weight;
92% of Cuban babies are. A Cuban newborn
has the hope of living to 74 years, compared
with the 69 years of life expectancy of a
Latin American newborn. He/she has one
of the best chances of any child in the
hemisphere to live to one year: the infant
mortality rate in Cuba, at 8.4 deaths per
1000 live births, is comparable only to those
of Canada and the United States.

Children are born into families that most
likely include several generations living in the
home. Grandparents are an important
element in the lives of children. Most likely
both parents work, and, although most fam-
ilies struggle to make ends meet, they have
a basic set of benefits that make life a bit
easier. The ration card provides at least two
weeks worth of subsidized food which the
family augments with more expensive pork,
chicken, rice, beans, and vegetables bought
in the black market, the farmers markets, or
the dollar food stores. There is significant
job security for his/her parents, by law they
pay only 10% of their salaries for rent (the
family is likely to own their home), and their
utilities are subsidized. But, in most cases,
children live in households where the essen-

tial things are taken care of, but there is not
a lot left for luxuries.

Day care may be the first formal schooling
experience, but it is not yet available for all
children. Primary schools are neighbor-
hood schools and are simple but clean; all
schoolbooks are free. In middle school
they will be exposed to art and literature
and will have biology, chemistry, and
physics before leaving the ninth grade. All
will have mastered math up to algebra and
be literate by then as well. Beginning in the
seventh grade, they will spend three weeks
working in the countryside in the “escuela
al campo.” Volunteer work in the neighbor-
hood is valued by the schools. Most children
complete nine grades of schooling; only
about 4% drop out from middle schools.
In the ninth grade children compete for
the slots in the elite pre-university schools
and in the technical and art schools. The
pre-university schools entail a rigorous
academic preparation, and most of their
students go on to the university. Technical
schools provide terminal degrees in
careers that do not require university
training. About 8% drop out of the pre-
university and technical schools. Neverthe-
less, most children are engaged in school
until their later teens. There is no child
labor in Cuba; children cannot work until
they are 17. In Latin America, almost one in
every 10 children works for a living before
age 14.

If a child runs into trouble, it will most
probably come to the attention of an adult
at school or in the community. Minor cases
are managed at the school level. In serious
cases, children will be referred to special
schools by the Commissions for Prevention,
which is organized in every municipality.
Very few children get to this point: only
0.3% of children ages 10 to 16 were in
these schools in 1995. Children less than
16 years old are not routed through the
court system.

a Municipal Assembly of Popular Power, which is the deliberative body closest to the
base, and a Municipal Administrative Council (CAM). The CAM is charged with
administering most of the government services that Cubans encounter on a day-to-day
basis. The population directly elects delegates to the Municipal Assembly from among
its neighbors.

These delegates report on the situations facing their area and also help

address the specific problems of constituents.

The Cuban structure is highly centralized. For example, while each province has a
Directorate for Health which reports to the Provincial Assembly, its work is largely guided
by the national-level Ministry of Public Health and its priorities. Likewise, each munic-
ipality has a Municipal Health Directorate, which oversees the local delivery of health
services. Local work in public health is monitored by the Municipal Assembly but,
again, guided by the national Ministry of Public Health.

This centralization has made it possible to focus resources on national priorities and to
deploy them quickly, making large-scale initiatives possible. But despite a goal of adapting
central directives to local conditions, provinces and municipalities have had great difficulty
in both matching central directives to local needs and steering resources to unique local
problems.

Over time, a growing number of local problems have been left unresolved,

particularly those that respond to specific characteristics not contemplated at the
national level. This problem has been strongly felt in the urban areas, particularly in the
city of Havana.

The central government and its ministries retain the policy development role as well as
the capacity to assign resources to the implementation of social policies. Local government
communicates the needs of the population to central government policy makers, but
although there are instances in which initiatives may “bubble up,” the tendency is for
directives to “trickle down.” The argument is that the central government has at its
disposal the best information and the best expertise to make decisions on public policy

CHAPTER 1: “THE RIGHT PRIORITIES: HEALTH, EDUCATION, AND LITERACY”

“Children are born to be happy” is a
popular saying in Cuba. Here children
from the Polo Viego farmers cooperative
in Saneti Spiritus province take a “free
ride” on a horse-drawn trailor.

MINOR SINCLAIR/O

AM AMERICA

for the country as a whole, be it because it gathers it in the nation’s institutes and think
tanks or because it taps it through the representatives gathered in the National Assembly
and its committees.

The are some avenues for citizens’ input into policy development, but their effectiveness
is very limited. One way is through the mass organizations which are present in aspects
of decision making at the different levels of government. Cubans argue that the role of
the mass organizations is to act as “pulleys” that carry up the information about the
needs of the population and carry down the

orientaciones

of the initiatives that are to be

taken to remedy them. The mass organizations cluster women (Federation of Cuban
Women), neighbors (Committees for the Defense of the Revolution), farmers (ANAP),
and youth (Pioneers, Federation of Middle School Students, and the Communist
Youth). Two of these, the FMC and the CDRs, are organized at the block level. The
mass organizations have similar tri-level structure to that found in government and
participate in policy making through its professional staff.

Neighborhood delegates are the main point for users to advocate for the solution of the
problems they face in service delivery. Most of the complaints presented to the delegates
refer to problems with municipal services of all types, including social services, education,
and health care, addressing both serious problems – for example, a health hazard in the
area – and specific individual problems.

But the delegates have only the strength of

persuasion on their side: they have little authority and control no resources. The delegates
report to their constituencies through

asambleas de rendición de cuentas

(accountability

assemblies). About 70% of the complaints raised in the assemblies are resolved,

and

there is evidence that the number of problems that are solved by the delegates is growing.

But the lack of resources and information available to the delegates, their lack of authority,
and the fact that they are volunteers have limited their effectiveness.

The combination of the lack of alternative sources of service and lack of clear avenues
for making opinions and complaints known has resulted in very low expectations
about the quality of services and a reluctance to raise complaints unless the problem is
both very serious and has a solution at hand. “The population does not bring up issues
when it is known there are no solutions,” said Pedro Chávez, former president of the
Provincial Assembly in the City of Havana.

Both the low quality of services and the

reluctance to complain have been exacerbated during the economic crisis as real shortages
affected service delivery. Users, conscious of the difficulties and supportive of the
efforts that were being made by the government to maintain the services, did not tend
to exacerbate their complaints.

At the same time, in spite of problems in their quality, Cubans use their health and
educational benefits – in fact all benefits and subsidies – amply and without reserve.
Because all services are universal and provided without complex processes of eligibility
or application, there appears to be no stigma or social cost for their use. Cubans conceive
of them more as entitlements than as benefits, and this has tended to develop a very
strong sense of ownership of these services across the population.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Maria Zurena, a representative of the
Cuban Women’s Federation (FMC) visits
women on cooperative in Santiago de Cuba
to congratulate them on their soy harvest.
Before the implementation of the popular
councils, the eight mass organizations
organized the population by sector rather
than by community.

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2. THE “SPECIAL PERIOD”

AND ITS SOCIAL IMPACT

Cuba staked its economic future on commercial relations with other socialist states. In
1988, the socialist countries accounted for most of Cuba’s economic exchange: 87.4%
of its imports and 86.4% of its exports.

Cuba relied on the socialist countries for most

of its imports of medicine, fuel, and food as well as most of the heavy equipment required
in sugar cane production, mining, and agriculture. When socialism ended in eastern
Europe and then in the Soviet Union, Cuba suddenly lost all of its commercial partners
and the providers of most of its infrastructure. The resulting dramatic plunge in Cuba’s
imports (see Figure 9) affected the availability of food, clothing, medicines, construction
materials, and many raw materials for industry. The drop in imports, in the context of
sluggish domestic production, severely jolted the Cuban economy.

The drop in imports was linked to a sharp, forced disinvestment in infrastructure and
deep alterations to the daily life of Cubans. The initial effect of disinvestment was
dramatic. In agriculture, which depended greatly on imported fertilizers, pesticides,
petroleum, and repair parts for machinery, the production of sugar cane plummeted;
sugar is Cuba’s historic mainstay in the world market and the source of about 30%
of its hard currency. When the economy touched bottom in 1994, Cuban agriculture
was producing 55% of what it had produced in 1990.

The nickel and tobacco

industries, other main sources of hard currency, were similarly affected by the lack of
materials. Other indicators of great economic malaise included a sharp decline in the

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

Members of the Antonio Goitizolo
cooperative in the province of Cienfuegoes
in front of empty pigpens explain the
devastation the economic crisis wrought
on animal production. Imported pigs
required imported or manufactured
feed and medicine. When imports plum-
meted, there was no way to provide the
necessary inputs to keep the pigs
healthy and breeding.

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CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

GDP and the explosion of a budget deficit that had been growing since the 1980s.

Although the situation was improving by 2000, Cuba’s imports in that year were still
40% lower than in 1989 (see Figure 9).

With U.S.-Cuba hostilities then entering their fourth decade, the U.S. Congress chose
the moment of Cuba’s crisis to further tighten the U.S. embargo of trade and travel with
Cuba, aggravating the economic situation. In 1992, Congress passed the “Cuban
Democracy Act,” which prevented U.S. subsidiaries in third world countries from trading
with Cuba. In addition, ships that delivered goods to Cuba were prohibited from docking
in U.S. ports for six months, adding an estimated 40% to Cuba’s shipping costs, according
to a report by the American Association of World Health. In 1996, just as Cuba began
to welcome foreign investment, Congress passed the Helms-Burton Bill, which sanctioned
foreign companies making investments in Cuban properties that were expropriated
from U.S. citizens. A controversial provision of the law covers expropriated properties
formerly held by Cuban citizens who later became U.S. citizens. This provision, known
as Title Three, so far has been waived by presidential action every six months, but hangs
like the Sword of Damocles over Cuba, its foreign investors, and U.S.-Cuba relations.

Product

% change

Condensed and Powdered Milk

-26%

Meats

-69%

Wheat Flour

-32%

Medicines

-61%

Pharmaceutical Products

-60%

Wood

-99%

Gasoline, Petroleum, and Diesel

-56%

Printing, Writing, and Craft Paper

-95%

Clothes

-94%

Shoes

-99%

TABLE 5

Change in imports of selected
products between 1988 and 1993

Source: Oficina Nacional de Estadísticas, 1999.

2000

4000

6000

8000

10000

1989

1990

1992

1994

1996

1998

2000

Imports

Exports

FIGURE 9

Imports and exports, Cuba 1990-1998
(millions of pesos)

Source: Oficina Nacional de Estadísticas, 1999,
p. 11, and 2001, p. 37.

Daily milk distribution for children,
pregnant and lactating women in a com-
munity in La Florencia, Ciego de Avila.
Throughout the crisis, the government
made enormous efforts to provide special
care for these vulnerable groups.

MINOR SINCLAIR/O

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CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

Early Effects of the Crisis

The impact of the crisis on the Cuban people was dramatic. Food scarcity was felt first
as food production plummeted and the shortage of imported milk, meat, flour, and
other foodstuffs made itself felt. Caloric intake fell significantly between 1990 and 1994
(see Figure 9). Food available from the ration card decreased markedly, especially the
protein and the fats, and there were few alternatives for acquiring food except at very
high black-market prices. The 2001 Human Development Report of the United
Nations reported that between 1996 and 1998, when the economy was already in some
recovery, 19% of the Cuban population was undernourished – a higher percentage than
in El Salvador or Peru.

During the early 1990s, when the food situation was worse, the

loss of weight among the adult population, estimated at about 20 pounds,

was very

evident. In 1999, Cubans were still consuming far fewer calories, both animal and
vegetable, than in 1990.

Health problems related to nutrition developed shortly after the crisis began. The first
indicator was a rise in low-birth-weight babies that began in 1992. In 1993, 9.0% of
babies were born with low birth weight compared with 7.6% in 1990.

Increasing

numbers of pregnant women presented with insufficient weight gain during pregnancy,
and special nutritional programs had to be set up to remedy the nutritional deficits of
the mother. Expectant mothers were provided meals in workers’ cafeterias; community-
based

Hogares Maternos

(akin to a day hospital for pregnant women) were set up to

attend to the most at-risk cases. By 1995, these situations were reversed and, fortunate-

FIGURE 10

Daily caloric intake by product,
Cuba, 1985 to 1999

Source: FAO, 2001

500

1000

1500

2000

2500

3000

3500

1985

1990

1995

1999

Calories from vegetable products

Calories from animal products

FINDING SOLUTIONS FOR HOUSING
IN THE SPECIAL PERIOD

We never imagined we would face a situation
like this. We thought we had resources allo-
cated for the next 10 years, so we demolished
seven

ciudadelas

[tenements]

, and we

placed the families within the neighborhood,
in special hostels prepared for them…And
then we were left, as we say,

colgados de la

brocha

(hanging from the paintbrush), and,

frankly, we did not know what to do with the
people. We had to slowly find them housing,
fixing some buildings to house them. We found

a shelter and we adapted it for three families
with a common bathroom…it was not a
complete solution but it was better than 14
families and one bathroom…We took the care
to make sure they all got along. We found a
solution for about 100 families in these ways.
We still have 10 families left…

Architect working in the neighborhood of
Cayo Hueso, Havana.

ly, the infant mortality rate was not affected: it continued its decline and by 2000 stood
at 7.2 deaths per 1000 live births.

An epidemic of neuropathy, which affected 60,000 persons between 1992 and 2001,

is another example of the health effects of the nutritional problems faced at this
time.

The recurrence of infectious diseases – such as tuberculosis – that had all but

disappeared in Cuba was another consequence of the deterioration of the standard
of living of the population. The decline in hygienic conditions because of the lack
of disinfectants and cleansers was an important contributor.

Housing, as was pointed out in the previous chapter, had always been a difficult problem,
particularly in the urban areas. Between 1990 and 1993, housing construction was
paralyzed as building materials, steel, and wood suddenly disappeared on the island.
Buildings being constructed in Havana were left half-finished. There were no materials
for repairs to existing buildings, so the already battered housing stock deteriorated dra-
matically. Construction picked up again as the investment in the tourism industry made
itself felt in the mid-1990s; but housing building materials, steel construction has yet to
approach the levels of 1990. The deteriorating condition of Havana’s buildings, even
today, is perhaps the most salient evidence of the crisis.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

200

400

600

800

1000

1991

1995

FIGURE 13

Number of registered bicycles in
Havana, 1991 and 1995 (thousands)

Source: González, 1997, p. 220.

1990

1993

1995

1998

2000

1990

1992

1994

1996

1998

FIGURE 11

Use of wood for energy in homes,
Cuba, 1990 to 2000

Source: Oficina Nacional de Estadísticas, 1998,
p. 165; 1999, p. 153; 2001, p. 56.

FIGURE 12

Bus trips in urban areas, Cuba, 1999
to 2000 (millions)

Source: Source: Oficina Nacional de Estadísticas,
1998, p. 237; 1999, p. 220.

Families began to operate in a “scarcity mode” and lowered their standard of living. For
example, as gas and kerosene, the most prevalent sources of cooking fuel, became very
scarce, families at times had to use wood for cooking (see Figure 11). In a country without
large forests, this wood came from remaining trees, and in the cities, from park benches
and old furniture as well.

Public transportation all but disappeared in the early 1990s both in the city (see Figure
12) and in the countryside, and very few owners of private cars were able to get enough
gasoline to drive with any regularity. Cubans walked for miles to go to work: in the
countryside it became usual to see groups of people walking along the highway. They
took to bicycles (Figure 13) to go to work or to travel. A common scene was a man
pedaling and steering, a woman riding over the back tire on the rack, often carrying a
bundle, and a child between the two of them. The massive and dangerous use of bicycles
in the city caused many accidents and deaths.

An already frugal society became even more so. Nothing was wasted. Pets ate the few
organic wastes, often their only source of food; all paper was saved for a variety of
purposes; old bottles and packaging were brought to the market to carry the family’s
share of groceries; old construction nails were straightened for reuse; every scrap of
wood was saved.

For those who shared the “Special Period in time of peace,” there are many emotions
that accompany the images of those days. Women leaving work early to find food for
the night meal; waiting for the end of the blackout in the searing heat of a summer night;
hoarding medicines and finding someone who had the one that was urgently needed;
walking many miles to work; cooking with wood because there was no gas or kerosene.

“No es fácil”

(it’s not easy), a favorite phrase, took on a whole new meaning. And

through it all, the joke in the lines waiting in the

bodega

(neighborhood store)

;

the night

conversations on the stoop; the offer of

agua con azucar

(sugared water), and the dignity of

a proud people.

Institutional Responses to the Crisis

By 1995, the economy had touched bottom and a very modest recovery had begun. This
recovery resulted from a series of measures taken by the Cuban government to restructure
the economy. The government’s action was far reaching; it created the conditions for
foreign investment, addressed critical problems in the internal finances of the country,
and opened up new economic spaces for Cubans to work privately (see Table 6). As
these measures wound slowly through Cuban society, they brought fundamental and
lasting changes to Cubans’ daily lives.

Ever since the nationalization campaigns of the 1960s, the Cuban government had been
the main actor in the economy. It was the sole producer of goods and services (with the
exception of a number of private owners of small farms), the sole importer, and the sole
employer. But beginning in 1992, Cuba took steps to stimulate foreign investment as
well as private domestic activity in some sectors of the economy.

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

This artisan is licensed to sell crafts to
tourists. With the dollars she earns, she
can buy items such as her tape recorder.
Cubans with no access to dollars have little
chance of purchasing these items.

AN CAB

ALLERIA

Mixed enterprises, with the Cuban government in partnership with foreign firms, made
their appearance. Foreign investment was particularly encouraged in the tourism industry,
which began to grow to the point that today it is one of the main sources of hard
currency for the island’s economy. State-owned associations and corporations developed
to service this and other sectors dominated by foreign investment.

To support investment, in 1993, the government legalized the use of hard currency (the
dollar),

and both the dollar and the peso (national currency) began to circulate freely.

At the same time, the government began to open “dollar stores” where food, import
items (mostly consumer goods), and some national products were offered in dollars. The
legal use of foreign currency by Cuban citizens gave them access to these goods. Stores
opened in every city neighborhood and throughout the country.

The growth of foreign investment also presented Cubans with the possibility of jobs in
the hotels, offices, and services being developed and/or administered by foreigners, as
well as working for the corporations (such as Cubalse and Corporación CIMEX) that
were organized to provide services to this sector. Special employment agencies were set
up to process the applications of workers hoping to enter this new sector of the economy.
The advent of a “dual economy” created

de facto

segmented commercial and labor

markets – one operating in dollars and the other in pesos – with very distinct pay scales
and working conditions.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

1992

1993

1994

1995

Decentralization of authority to engage in foreign trade, permitting
non-government entities to engage in it

Recognized mixed ownership of properties

Decentralization of sectors of the agriculture industry through the creation
of the Unidades Básicas de Producción Cooperativa (UBPC)

Expansion of the economic areas outside of the government sector in
which private citizens could engage in work

Legalization of the holding and use of hard currency

Granted permission to state entities to engage self-financed economic
activity in hard currency

Creation of a network of shops that were open to Cuban citizens where
goods could be purchased in dollars

Introduction of the convertible peso, worth US$1.00

Creation of the agricultural markets, industrial and artisan markets

Passed tax laws (on both income and sales) that affected non-state
workers and activities

Eliminated some non-essential gratuities and increased the prices of
some products and utilities

Opened establishments for currency exchange

TABLE 6

Economic measures taken by the
Cuban government during the early
years of the crisis

Two other reforms also helped change the economy’s landscape. In 1993, the state
turned over the land formerly used by state farms to cooperatives called Basic Agricultural
Production Units (UBPCs), swiftly privatizing large sectors of agricultural production.
In 1994, the government opened the Farmers Market (for private farmers and state
producers), which allowed for the sale in pesos of food products. Prices were determined
by supply and demand in an open, legal commercial relationship between private farmers
and consumers. This meant additional sources of food for a population that sorely needed
them but also food at a very high price.

Finally, also in 1993, the government expanded sources of self-employment for Cubans,
permitting private enterprise in a broader number of areas, These “trabajadores por cuenta
propia” (self-employed workers) range from taxi drivers, hairdressers, and fishermen to
restaurant owners and video producers. particularly personal services, food preparation,
and the like. These “trabajadores por cuenta propia” (self-employed workers) range from
taxi drivers, hairdressers, and fishermen to restaurant owners and video producers. In
1995, 138,000 Cuban workers were self-employed.

Self-employed workers are charged

both a tax on their gains and a significant amount in fees, justified as their contribution
to public services such as health and education.

The high rate of fees and taxes,

competition, and the harsh conditions of self-employment have tended to discourage
this type of work.

In 1994, the National Assembly passed a series of measures aimed at reducing the deficit
and controlling inflation. The state established the mechanisms by which it could collect
some of the gains of the growing private sector and also removed some gratuities. An
income tax was established for gains from private activities, and fees were collected to
pay for the state’s supervision of tax payment of this new sector. Other measures instituted
at this time included taxing the sale of items such as tobacco and alcohol, charging fees
for some services that were not deemed essential (language classes for adults, for example),
and reducing some subsidies such as those for water and electricity.

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

5000

10000

15000

20000

25000

1989

1988

1992

1990

1996

1994

2000

1998

FIGURE 14

Gross domestic product of Cuba,
1988 to 2000

Source: Oficina Nacional de Estadístisticas,
1996,1999, and 2001. Note: in constant
1981 pesos

These measures improved the economy. The GDP inched upward consistently after
1994 (see Figure 14), the deficit narrowed, and imports expanded slightly. As a result,
caloric intake improved, as did transportation; electricity, gas, and some consumer goods
became more available. In general, the quality of life of Cubans improved somewhat,
though it was still far from the level enjoyed in 1990.

Social Impact of the Economic Measures

But even as the success of the measures was becoming evident, the Cuban government
often expressed reluctance at having to implement them. “Some of these measures are
unpleasant,’’ said President Fidel Castro in July of 1993. “We don’t like them.”
Throughout, the measures were projected as “necessary evils,” as temporary, emergency
measures that would be reviewed once the crisis was over. “It’s a risk that government
leaders have decided to take… because they have no other alternative,” explained the
Agencia de Información Nacional in 1998, “but also because they are confident that
these are transitory circumstances.”

But as the measures proved to be permanent,

many people raised serious concerns about the effects of the reforms on Cuban society.
“There will be those who will have privileges, while others do not,” explained President
Castro. And this, indeed, was the case.

Income Inequality

The most critical effect of the reforms has been the increase in income inequality,
propelled primarily by the transformation in the structure of the labor market. “The
greatest income inequality in the population,” writes Cuban economist Angela Ferriol,
“responds to the new characteristics of the labor market, which is related to the opening
to foreign capital and with the adjustments and reforms we have undertaken.”

Although there had always been a “private sector” in Cuba, it was small and had been
shrinking.

The measures introduced in the early 1990s reversed that trend. Currently

the labor market is privatizing rapidly, as joint ventures and the Cuban public/private
entities developed to service them continue to grow. Many of these are “new economy”
jobs in the tourism industry, in areas with heavy foreign investment, and in private
national industries and agencies created to service this sector (like Cubalse and Corporación
CIMEX). Others are self-employed workers, independent farmers, and farmers working
in cooperatives. Close to one-quarter of Cuban workers were employed in the emerging
private sector in the year 2000 (see Table 7).

The difference between the working conditions and the rewards for workers in the state
and in the “new economy” sector (except the self-employed workers) is significant.
Workers in the emerging sector have access to technology, office supplies, and comforts
(such as air conditioning) that are often lacking in state enterprises. Aside from the reg-
ular salary in pesos, these firms would reward workers with needed “extras” that were
hard to come by during the Special Period, such as clothes, toiletries, and some specialty

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

foods. In time, some of these enterprises offered workers – both under the table and
legally – at least some of their salaries in dollars.

Prior to the Special Period, the highest-paid Cuban workers – mainly professionals such
as doctors or engineers – were paid only 4.5 times as much as the lowest-paid workers.

This built in a significant equity based on income. But during the Special Period, this
was greatly altered in an unusual way. Now it is possible for a waiter in a tourist hotel,
which is one of the lowest-paid jobs in Cuba,

to obtain a set of rewards – salary in

pesos, tips in dollars, the “extras,” and improved working conditions – worth many
times more than the rewards that could accrue to a top professional who works for the
state and earns a top salary, but only in pesos. Cubans call this the “inverted pyramid,”
a phenomenon that reflects the devalued return on education and professional preparation
in the new economy. The immediate result has been the exodus of public service workers
into low-level service jobs in the tourism industry. During 1993-1994, for example,
almost 8% of teachers made this leap.

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

TABLE 7

The changing structure of the Cuban
labor market

Source: Oficina Nacional de Estadísticas, 1996,
1999, and 2001.
Notes: (a) Data come from Cuba’s last census in
1981; a new census is scheduled to take place
in 2002; (b) in 1997.

1981

1995

2000

Total Employed Population (thousands)

2,867.6

3,591.0

3,843.0

State (%)

91.8

80.5

77.5

Private (%)

8.2

19.5

22.5

In joint ventures

0.5

0.7

In national private enterprises

5.5

5.2

9.4

Self-employed (“cuentapropistas”)

1.6

3.9

4.0

Cooperativists

1.1

9.7

8.4

Pork is available again in the markets all
over the country but only some can
afford it.

AN CAB

ALLERIA

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Income inequality has also risen as both the economic crisis and the subsequent restruc-
turing of the old economy displace workers. From 1990 to 1998, 155,000 workers
became unemployed.

The initial policy, begun in 1991, was that, when factories

stopped production or state entities were restructured, workers continued to draw at
least 60% of their salary. There has been an effort to relocate workers to other jobs, and
in fact, most have been relocated. Those who have not are protected by unemployment
for a period of six months to three years depending how long they had worked for the
state. Many of these workers have entered the ranks of self-employed.

Retraining workers for new jobs is ongoing as are the special programs to support the
entry of young people, particularly young women, to the labor force. But this has not
succeeded completely in stemming the flow of female workers out of the labor force. In
1997, male unemployment amounted to 4.4% while that of females reached 10.1%

Zulema Hidalgo, who runs a self-esteem group for women in the neighborhood of
Atarés in Havana explained:

During the Special Period, we were surprised at the amount of women in the
neighborhood that were unlinked from work. They told us that they received little
result from their work: that they spent almost as much going to work, having
lunch, and maintaining themselves there as what they earned. They had a lot of
limitations, really, that were very crude and hard. In addition, the women also
had to spend a lot more time in domestic tasks, getting food and solving prob-
lems due to the lack of resources available. These limitations led many women to
leave their jobs.

Finally, another salient factor contributing to the growing inequality is the unequal
access to dollars that the new structure provides. About one-half of the population has
access to dollars in some way. Many earn dollars through their work: according to
newspaper reports, about 35% of Cuban workers receive some remuneration in dollars.

Some of these are state workers, a small percentage of which receive part of their salary
in hard currency.

But the majority of Cubans with access to dollars earn them as part

of self-employment, formal and informal – in

paladares

(home restaurants), as unofficial

taxi drivers, performing different services, or selling goods in the black market.

Employment is not the only way Cubans have access to dollars. Remittances come from
across the world, but mainly from Cubans living in the United States.

Estimates range

between $400 and $800 million per year, now a major source of hard currency for the
country and of income for many families.

The importance of dollars to everyday survival has produced great differences in conditions
between those who have family abroad and those who do not, between salaried and
self-employed workers, and between salaried workers in different sectors of the economy.
Among the most economically vulnerable households are those that depend solely on
the wages of low-paid state workers, on the fixed incomes of retirees, or on social
assistance – that is, households where no member has the means to increase his or her
income through private enterprise. Persons without access to dollars through remittances

or employment are also very vulnerable.
Vulnerability is most characterized by
lack of access to alternative possibilities
for the purchase of food and goods out-
side of the subsidized ration card. This
can happen if the household does not
have access to dollars or has a level of
income in pesos that does not permit
them to purchase food in the higher-
priced agrarian markets or in the gouging
black market.

Effects on Families

Increased economic vulnerability has
made the situations of many families quite
difficult. These difficulties result not only
from the problems that arise from lack of
income, but also from the problems that
come from the way that the emergent
economy affects families. Members of the
family often work for the state but have additional ways of earning dollars, usually informally.
This can range from selling arts and crafts, to renting out a room in their home, to running
a

paladar.

Working adults in families are extremely busy managing the problems of get-

ting to and from work with a badly deteriorated transportation system, obtaining the
necessary food and supplies for the home, and, in many cases, having this second job.
This is contributing to less attention being paid by adults to the daily family life at
home, including the supervision of children.

The new economy has also made for very deformed economic relationships within the
family. Many different forms of participation in the economy can coexist in a family:
most continue to be salaried workers working for the state, but increasingly, members
of the family will work in the firms and businesses of the emergent sector, while others
are self- employed working in both the established and the informal economies. Under
the new conditions, a teenager can earn more money in one afternoon showing a tourist
around Old Havana than his father earns in a month working in his government job.
Parents complain that they have lost authority over their dollar-earning children, especially
their teenagers. Parents feel pressure from children to purchase items in dollar stores
when they may have no or very limited access to dollars. Families are under a great deal
of pressure to raise children under very new and very different circumstances; this has
led to significant family stress and dysfunction.

One indicator of the stress placed on families by these new situations is the increase in
the divorce rate, which climbed from 3.5% in 1990 to 6.0% in 1993.

By 1998, this

rate had stabilized at the 1990 level. Another is the reappearance of children begging

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

Although the Special Period brought real
hardship to the Cubans, people shared a
great commitment to work together to
find solutions to the myriad of problems
in everyday life.

MINOR SINCLAIR/O

AM AMERICA

from tourists or doing small jobs as unofficial tourist guides. Political scientist Sheryl
Lutjens from Northern Arizona University writes that a 1996 report on education in the
City of Havana identifies over 20,000 children living in conditions of social disadvantage
and vulnerable to the pull of street life. Lutjens further reports, for example, that in the

Casco Histórico,

the renovated historic section of Old Havana, most children working in

the streets were boys between 5 to 11 years old, and that authorities had identified over
2,200 children in this situation in 1996.

An additional burden for families is the fact that some long-disappeared social problems
have returned. Illicit street life has reappeared in a very public way in high tourist areas.
Prostitution has increased significantly in cities with high tourist traffic, often in very
blatant forms and involving young women. Petty crime has also increased involving
mostly but not exclusively tourists.

Although Havana’s streets are still relatively safe

compared with those of large urban areas elsewhere in the hemisphere, the reappearance
of social problems and crime has been very troubling to a population that believed these
social ills were problems of the past.

In many ways Cuba spent the first part of the decade focused on the economic crisis
with very thoughtful, measured, and, in the Cuban context, unexpected initiatives. But
the second half of the decade has required a different response: managing the impact of
these measures in Cuban society. For the first time in 40 years, Cuba is contending with
a growing set of social differences emerging from the new economy and their consequences
for vulnerable groups, for families, and for communities. And this is happening in an
environment of extremely reduced resources and options. It is still too early to foretell

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

EMIGRATION TO THE UNITED STATES AS A SOLUTION

Emigration has always been a sensitive
issue in Cuba. Long manipulated for polit-
ical reasons, it has been perceived, at best,
as an abandonment of the homeland. U.S.
immigration policy favors Cuban entrants,
allowing them entrance to the United
States even if they reach American shores
illegally. In 1994, emigration to the United
States exploded as thousands took to rafts
to cross the Florida Straits. There was no
condemnation by Cuban authorities or by
the Cuban people. This time many per-
ceived that the emigrants were making the
hard choice between family life in Cuba
and the possibility of helping their family
from abroad.

A report by Martín y Pérez asserts that “we
have seen an abrupt rise – especially of
illegal emigration – since the 1990s. Fig-
ures show that between 1991 and 1994,
13,147

balseros

(people leaving in rafts)

arrived in the United States and that the
Cuban government intercepted 36,208
attempted exits. If we add those held in the
United States Naval Base in Guantanamo
between 1990 and 1994, the figure of
those who arrived to the United States
reaches 45,479. To those, we must add
the 15,675 who traveled with a temporary
visa and never returned. As can be ascer-
tained, the number of persons who chose
this strategy is not easily dismissed.”

Sources: (a) Martín y Pérez, 1997, p.16-17; (b)
U.S. Bureau of the Census, 2000, p. 10; (c)
Figure for this decade includes the 100,000
immigrants who arrived through the Mariel
boatlift of 1981.

CUBAN IMMIGRANTS ADMITTED TO THE UNITED STATES

1981-1990

1991-2000

159,200

180,700

the policy prescriptions that Cuba may adopt to face these challenges, but all indications
show their intention to hold to the strong values that have shaped Cuba’s social policy
in the past and build on the considerable strengths of both their social programs and
their communities.

CHAPTER 2: THE “SPECIAL PERIOD” AND ITS SOCIAL IMPACT

LESSONS FROM THE SPECIAL PERIOD

While economic hardship, crime, and pros-
titution may be the headlines arising from
the Special Period, many Cubans point to
the lessons learned from the past 10 years
of economic crisis: initiative, innovation,
self-reliance, group solidarity.

The Special Period taught me the value of
spirituality, the strength of example. When
one is trying to determine the worth of certain
actions, one has to value the material aspects,
but also those that are more subjective, more
of the spirit. We cannot just concentrate in
giving people things; we must look after how
they live their lives, what they value, what they
believe in.

Community activist in the neighborhood
of Atarés, Havana

With the Special Period we were able to see
clearly what is possible and what is not possi-
ble. When we were left in midair by the crisis,
we realized that we had to find new solutions
to old problems because the usual solutions
were just not available…

City planner, Havana

People were used to having others take care of
their needs, to wait for others to solve their
problems. When the Special Period arrived,
those first years when we hardly knew what
was going on and what we could do, people
suffered through many problems. At first all

said ‘no, no, there’s nothing to do,’ but then
we learned that we could all come up with
solutions. I believe that the Special Period
has helped us Cubans to become better,
more capable…

Women’s group leader in Atarés, Havana

I learned how much people can resist when
they are determined not to be defeated. There
were many problems, new problems, old
problems; it was unexpected, but we pulled
together to get over the worst times…

Popular Council President, Guanabacoa

The Special Period taught me to do more with
less… that coming together, getting every-
one’s collaboration, we can achieve a lot with
very few resources.

Social worker from the neighborhood of
Pogolotti, Marianao

I realized that I could not just receive or be an
echo, but that I needed to be the subject of
the solutions of the problems in my family and
in my neighborhood. I feel a lot of pride in
what I achieved during that time.

FMC member in Pogolotti, Marianao

I have learned about the richness that people
have inside them, if we know how to reach
them…. We found the true value of a lot of
people during the Special Period…

Community activist, Centro Habana

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

3. A SAFETY NET TATTERED

BUT HOLDING

The introduction of market-based reforms, which quickly began to heal the economy,
had the same effect as in market societies – a sharpened economic inequality – and gave
rise to a host of the emergence of new social problems. Where Cuba differed from other
countries undergoing liberalizing reforms was the political will to shield the population
from the most pernicious of these effects as well as from the impact of the crisis itself.
Cubans sought to maintain the basic values of the Cuban social policy: universality,
equitable access, and government control. This meant protecting social expenditures as
much as possible in a rapidly shrinking budget. Table 8 summarizes the outcome indicators
in health and education that underwent most severe change during the crisis, and the
ways in which policies were adjusted. These examples are drawn from reviews of writing
by Cuban social policy analysts as well as from the author’s own research.

The basic outcome indicators, some of
which were reviewed earlier, show the dete-
rioration of some gains in health and edu-
cation. The increase in low birth weights
and the decrease in the nutritional status
of young children, although they did not
affect the infant mortality rate, were great
concerns. Notable also were the reappear-
ance of diseases such as tuberculosis, the
increase in mortality from some infectious
and parasitic diseases, and increases in
incidence of contagious diseases, such as
hepatitis and sexually transmitted diseases.
Finally, the appearance of epidemics, such as
the neuritis epidemic in 1992, mentioned
earlier, underscored the effect of the eco-
nomic crisis on people’s health.

In education, the most affected indicators were enrollments and dropout rates. Enrollments
decreased slightly in post-secondary schools and more sharply in higher education.
In 1990 to 1991, 94.5% of the graduates from secondary schools (ninth graders) went
on to further education; by 1994 to 1995, that figure had dropped to 86.4%.

Moreover, whereas in 1990 most of these students went on to pre-university high
schools, most were now going on to technical schools. This shift may represent a choice
but most likely indicates tighter enrollments at the university level. University slots are
highly linked to available positions in the Cuban economy, which was greatly reduced
during the 1990s. As a result, enrollments in higher education dropped from a high of
21% in 1990 to 12% in 1996;

dropout rates from high school also rose, particularly

The most vulnerable groups in society such
as these mentally and physically challenged
children in the Tomas Garcia school for
special education in the province of Ciego
de Avila continue to receive schooling
throughout the crisis.

MINOR SINCLAIR/O

AM AMERICA

CHAPTER 3: A SAFETY NET TATTERED BUT HOLDING

for students enrolled in pre-university education. These schools, which are almost all
located in the countryside, represented a lot of hardship for students as food became scarcer
and problems in transportation prevented teachers from reaching the schools.

The decrease in the quality of services also had an effect on health and education outcomes.
The crisis led to the physical deterioration of hospitals, clinics, and schools; the absence
of medical supplies and equipment and disinfectants; and the declining quality of
education due to the lack of supplies and an exodus of teachers to jobs in emergent sectors.

In the area of social security, the most notable impact was the erosion in the buying
power of pensions and social assistance. As the buying power of wages and pensions
decreased

and the subsidized ration goods covered less of a person’s needs, those with

fixed incomes, such as pensioners, became increasingly vulnerable economically.
Nevertheless, the difficulties of daily living under the crisis made it very hard for persons
to maintain employment; many older workers retired, increasing the number of retirees
and the expenditures in social security.

In response to the crisis, the Cuban government has strongly reaffirmed the basic values
of Cuban social policy and has reasserted the political will to maintain its social
development model. At the same time, the government has begun to transform aspects
of the model, particularly in the area of service delivery, in order to guarantee its reach
and effectiveness.

Effects on
outcomes

Effects on
Services

Education

Illiteracy rate held at 3.8%. There was
an increase in dropout rates from
pre-university and technical schools,
especially the latter.

Enrollments decreased at all levels; there
were sharp decreases in enrollments in
higher education

Significant deterioration in the physical
conditions of schools. There were
shortages of food and supplies in boarding
schools, and student/teacher ratios
increased across the board.

Exodus of teachers to private-sector jobs.

Health

Continued improvements in the rates
of infant mortality but worsening of
indicators such as low birth weight and
nutritional status of young children.

Appearance of epidemics, such as the
neuritis epidemic in 1992; increase in
mortality from some infectious and par-
asitic diseases and increases in incidence
of contagious diseases, such as hepatitis
and sexually transmitted diseases.

Continued improvement in the rates of
immunizations

Significant deterioration of the physical
condition of hospitals and clinics.

Decrease in the quality of services at the
community level due to lack of material
resources, lack of materials for training.

Decrease in the overall quality of care
due to the lack of medicines, medical
supplies, instruments and equipment,
and disinfectants.

Social Security and Social Assistance

The erosion in the purchase value of
pensions and social assistance due to
decreased value of the national currency
and the introduction of the use of dollars.

Increase in the number of pensioners
from 1.13 million in 1990 to 1.35 million
in 1995.

53,134 families (97,000 individuals) were
provided social assistance (cash) in 1994

TABLE 8

Summary of effects on outcomes and
services in the areas of education,
health, social security, and social
assistance in the 1990s.

Note: (a) These do not include military pen-
sions. Centro de Investigación de la Economía
Mundial, 1996.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Maintaining Basic Principles and Policies

A review of the current writing in social policy makes evident that the basic principles
of Cuban social policy have remained in place. First of all, there continues to be a clear
commitment to equity in access by maintaining all services free of charge, as has been
the history of health, education, and other benefits in Cuba. Although some fees have
been instituted, these are minimal and affect services that are not central to the mission:
for example, fees for school lunches in high schools and fees for some adult education.
Cuba did not use the crisis to revoke the basic benefits of free, socialized medicine and
public education.

It is also clear that the commitment to universal accessibility has been retained. Cuba
did not approach the current funding crisis by excluding sectors of the population from
basic benefits and services, and there is no evidence of serious efforts to curtail benefits
with new eligibility criteria or time limits, even in areas like social assistance. The com-
mitment to universality is strong, although this does not mean that no consideration has
been given to developing targeted programs, directed toward the most vulnerable.

Finally, in spite of the thrust to decentralization existent in Cuba in the last decade, the
government’s role as the main actor in this sphere remains unchanged. The central
government continues to be responsible for funding, developing, and providing the
benefits and services of the Cuban safety net.

Education

State continues as sole provider
of education.

Educational services remain free. Some fees
are charged for non-essential services (adult
classes, for example).

All schools and programs remain open.

Additional libraries were opened in munici-
palities and their services promoted.

Health

Preserves coverage and universal access.

Health services remain free of charge.

State continues as sole provider of
health care.

Social Security and Social Assistance

State provides 100% pension and disability
coverage for all state workers; continues at
the same level of coverage.

All contributions continue to be made by
employers; government covers difference
between social security contributions and
disbursements.

Increase in minimum retirement pension
payment from 83.69 pesos in 1990 to 102
pesos in 1997.

Central government continues as sole
provider of social assistance.

Eligibility requirements for social assistance
remain the same, as does the level of benefits
provided.

TABLE 9

Effects of the crisis on policy
and eligibility

FIGURE 15

Expenditures for health, education,
social security, and social assistance
in Cuba, 1990-2000
(millions of pesos)

Source: Oficina Nacional de Estadisticas, 1996,

1999, 2000.

500

1000

1500

2000

2500

Education

Health

Soc. Sec.

Soc. Ass

is.

1990

1994

1998

2000

CHAPTER 3: A SAFETY NET TATTERED BUT HOLDING

Protecting Social Expenditures

In the midst of the crisis, the commitment to social benefits – education, health care,
social security, and social assistance to the poor – was maintained. In fact, social
expenditures increased in absolute terms through the period of 1990 to 2000, from 3.816
to 4.705 million pesos.

With the exception of education, which experienced a reduction

in 1990 to 1994, expenditures in all areas increased through the period (see Figure 15).

Social expenditures also held their own as a proportion of the Gross Domestic Product
(GDP). Figure 16 shows changes relative to 1990 in GDP, total budgetary expenditures,
and social expenditures, here limited to education, health, social security, and social
assistance. As the GDP dipped by 40% between 1990 and 1994, overall expenditures
remained constant but social expenditures increased slightly. As the GDP began its slow
recovery in 1996, total expenditures were actually reduced, as part of the campaign to
reduce the deficit, but social expenditures continued to increase. By 1998 they were
23% higher than they had been in 1990.

-40%

-30%

-20%

-10%

10%

20%

30%

40%

50%

60%

1990

1992

1996

1994

1998

2000

GDP

All Expenditures

Social Expenditures

10%

15%

20%

25%

30%

35%

1990

1992

1994

1996

1998

2000

Total Soc. Expen.

Education

Public Health

Soc. Assistance

Soc. Security

FIGURE 16

Change in GDP, public expenditures,
and social expenditures (relative to
1990), Cuba, 1990 to 2000

Source: Oficina Nacional de Estadís-
ticas, 1996, 1999, 2001.

FIGURE 17

All social expenditures and expendi-

tures by sector as a percentage of
GDP, Cuba, 1990 to 2000

Source: Ofcina Nacional de Estadísti-
cas, 1996, pp. 85 and 99; 1999, pp.
82 and 93; 2001, pp. 30 and 34.

The fact that social expenditures increased even as the GDP decreased tends to indicate
a strong protective inclination toward social expenditures

(though it may be also due

to the inherent resistance to change of items such as pensions). In fact, social security
showed the sharpest increase in relation to the GDP, surpassing education in 1993 as
the largest social expenditure (see Figure 17). But increased allocations to education and
health care and, to a lesser extent, social assistance also demonstrated a clear commitment
to and protection of these areas.

Cuban social expenditures as a share of GDP are nearly double the average in Latin
America. In 1990 Latin American countries devoted an average of 10.4% of their GDP
to social programs;

Cuba’s share was 21%. By 1998, after a decade of crisis, Cuba’s

financial commitment to social programs, at 32% of GDP, was still the highest in Latin
America.

Like Cuba, other Latin American countries experienced a rise in the share of

GDP dedicated to social expenditures during this period; but at 60%, Cuba’s rise has
been much more pronounced than those of other Latin American countries, which
experienced an average rise of 30%

. Only Paraguay and Colombia had higher rates of

increase of social expenditures in relation to GDP.

In spite of this clear financial commitment, the negative impact of the economic crisis
on services was evident, due to two critical factors. The first was a decrease in the
allocations in convertible currency (i.e., U.S. dollars) toward education, health, and, in
fact, all areas of life in Cuba. In 1994, for example, the allocation in convertible currency
for the health sector was 39.6% of what it had been in 1989;

by 1997 the allocation

had risen to only 49.4% of that available in 198985. These restrictions limited the
importation of such necessities as medicines and medical supplies, materials needed for
the production of medicines, building materials for the repair of hospitals and clinics,
and tires for ambulances. A similar situation took place in education, which was left
without supplies and without paper to print books. Only funding for personnel, who
are paid in pesos, was unaffected.

The second factor that tended to undermine the government’s financial commitment to
social benefits was the decreased buying power of the peso. Although government
ministries received the same or even more pesos during the 1990s, the fact was that,
except again for personnel, the real purchasing value of the peso had dropped.

Transforming the Delivery of Services

Even as Cuba has reaffirmed its social development model and sought to protect the
funding of social services, the government has felt the need to transform the delivery of
services. In the past, Cuba has created service effectiveness by placing large amounts of
funding behind a universal coverage for all services, without strong regard for efficiency.
But this logic faces critical challenges at this time. Outcomes along many social indicators
are not yet at levels achieved in the late 1980s. Although their amounts have been
sustained and even increased, budget investments in social benefits have not completely
prevented their deterioration, signaling that a much stronger financial investment will

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

CHAPTER 3: A SAFETY NET TATTERED BUT HOLDING

TABLE 10

Effect of the crisis on the delivery
of services

be required to reach the levels of 1989. All this takes place in a context of increasing
demand: not only are more retirees requiring pensions, but more families are put at risk
by the economic pinch. More attention is needed for pregnant women, more support is
needed for families with less income, more work is needed with adolescents facing
temptations to stay out of school – the list is long.

There is also great pressure to improve the quality of services. A large gap separates the
service system as conceived by policymakers and providers and what is actually delivered
today. This gap is becoming an increasing concern of users and will become even more
critical as services begin to represent a more important survival element for those in
need. The timeliness of a pension check, for example, takes on a different meaning when
the recipient population is so economically stretched, as it is today.

In many ways, the now decade-old crisis appears to have underscored the need for
transformations in the implementation of social programs. Without abandoning the
basic values that have shaped policy, Cubans now look for ways in which social policy
can be delivered both efficiently and effectively.

Doing more and doing better for less is not a new concept in the delivery of service.
Most countries approach these challenges by curtailing eligibility and working hard to
improve both the efficiency and the effectiveness of services. Cuba’s approach so far has
been to maintain a commitment to universality and prevention and to introduce limited
reforms at the level of delivery to increase efficiency and reach.

Many of the reforms

seek to improve the encounter between service and recipient and to improve the quality
of service delivery, not only in education and health but in other areas as well. But making
improvements, writes economist Angela Ferriol, will require transforming service delivery
at the local level through collaboration, modernization, and training.

This emerging

transformation shows certain characteristics, which we will describe in the following
sections and in Chapter Four.

Education

Increased support at the delivery point. For
example, increase of methodological support
for teachers and principals was instituted to
address higher student/teacher ratios.

Collaboration with other ministries on com-
prehensive initiatives (e.g., the anti-dropout
program instituted in 1995 involving actions
from several ministries and entities at all levels).

Established recreational and after-school pro-
grams in collaboration with local organizations.

Health

Continued emphasis on primary prevention;
continued deployment of family doctors and
family nurses to attain greater coverage
nationally.

The development of comprehensive, collabo-
rative initiatives (e.g., the Low Birth Weight
Prevention Program). Other initiatives
include collaboration in the improvement of
nutrition, public hygiene, and water quality.

Focused attention to vulnerable groups,
including those at risk because of age, gen-
der, and income.

Social Security and Social Assistance

Growing collaboration between the Ministry
of Labor and Social Security and MINSAP
and others on the care of elders.

Experimentation at the municipal level with
the delivery of services to persons eligible
for social assistance.

Massive training and deployment of social
workers to provide assistance to needy
families.

Comprehensive initiatives at the community level addressing the service needs of women, youth and children as well as specific community
development activities.

Building the capacity of Popular Councils to monitor the delivery of service at the community level.

The first characteristic is the increase in collaborations across sectors in the approach to
the new problems that are emerging as the result of the Special Period. There is a recog-
nition that the problems faced by the growing number of poor persons, or the issues of
adolescents who drop out of school, or the prevention of criminal behavior – or any
social problem caused by a constellation of factors – do not often respond well to cate-
gorical solutions. Collaboration among government ministries, between ministries and
elected government structures at the local level, and between all of these and commu-
nity-based organizations represents an important change.

The second characteristic is the understanding that, in spite of the commitment to
universal programs, the current situation calls for focused attention on the most vulnerable
sectors of society. Important initiatives that focus resources on those groups have begun
to be implemented and represent an important departure from past practice.

Finally, the last decade propelled the development of community-based initiatives.
Although begun in the 1980s, the current methods of community practice have evolved
greatly under the pressure to attend to local problems. The actions of both community-
based organizations and the Popular Councils are new elements in the social arena in
Cuba, elements with great potential for enhancing the reach and the effectiveness of
social programs. These community-based initiatives are the subject of Chapter Four.

A Growing Tendency Toward Collaboration

Critical problems in the delivery of services have been the strong sectoral orientation of
services and the lack of collaboration among the different areas of service delivery. This
is not unusual in the delivery of services anywhere. But, in a highly centralized society,
without any alternative sources of service, this separation is much more constraining. In
Cuba, within every sector – health, education, social security and assistance, social pre-

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

The necessities of the Special Period
created new types of horizontal collabo-
ration between different sectors. Right,
representatives from the Federation of
Cuban women, the Ministry of Agriculture,
the Ministry of Science, Technology and
Environment work together on a project
which organizes women to grow soy to be
processed into yogurt for school children
in Santiago de Cuba.

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CHAPTER 3: A SAFETY NET TATTERED BUT HOLDING

vention, culture, and others – planning takes place nationally, and directives flow down
to the provinces and the municipalities. Collaboration among the sectors at any particular
level is infrequent, and the result is a kind of incoherence at the community level. In 1996,
the Sociological Research Group of the Cuban Academy of Sciences complained of
“programs that act simultaneously upon a community but without articulating common
objectives and methods,” leading to “overlap, competition among different actions, and
a general decrease in efficiency and effectiveness.”

Moreover, the strict vertical structures

may prevent the accurate assessment of complex problems that overflow disciplinary
boundaries. Verticality may hinder the mobilization of professionals from diverse disciplines
and with diverse experiences to address the problems.

The fiscal crisis of the 1990s presented Cuban social institutions with precisely these
types of problems. In the face of increasing complexity and differentiation, social systems
cannot succeed in their missions if they act alone. The rise in poverty; the resurgence of
prostitution, petty crime, and drug use; the escalating school dropout rates; the nutrition
problems; the problems facing urban neighborhoods – these are precisely the kinds of
problems that challenge disciplinary boundaries and call for cross-sector collaboration.

There is evidence that approaches directed toward these problems are becoming better-
integrated and more collaborative. Initiatives that foster horizontal collaboration have
included those undertaken to address, for example, the increasing incidence of low-weight
births, the rise in school dropouts and the tide of children engaged in street activities,
and the problems of single mothers and elders on fixed incomes. These initiatives have
brought together the resources of the Ministries of Education, Public Health, Internal
Commerce and Work, Social Assistance and Social Security; the Commissions of Prevention;
the mass organizations; and local governments – all focusing their interventions on problems
affecting specific groups. These types of initiatives are also at the center of community
development efforts, where they are focused on environmental interventions.

The following vignettes illustrate some of the ways in which collaboration is bringing
new energy into the solution of community problems.

1: Reducing Low-Weight Births.

After showing a consistent improvement during the 1980s, the prevalence of babies born
with low weight (under 2500 grams) began to increase in 1991, reaching in 1993 a rate of
9% (compared to 8.7% in 1988). The National Program of Low Birth Weights established a
collaboration between the Ministry of Public Health (MINSAP) and local governments to
address the nutritional needs of at-risk pregnant women. At-risk pregnant women were iden-
tified in every neighborhood and connected to Hogares Maternos, which provide preventive
education, social assistance, and recreation for pregnant women and their young children.
Through the work of local governments, at-risk women were connected with a workers’ lunch-
room, where they receive at least one free meal every day. By 1995, low birth weights had
been reduced to 7.9%, and they were continuing to decrease through the late 1990s.

Collaboration is evolving, but not without resistance. Turf issues and lack of practice in
collaboration and integration of services are barriers. “There is a need to transform the
existing thinking… of caring for people in a fragmented way and from the perspective
of only one area, be it health, education, or social security,” writes sociologist Lourdes

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

2: Helping Mothers Raise Children.

Many of the mothers raising their children alone in a neighborhood in Marianao did not have
any source except social assistance, which, as the economic crisis hardened, barely covered the
basic essentials for the family. The Municipal Directorate of Work, Social Assistance and Social
Security, the Popular Council, the Federation of Cuban Women, and the neighborhood
community development organization began a collaboration directed to identify the needs of
these women and develop a plan of action to ensure appropriate resources for the families. The
group trained community women, including some of the mothers, in interviewing skills and set
them off to identify and interview needy mothers in the neighborhood. Twenty-nine mothers,
all receiving social assistance, were interviewed. The survey revealed that all had children
between ages 0 and 16; only 26% received support from the children’s fathers, with half
reporting very little support from other family. Most lived in very precarious housing. Most
women had worked, but not in stable jobs; most were willing to work if child care was provided.

Together, the different institutions set out to provide some relief. Eight mothers were found
jobs, most of them providing services to elders in the area. Three were referred for appropriate
medical care, and three were placed in courses to prepare them for work. Collaboration
continues in the development of resources for mothers in Marianao.

3: Working Together for Clean Communities.

In 1997, the lack of fuel had made garbage pickup in Pogolotti very erratic. At first, families
began to hang their small plastic bags from trees and posts to allow foot and vehicle traffic
through the streets while they waited for the garbage to be picked up. But as time went by,
large areas of the sidewalk, then the street, and, often, any empty lot became a dumping
ground for household wastes. During that year, the Popular Council, the Metropolitan Park of
Havana, the Taller de Transformación Integral de Pogolotti, and the Martin Luther King Center
came together to form an Environment Group, made up of residents and community workers
concerned about the environment. They reported on a diagnosis of environmental problems
carried out by community members which documented every dumping site and all areas
where contamination was suspected. In community meetings, 50 residents prioritized the
elimination of the garbage dumping sites but also raised the need to reforest the areas and
develop places for recreation of children, “making the connection between an environmentally
healthy community and a healthy community.”

And so the project, funded in part by the Canadian International Development Agency
through the Canadian Urban Institute, included all three: they implemented a pilot recycling
program for 150 families; they provided seven workshops on environmental education on
recycling for the neighborhood, and they eliminated all the dumping sites (some of them have
been reforested, and one was used to develop a sports area for children). Participation of the
population was an integral part of the project. “We involved the community from the start,
and they participated in the decision making on the project,” said the project’s social work-
er. “They… were helpful because they have great interest in the solution of their own prob-
lems. [Because of this], we had very concrete results.”

CHAPTER 3: A SAFETY NET TATTERED BUT HOLDING

Urrutia Barroso.

Nevertheless, the experiment with collaboration across sectors has

been positive, not only in terms of the effective and efficient use of resources but, more
important, in terms of gaining success over new, very complex problems.

Focusing Attention on the Most Vulnerable Groups

In a culture of universality, attention targeted to the problems of specific groups is not
expected. And so, when in September of 2000, the Social Work Student Brigades began
to assess the needs of the poorest families in the city of Havana and weeks later returned
to give these families some of the goods and services they needed, there was consternation.
The prevailing ethic for many years was that everyone received the same from the
government – be it food from la libreta or universal medical care and education – and
only those who had performed with merit at work were entitled to receive extras. Made
up of university students, the Brigades reported on their findings directly to the leadership
of the country, bypassing the structures of local government but also sensitizing the
leadership to the growing problems of the poor in Havana. Special funds were made
available to alleviate the worst situations, and students worked to connect families to
needed services. The fact that some families were singled out for additional government
benefits, and that in some cases these were families with difficult social behavior, raised
questions.Delivering focused attention to families with great economic and social needs
would later be understood and largely supported as the means of reaching out in a
preventive way to society’s most vulnerable people.

That same September, over a thousand young persons began training as “social workers”
in the first of what would soon grow to four Social Work Training Colleges that now
operate throughout the island. Training for professional social work had ended in Cuba

Many of the government’s new social
initiatives seek to prevent problems.
Increasing cultural programs for youth at
a community level is a priority. These
children in a school in the province of
Vinales prepare a school concert.

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CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

in 1962. The perspective was that the changes brought about by the revolutionary
process would address most of the social problems and those that remained could be
handled by the mass organizations (the Committees for the Defense of the Revolution
and the Federation of Cuban Women).

In the 1970s para-professional training in

social work was started by the Ministry of Public Health, and in 1998, in the aftermath
of the economic crisis and at the request of both the Ministry of Public Health and the
Federation of Cuban Women, an undergraduate program in social work was started in
the Department of Sociology at University of Havana.

The founding of the Social Work Training Colleges, has introduced social work to a far
broader segment of people, but at the paraprofessional level. Their first group of students
was young people ages 16 to 22 who had not attained admission at the university

and

had an inclination for this type of work. They received a 10-month training program
delivered by faculty from the University of Havana and began their work in the city,
tending to youth, the elderly, and others in need. Once they begin to work, these social
workers are eligible to attend the university social work program or any other under-
graduate program.

Attention is currently being provided to at risk-groups, which include persons with poor
living conditions, the disabled, families of incarcerated persons and ex-prisoners, pregnant
teens, single mothers, seniors, and children and youth, particularly those no longer in
school.

Although there is a strong social support function in these emergency programs,

there is also a strong focus on preventing delinquency. As a result of the crisis, along with
the losses of jobs and livelihoods, “criminal behavior escalated together with changes in
social values and the emergence of new manifestations of social indiscipline,” explains
Lourdes Perez. “These programs emphasize prevention and nurturing over punishment.”

Aside from the initiatives taken by the new social workers, other targeted programs have
also been implemented. These have focused, for example, on protecting women’s
employment by protecting their jobs and retraining them for jobs in the emergent sectors.
They have emphasized the development of cultural programs for youth at the community
level and created networks of resources in the community to provide food at workplace
cafeterias at very low prices for the elderly and for pregnant women.

This has not meant abandoning a universal approach and its great advantages. The current
debate on the role of targeted programs in Cuba’s universal system focuses on two
fundamental aspects. The first is the need to reach out and support vulnerable groups,
as the government has done, without having to provide similar services to everyone.
This is an approach that receives consensus because of its role in preventing the devel-
opment of more serious social problems and the limited character of its intervention.
The second aspect of the debate is re-examination of current universal benefits with an
eye to possibly focusing resources on the most vulnerable groups, taking into account
poverty and other special needs. There is far less consensus at this time on the need for
such a shift.

Grassroots organization in practice,
these men participate in a community
clean-up organized by the CDR as part
of a nation wide public health campaign
against dengue.

AN CAB

ALLERIA/O

AM AMERICA

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

4. TRANSFORMING COMMUNITY

DEVELOPMENT

Community development is not new in Cuba, but it took a different form in the 1990s.
The main social organizations in Cuba, such as the Committees for the Defense of the
Revolution (CDRs) and the Federation of Cuban Women (FMC), are organized at the
block level. Although not professional service providers, both do offer resources at the
community level. The FMC, for example, organizes vaccination campaigns and conducts
public education in a variety of areas. Although the CDR are charged with the security
of neighborhoods and with mobilization for activities and volunteer work, they too
provide primary support for neighborhood residents. Other important resources at the
community level are the family doctor/family nurse teams that provide primary care in
the community and the local schools. Schools are used by neighborhood children all
day. After classes, many children participate in activities organized in the schools by the
Young Pioneers.

When the economic crisis hit in the early 90s, community organizations proved to be a
crucial element in the organization of social support, particularly in urban areas. When
there was no transportation out of the neighborhood, the CDR could ask a neighbor
with gasoline and a car to drive to the hospital in an emergency; the CDR provided
recreation at the block level; the FMC distributed vitamins to every household and held
meetings to talk about ways to cook meals with the limited choices available; in the
darkest times of the crisis, the CDR would organize a neighborhood cleanup. Mass
organizations also participated in the prevention of crime and delinquency at the
community level by activating the neighborhood watch and organizing activities for
youth. This continuous work at the community level is clearly an important element
that allowed Cuba, and especially Havana, to weather the crisis.

During the Special Period, however, long-standing problems in the communities were
joined by new problems. The surging needs of the population, together with the lack of
resources and the hardship of daily life during the Special Period, quickly went beyond
what the mass organizations could address. Their structures and their proclivity for waiting
for

orientaciones

(directions) before stepping out of the usual line of work meant that the

mass organizations were unable to provide either leadership or a response to the specifics
of the crisis facing individual communities

. Although an important element in the

fabric of Cuban society, mass organizations proved not to be the best vehicles for more
proactive activity.

The “local level” in Cuba had always meant the municipalities, but the Special Period
highlighted that the municipality was too far away from the base and had too few
resources to prove effective in addressing community needs. This is so, first of all,
because the territory occupied by the municipality is much too large and the needs of
its population are much too diverse to be addressed by “one size fits all” solutions.

Responding differentially to the many demands was especially difficult during the Special
Period, when differences became even more salient while the resources all but disappeared.

The Special Period also demonstrated that, although there had been a process of
deconcentration of decision making and administration from the central government to
the provinces and municipalities, the municipalities still have very little power.
Although they oversee a broad range of services – including some that in the United
States are handled by the private sector, such as grocery stores, bakeries, and repair shops –

they are not empowered to raise revenue,
make budgetary decisions, or veer very far
from established priorities.

Over time, this

has left a growing number of local problems
unresolved.

The vacuum that existed at the community level
and the great needs that arose during in the Spe-
cial Period led to the forceful emergence of what
sociologist Haroldo Dilla has labeled a “neigh-
borhood movement.”

Community-based

organizations, hundreds of them, developed in
Cuban barrios to address urgent needs facing
urban dwellers in the Special Period. The
“neighborhood movement” focused attention on
the neighborhoods, most particularly on hori-
zontal networks at the community level. In

doing so, the new initiatives ushered in the participation of many actors: local govern-
ments, the mass organizations, Cuban non-governmental organizations, international
development organizations, institutions of higher education, and, most important, the
neighbors themselves. The first entity to engage in this urban development work were
the Neighborhood Transformation Workshop (Talleres de Transformación Integral del
Barrio [TTIB]). The second were the Popular Councils, which today are the institutions
that are best poised to take good advantage of the new experience acquired at the com-
munity level. Both are described in detail below.

The Neighborhood Transformation Workshops

In 1988, Fidel Castro inaugurated the Group for the Comprehensive Development of
the Capital (Grupo para el Desarrollo Integral de la Capital – GDIC) under the
sponsorship of the Provincial Assembly of Popular Power. The GDIC was made up of
top Cuban urbanists and was charged with improving the life of people in the capital.
Havana, free from some of the more pressing social problems facing urban areas in Latin
America – such as overpopulation, homelessness, huge marginal neighborhoods, great
social inequality, drugs, and crime – was in a good position to make important steps in
this direction.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

MINOR SINCLAIR/O

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Neighborhood Transformation Workshop
team members meeting with community
leaders to jointly identify issues of concern
in El Canal, Central Havana.

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

One of the first demonstration projects implemented by the GDIC was the initiation
of Neighborhood Transformation Workshops

(Talleres de Transformación Integral del

Barrio)

in three vulnerable neighborhoods in the city of Havana: Atarés, La Guinera,

and Cayo Hueso. Both Cayo Hueso and Atarés are located in the central part of the city,
in Centro Habana and El Cerro respectively. Both boast great historical and cultural
traditions but also are old, poor neighborhoods with serious problems in the quality of
the housing and an equally difficult set of social problems. La Guinera, in contrast, is
located in Arroyo Naranjo in the outskirts of Havana with many people living in
marginal, precarious neighborhoods with no water, electricity, or services.

The Workshops gathered together six or seven professionals – architects, planners, social
workers – to address the problems of the neighborhood. The early approach of the
Workshops consisted of identifying the main problem areas in the neighborhood
(usually housing) and mobilizing neighborhood and outside resources to address them.
The Workshops were quite successful. In Cayo Hueso and Atarés, for example, they
worked to remove tenement buildings. The Workshops convinced the residents to move
if the tenement building was in precarious condition and helped design and renovate
the housing. More than 12 tenement buildings were repaired in the first three years.

100

The Workshops were also effective in bringing resources into the neighborhood. In the
early years, the GDIC and the Workshops enjoyed considerable government support,
which helped overcome many barriers and permitted a very entrepreneurial approach in
the search for solutions; for example, the Workshops were often able to bypass clogged
municipal bureaucracies and mobilize provincial and even national resources. Leveraging
resources to address problems identified at the neighborhood level by neighborhood
residents would become the landmark contribution of the Workshops. By 1991, five
additional Workshops were working in Havana neighborhoods.

The 1990s economic crisis in many ways
transformed the work of the Workshops.
As construction materials became scarce,
the brick-and-mortar approach of the
Workshops transitioned into interventions
that focused on the social needs of the
community. In order to do so, the Work-
shops had to come to understand the
community in which they worked in a
much deeper way and transform the meth-
ods by which they carried out their work.

Workshops began to apply participatory
community planning methods that
helped the activists conduct needs
assessments of the neighborhood. They
aggressively looked for ways to involve
residents in the process. Workshops
began to focus on the needs of vulnerable

DERICK SINCLAIR

An example of new kinds of collaboration
on community projects, this housing
reconstruction project is coordinated
with the Neighborhood Transformation
Workshop of Central Havana, the
Martin Luther King Center, the popular
council and the municipal government.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

populations, such as women and adolescents; on reinforcing the cultural identity of the
neighborhood; and on working, as much asresources permitted, on concrete neighborhood
betterment projects. The work so far has included:

•

Construction projects

such as the renovation of neighborhood housing and schools and

the construction of offices of the family doctor and grocery stores;

•

Environmental projects

such as the organization of neighborhood solid waste

recycling programs and reforestation campaigns;

•

Small-scale economic development projects

such as workshops for neighborhood artisans

(where women make products that go on sale in the neighborhood), the organization of
video centers and showings, job training for women, and computer classes.

•

Social service activities

such as the organization of teen clubs, mothers groups,

self-esteem groups for women, and after-school programs focused on local
cultural expressions.

Zulema Hidalgo is a member of the
Neighborhood Transformation Workshop
in the community of Atarés. Zulema
focused on women in the community and
their motivations for improving their lives
and their community. She was interviewed
in March 2001:

We felt that it was necessary to work with
women in a different way for many reasons.
Ours is a neighborhood where a sexist education
predominates, where there are many customs
that are strong shaped by machismo. At the
same time there were many women who were no
longer working. It was through our work with
the children that we realized the need to focus
on women because there was a lot of violence
directed at them and at their children. The vio-
lence and their lack of participation in work
meant that there were no spaces where they
could better themselves and little by little there
was less presence of women in the issues that
were concerning the community.

They were members of the popular organiza-
tions such as the CDRs or the FMC – our
neighborhood participates actively and with a
lot of joy in the activities of its central organi-
zations. But we felt that women needed a more

specialized attention, attention with more
technical rigor. It couldn’t just be going to a
meeting or seeing each other about basic
problems like we do at the Federation. It had to
be different.

We formed a self-esteem workshop, where
women come once a month to our community
house. It is the same members of the Federa-
tion that live in our community, but we give a
space for reflection and exchange. We work
on our self-esteem through several themes; for
example, we have invited housing specialists,
lawyers, doctors to speak about sex educa-
tion and breast cancer.

We wanted them to share their potential and
their values, become more active in the work
that was going on in the community. And the
work demonstrated that this took place. After
a few meetings the women began to become
more involved in their organization, the FMC.
They began to take leadership in the base
organizations and became more involved in
the work of the Taller. It has had a great
impact because it has helped women to
become involved. And it has also changed
these organizations.

SELF-ESTEEM AND COMMUNITY DEVELOPMENT

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

The Workshops quickly related to the neighborhood in ways that had been difficult for
provincial or municipal entities to do. Workshop staff were known in the neighborhood;
they addressed issues that the residents felt were priorities; and, unencumbered by
emergencies in other areas, they had the time to build the relationships and the networks
necessary to address problems at the neighborhood level. The Workshops provided
mechanisms by which other entities (such as the mass organizations, the school principals,
the family doctors, and others acting in the neighborhood) could focus on neighborhood-
identified problems. Their role was not to replicate the efforts of the CDR or the FMC
or the public health system, but rather to bring the CDR and FMC and the health system
to focus on the specific problems of the neighborhood.

The Popular Councils

Perhaps the most aggressive advocates of local issues and the institution that holds the
most potential in truly transforming life at the local level are the Popular Councils. The
Councils were formed precisely to help bridge the gap between the municipalities and
the neighborhoods by focusing on horizontal networks at the neighborhood level that
had been previously overlooked. Through their work, the Councils look to support the
efforts of the local delegate to the Municipal Assembly. Pilot Councils were first founded
in 1988 and then four years later were implemented throughout the country. Today
there are about, 1505 Popular Councils in the country; Havana alone has 105 Popular
Councils, each serving an average of 20,000 residents.

The Popular Councils consist of volunteer delegates elected directly by the population
as well as representatives of the main economic, social, and service institutions in the
area, including the CDRs and the FMC. The president of each Popular Council, elected
by the delegates who compose the Council, dedicates his or her time fully to its work.
As a full-time employee, the President has more time than the other delegates to investigate
problems and bring them to the Council for discussion and recommendation. With the

Self-esteem and community development:
“We wanted women to share their
potential and their values, become
more active in the work that was going
on in the communities…”

Zulema Hidalgo, Neighborhood
Transformation Team worker in
Atarés, Havana

ODERICK SINCLAIR

backing of the Council, the Council President makes the case before the municipal
authorities and, if necessary, the Municipal Assembly.

Neither the President of the Popular Council, the Council itself, nor the delegates have
any administrative authority in their territory. Their job, by law, is to monitor all entities
in the territory – municipal, provincial, and central government entities alike – for the
purpose of improving services at the local level. The Council’s role, as stated in its
founding resolution, is to “work actively for efficiency in the development of activities
of production and services and for the satisfaction of the medical, educational, cultural,
and social necessities of the population, promoting the greatest participation by the
population” in the solution of its problems.

101

The Council is charged by law with address-

ing the specific needs of the population, establishing coordination and promoting col-
laboration between the different entities in the area of the Council.

The Popular Councils began their work at the peak of the economic crisis, which has
presented quite a challenge. As one government official put it, “The amount of objective
problems that exist in the community and the limited capacity on the part of the
government, places the delegates and the Presidents of the Councils in a very difficult
position.”

102

And that was surely the case: almost all community problems came to the

Popular Councils. As the central, provincial, and municipal governments became less
able to provide resources and less effective in addressing the growing problems at the
local level, the Councils became, in practice, the managers of the impact of the crisis
at the community level.

The urgency of the economic crisis pushed the Councils to find local solutions to a great
variety of community problems and some entrepreneurial Councils have moved forward
with aggressive community development projects. For example, Havana’s early initiatives
in urban agriculture, instrumental in improving people’s nutrition, were largely based in
the city’s Popular Councils.

103

Many environmental awareness and cleanup projects, as

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

We are thinking of a Popular Council for the
present and for the future… We are focusing
on the control and monitoring role that Pop-
ular Councils should exert as well as on the
role of the Council in organizing participation
of the residents…

Without a doubt, the Council is a fundamental
element in the art of coordinating and inte-
grating all the organizations and entities at the

community level. I think there is the willingness
to develop this type of activity. But the issue is
not so much to be successful in one small place
or in one experience. The challenge is in how we
implement this across the country. But for
that, we need to let the different experiences
evolve so that we can learn from them.

Tomás Cárdenas, Comisión de Órganos Locales,
Asamblea Nacional del Poder Popular

105

LEARNING FROM THE EXPERIENCE OF POPULAR COUNCILS

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

well as cultural programs and other initiatives, are also sponsored by the Councils. The
same is true of many other areas of community work.

But not all Councils took this broad approach, and many that did were not as effective.
In fact, analysis of the work of the Councils reveals great deficiencies in their ability to
monitor services, to promote the participation of residents, and to strengthen the ties
among those responsible for different services at the community level.

104

Ongoing efforts to enhance the Councils’ effectiveness emphasize their coordinating
role vis à vis other actors in the neighborhood and their capacity to monitor the quality
of services at the community level. And many believe that this increased effectiveness
depends on the transformation of the relationship of the Council to the residents. In
particular, promoting popular participation in decision making is perceived as key to
transforming governance and to improving services at the local level.

Significant attention is being placed on supporting the Councils’ role in this regard. For
example, in 2000, the National Assembly approved Law 91 of the Popular Councils, which
emphasized in its language the role of popular participation in the work of the Councils:

Popular participation in the activities of the Popular Council constitutes the
fundamental means for carrying out the work of the Council. Participation has
to be present from the time that problems, needs, and solutions are identified,
to the process of decision making, as well as in the planning, development, and
evaluation of the main activities that take place in its territory.

106

The adoption of these processes may not necessarily mean that there will be structural
changes to Poder Popular – for example, the greater control of resources at the local level –
but the adoption of this language signals that Popular Power is seeking a more effective
way of carrying out its work. Although this quality of participation remains a goal, it
does provide the context for continued experimentation in transforming relationships at
the local level.

A Different Way of Working: What Is New?

The decade was full of experimentation in the areas of community participation,
community development, and the uses of participatory community planning
methodologies. By 1993, the three original Workshops had grown to seven; in 1997,12
barrios of Havana had Workshops; and today there are 20 in the city of Havana. At this
point most Workshops work closely with the Popular Councils. To date there is no exact
count of the number of experiences of participatory community development taking
place in Cuba, but some estimate that the number is in the hundreds.

107

In the City of

Havana alone, Popular Councils are sponsoring an estimated 70 community devel-
opment initiatives. What then are the characteristics of the “neighborhood movement?”
How is this practice different from its precursors? And finally, how does it relate to the
improvement of services?

The Miramar popular council in Playa,
Havana took the initiative to set up a
store selling organic agricultural inputs
to urban gardeners at a low cost.

MINOR SINCLAIR/O

AM AMERICA

Five key characteristics of community development initiatives in Cuba can be identified.
These initiatives, which are analyzed in greater detail below, generally:

• act upon small, geographically defined areas

• have a comprehensive and integrated vision of the neighborhood

• use participatory community planning methodologies

• prioritize efforts that can be accomplished with neighborhood resources, supported

by small government and/or international NGO support.

• seek to build capacity at the community level

1. Focus on Local Communities

Traditionally, social organizations in Cuban society had not ignored the community, but
they had not highlighted their role. That was to change in the 1990s. “Although the Spe-
cial Period has made more evident the need to pay attention to this scenario of social
life,” expresses a document from the Grupo de Investigaciones Sociológicas (Social
Research Group) of the Academy of Sciences, “today, the [issue of the community is
more opportune, more indispensable” because it is the locus for popular participation
and a key element for social development.

108

Community development initiatives act upon a specific community, unlike the large-scale
initiatives that target large territories (and at times the whole island). In almost all cases
this is a geographically defined community, with the most common locus being the area
served by a particular Popular Council. The Popular Council joins together the delegates
of several

circumscripciones,

the equivalent of a “ward” in the United States, each of

which is represented by a locally elected delegate. The existence of the Popular Councils
allowed for a redefinition of

lo local

as a space much closer to the everyday life of people

and of a size much more amenable to community-based interventions.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

Strategic community planning is taking
place in the 22 Popular Councils in the City
of Havana in which there is a Taller de
Transformación Integral. Strategic commu-
nity planning begins with a participatory
diagnosis of the major issues affecting the
residents in the Council conducted by the
Taller together with Council members and
persons from the community. Once this is
completed, a series of meetings are organ-
ized where the Council and community-
based organizations analyze the findings

and determine the strengths, weaknesses,
opportunities, and threats they face in
addressing the problems. This technique
assists the group in prioritizing those areas
in which they have the potential for success.
Objectives and action plans are devised as
are methods for monitoring the progress.
The hope is that all entities in the neigh-
borhood can take direction from the
strategic community plan as they organize
their own activities.

109

DEVELOPING STRATEGIES FOR THE NEIGHBORHOOD…

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

2. Emphasis on Horizontal Networks

The second characteristic is that community development efforts have tended to seek a

comprehensive, integrated vision

of the needs of the area and of the solutions that best

fit those needs. This requires a focus on the neighborhood and prioritizes the construction
of relationships among the different neighborhood stakeholders, who are then forced to
take into account the actions of all those entities that impact upon the neighborhood
(a horizontal perspective).

3. Participatory Methodologies

The third characteristic of new community development initiatives is the use of partic-
ipatory methods in the planning and execution of the projects. Cuban initiatives use
many variations on classic community planning processes.

111

With guidance from the

GDIC, the Ministry of Culture, and the Martin Luther King Center, Popular Councils
and community-based groups are experimenting with the application of these
methodologies to the Cuban context.

One of the issues that has elicited most
debate has been the potential of generating
in the Cuban context the level of partici-
pation that is required for effective
community development. There is a
strong and rich history of social and
political participation and voluntarism in
Cuba. Most successful Cuban initiatives,
from the Literacy Campaign to the vacci-
nation of children, have benefited from
the active and selfless participation of
ordinary citizens. But most of this partici-
pation has focused on the execution of
initiatives that are often designed centrally.
The opportunities for citizens to participate

When I speak to local Popular Power leaders
about community work, I tell them that I am
talking about a new way of working. What do
you mean, “a new way of working”?, they say.
And I tell them that they have to think about
an integrated development rather than the
sectoral perspective we are used to-that if you
are talking about community development, of

community work, you are talking about inte-
grated, comprehensive development, and that
the Popular Council permits that kind of work.
In fact, it encourages it.

110

Interview with David Diaz Carbo, a sociologist
and former trainer of Popular Council dele-
gates, March 2001.

A DIFFERENT WAY OF WORKING IN THE
POPULAR COUNCIL (1)…

Representatives of the popular council,
Cuban NGOs, municipal government,
construction brigades, and community
members gather to unveil the housing
rehabilitation project they have all col-
laborated on in La Juara, Havana.
Housing rehabilitation projects are
a principle vehicle for new forms of
horizontal coordination among differ-
ent sectors.

FAM CANAD

in decision making, even in areas that affect their daily lives, have been limited. Local
planning for services and neighborhood improvements favor professional intervention
and, less so, the participation of those affected by the plans. Participation in the
identification of problems and solutions, and in the planning, development, and
evaluation of local activities is relatively new. But the fact is that the new law guiding
the development of the Popular Councils requires precisely this level of involvement.

113

In many ways, the core element of community development processes is participation,
real and sustained participation by those impacted (positively or negatively) by the services
and the plans. Most Cuban community development projects make strong efforts to
promote “real” participation, but in many cases providing real-decision making power
to residents has not been fully achieved. Some participation processes have involved
structured methods of participation such as that taking place in some of the strategic
planning processes that have begun to take place in Popular Councils in Havana, while
others emphasize less structured methods such as those exemplified by the initiative in

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

The neighborhood diagnosis and the
strategic plan identified Ward 10 in the
neighborhood of Atarés as one of the poor-
est, least developed areas of the neighbor-
hood. The Taller began to work with the
residents of Ward 10 in conducting a par-
ticipatory assessment which showed the
main areas of concern of the population:
the petty crime perpetrated by groups of
neighborhood adolescents; an unfinished
building that had become the site of illegal
activities; a small group of students who
were skipping and dropping out of school;
and an increase in the recreational use of
alcohol and drugs. The residents also noted
that the neighborhood lacked areas of
recreation for children and youth and that
the physical condition of the neighborhood
left a lot to be desired: streets and side-
walks were in a bad state, there were sever-
al dumps of solid wastes in the
neighborhood, the streets needed lights…

The Taller called together neighbors, the
delegates of Ward 10, the CDRs. The FMC,
and in a series of meetings, using participa-
tory planning techniques, they decided the
objectives and specific actions to be taken.
These focused on the improvement of the
physical conditions of the neighborhood as

well as on the specific problems facing fam-
ilies. Specific actions in relation to the latter
included a neighborhood youth confer-
ence, which highlighted the family conflicts
and school issues, as well as the issues
related to alcohol and drug use. They also
included series of very well attended “street
conferences” focused on drug abuse as well
as specific initiatives such as the develop-
ment of a neighborhood baseball team, the
construction of a park in the former site of
a garbage dump, and the organization of
cultural activities for youth and adults.

“When we finished one of our work ses-
sions,” writes Regla Barbon and Isabel Mora
of the Taller, “we invited the residents to
reflect on the following dedication by Jose
Marti to his son: ‘Horrified with everything,
I take refuge in you. I have faith in the bet-
terment of humankind, in our future, in the
value of virtue, and in you.’ One neighbor
responded: ‘Our society today is very con-
vulsed, but it is necessary to think in the
positive in order to work with our children
and our youth, we have to demonstrate our
confidence and faith in their betterment.’
We think that our work has gotten all of us
nearer to this goal.”

112

AN INITIATIVE IN WARD 10 IN ATARÉS…

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

Ward 10 described in a box in this section. “To perfect this process is still a goal for us,”
says David Diaz Carbo, who trained City of Havana Council presidents in these
methodologies. “There are many projects experimenting in this direction with some
good experiences, but we still have a ways to go.”

115

A significant amount of training has

been devoted to achieving better levels of participation.

116

Finally, there is evidence of something akin to a glass ceiling when it comes to participa-
tion, in that participatory initiatives remain unlinked to decision making in critical areas
of life in the community. Urban planner Carlos Garcia Pleyan

117

expresses it this way:

“There is this tremendous opportunity – perhaps the only one in the world – of having
a powerful State, organized and with an ideology that supports these popular initiatives,”
but it “has had a hard time linking with them because of some unworkable structures.
We have to imagine, investigate, discuss, and propose solutions that articulate both
elements.” Here, Garcia Pleyan underscores the importance of partnerships between
local community processes and municipal, provincial, and central government structures,
all working to address problems facing families and communities.

4. Mobilizing Resources

Mobilizing resources for neighborhood priorities has proved a challenge. Most projects
aim to use neighborhood resources, which are often readily available, especially if they
entail only person-power. For other resources, groups have to rely on local organizations
like the CDRs or the FMC, or on government agencies such as the Ministry of Culture
or the Ministry of Health. The Ministry of Culture, for example, funds the Houses of
Culture in every municipality and, more important, along with the Union of Cuban
Writers and Artists (UNEAC), funds directly thousands of community-based artists.

A very common comment, for example, is that
the ‘accountability assemblies’ held by Popular
Power delegates are a mechanism to pick up on
needs, and I say that this is not so, that you
are picking up on demands, using a mechanism
that the government put in place to pick up
complaints, not needs, and that you don’t have
in place a systematic way of picking up felt
needs directly from the people, to understand
how people see their problems.

I tell them that this work requires building the
capacity of and supporting local leaders, that
this work is slow and leaders need to be
encouraged and supported. It requires self-help
and leadership generated from the community.
And when I say that, all kinds of discussions

begin: But what kind of self-help are you
talking about? Money running about in the
community? Not now, I tell them. Right now we
are talking about the work that we can do
together with existing resources and maybe a
bit more.

I tell them that this is a method, a different
way of working that requires significant ini-
tiative on the part of the community and that
this initiative needs to be encouraged and
supported…Community development is not
adding another category of tasks to what
[the members of the Council] are doing, but
transforming what they are doing by doing it in
a different way.

114

A DIFFERENT WAY OF WORKING IN THE
POPULAR COUNCILS (2)

Large urban projects, such as the Metropolitan Park of Havana and the

Plan Maestro

for the Renovation of Old Havana, support many community development initiatives
in their areas. The Metropolitan Park, which applied participatory methods in the
development of its strategic plan for the environmental restoration of a large swath of
land bordering the Almendares River,

118

has organized Environmental Groups in the nine

Popular Councils within its territory. The Park coordinates the work of the neighbor-
hood and involves neighborhood residents and the Councils in planning for the Park.
Many Metropolitan Park projects are conducted in conjunction with the Councils and
receive assistance from international agencies.

Community projects have attracted significant support from local universities and research
centers, which sponsor training, student and faculty research, seminars, and publications
on the topic. They also receive direct as well as technical support from national non-
governmental organizations such as the Martin Luther King Center, the Council of
Churches, and the Center for Information and Study of InterAmerican Relations (Centro
de Información y Estudio sobre las Relaciones Interamericanas CIERI).

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

A woman resident contributes her work on a
community housing repair project funded
by Oxfam through the Martin Luther King
Center in Central Havana.

Oxfam America’s program in Cuba began in

1994 as a humanitarian response to a

country in economic crisis. Oxfam America’s

initial focus was quite specific: support

farmers to produce more food for local

people. Oxfam America partners, such as

the National Association of Small Producers

(ANAP) and the Cuban Council of Churches

proposed creative solutions and innovative

strategies – such as extensive urban agri-

culture to feed the cities and animal traction

to substitute for antiquated machinery –

and gradually an alternative path to farming

took hold. What began as a piecemeal

approach to help the country regain its

footing and feed its people evolved into

program support of key grassroots and

membership organizations which are suc-

cessfully promoting alternative development

strategies. In Cuba this means strategies

rooted in the community, which renew not

deplete the environment and which make

good sense for people.

Oxfam America’s involvement, whether sup-

port for community response to destructive

hurricanes or for farm management training

for family-run forestry farms or for farm

cooperatives to modernize, have exposed

agency staff and partners to many innova-

tions forged in the communities and fields

of Cuba. Increasingly, sharing this knowl-

edge and helping Cubans make the con-

nections with communities and

organizations in other countries will figure

highly in Oxfam America’s future support

for Cuba.

For a complete description of Oxfam

America’s program in Cuba, refer to the

website

www.oxfamamerica.org/global.

OXFAM AMERICA IN CUBA

MINOR SINCLAIR/O

AM AMERICA

CHAPTER 4: TRANSFORMING COMMUNITY DEVELOPMENT

Community projects are also funded by international non-governmental organizations,
which began to operate in Cuba during the mid-1990s. The international NGOs’
presence initially stirred some controversy in Cuba because of their preference to fund
non-governmental organizations instead of state institutions, but generally their role has
been accepted and well received. International NGO support has been crucial in funding
of community development projects as well as in providing technical support and
facilitating international exchanges.

5. Building Community Capacity

A final characteristic of the Cuban community development process is the way it has
supported and developed local leadership. Cuban mass organizations, present at the block
level and at every workplace, have always been the site of significant leadership development.
Most promising leaders who were identified at the base moved on to positions outside
the neighborhood. In the past, community-based leaders were not called upon to address
the level of complexity that is required today of the local leaders in the Popular Councils,
the Workshops, and the community projects. And therefore, one of the first tasks was the
development of the capacity of grassroots leaders to take on these tasks.

An important element in the participatory
processes of the 1990s has been the
application of methods of popular educa-
tion pioneered by Pablo Freire, a Brazilian
educator specializing in adult literacy for
liberation, and used widely in Latin America.
But Cuban practitioners found that the
methods could not be applied without
taking into account the particularities of
the Cuban experience. Here Esther Pérez,
the founder of the training program of the
Martin Luther King Memorial Center in
Havana, explains the reasons:

As time went by, the popular education has
gained in complexity because of various reasons.
The most obvious is the high educational level
of people here. This means that we have dis-
carded the Latin American materials with which
we started to work since they were designed for
people with less contact with written texts. We
also include or produce texts that our people
subjects not only understand but usually
demand, since they create a very strong link
between the written word and the learning

process. We also do away with some common
topics or approaches to training processes
used in Latin American countries for example,
the creation of capacities for simple diagnosis,
observation, and research processes since
people in our workshop already have those
skills. High educational levels have also allowed
us to do several things among them, for example,
to use elements from various social disciplines
in our training.

But it is not only the educational level that
makes our groups different from others. The
experience of Cubans is very different from
that of others. The practice of being members
of organizations and, therefore, the clear link
established between organizational and educa-
tional processes, and the widely spread idea
that individual realization is linked to the col-
lective project are some of the characteristics
that make them specific. All this has compelled
us to smell and sense as accurately as we can,
to study like mad, to learn all we have been
able in order to ‘Cubanize’ our experience.

120

CUBANIZING POPULAR EDUCATION…

Initially, people learned by doing in an atmosphere of innovation and experimentation.
Cuban institutions such as the GDIC, the Martin Luther King Center, CIERI, the
Council of Churches, the University of Havana, and others provided support for these
efforts.

119

Later on, national organizations began to systematize what they had learned

from these early experiences and with support from international NGOs began to train
community members in substantive areas – such as community planning methods,
facilitation of meetings, use of computers, health and environmental education methods,
casework, youth work, etc.

The government, particularly at provincial levels, has also supported the training programs
of delegates and Popular Council presidents in order to improve the functioning and
effectiveness of Councils. A training program sponsored by the Secretariat of the Provincial
Assembly, for example, for new delegates and Council presidents, covers a variety of topics
including participatory methods of identifying needs of the population, the skills for
running meetings, and the processes of monitoring services at the community level.

The capacity developed in people and organizations as a by-product of the process of
community development tends to strengthen all aspects of the neighborhood. Participants
learn methods and ways of working that they carry to their work elsewhere, strengthening
other community organizations with their new vision and their new skills.

Community Development, Social Development

The critical ingredients for the substantial transformation of services, particularly the
way that users experience them, are slowly emerging. There is a growing recognition that
universal policies and centralized initiatives alone, as successful as they had been in
addressing key social problems in the past, may not be enough in this new, complex
environment. There is recognition that preventing the entrenchment emerging from
social problems requires comprehensive and integrated approaches. Strong steps are
being taken in the direction of increased collaboration and coordination among services,
especially at the point of delivery.

These new transformations of social service systems are closely tied to the strengths and
capacities being developed at the community level. The processes of community
development in Cuba are strong precisely in the areas that best interact with the
improvement of services: placing families and communities at the center of their mission;
identifying the needs of families and communities; encouraging the horizontal coordi-
nation of services at the community level; and strengthening the connection of families
to that network. While many developed countries are seeking to improve the accessibility
and quality of services in some of these same ways, few countries have the conditions
present in Cuba that give this experimentation the hope of success.

Another critical ingredient in the transformation of systems of service can be found in
the interaction between participation and public policy. “Participation is understood in
its most integrated sense,” says the document written in 1996 by the Group of Socio-
logical Research of the Academy of Science on work at the community level, “…in the

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

5. SOCIAL DEVELOPMENT: LOOKING

FORWARD

As Cuba weathered the economic crisis of the 1990s, many wondered whether continued
commitment to the values of universality and full government sponsorship that framed
the development of its social safety net would be possible. Clearly, this commitment
held true: the government had the political will to sustain the full array of social benefits
that remained un-cut during the decade of crisis. But, in spite of continued investment,
the quality of services has deteriorated over time. The investment in social benefits
required to regain the level of services available in 1989 is now much larger than what
it has been so far.

Until today, Cuba has covered the needs of its people by devoting a large percentage of
its GNP to services. But as the country moves to rebuild its economy, it faces critical
challenges to the sustainability of its system of social benefits under these premises.

• There is great urgency to address an increasing demand for services. This demand

flows from an expanding sector of the population that is increasingly vulnerable.
Such demands are all the more urgent when they come from a population accustomed
to having their social demands readily met.

• There is also urgency to address the problems posed by a population aging rapidly in

the context of reduced government resources; this has great implications for the
national budget, which must cover the full amount drawn by pensions.

• There is also great pressure to improve the quality of the services damaged during the

special period. Although funding has been increased across the board, both in pesos
and in hard currency, it has yet to reach the buying power of resources allocated in
the 1980s.

That is the bad news.

But Cuba faces this set of challenges with considerable strengths:

• The first is that Cubans know how to take care of their own. There is a vast reservoir

of knowledge and successful experience in improving and maintaining the health
status of the population, in eradicating illiteracy, and in maintaining one of the most
educated workforces in the hemisphere, all of which give Cuban social services great
legitimacy and credibility.

• The most serious social problems facing Cuba today are not yet entrenched. The worst

effects of poverty; the increased presence of prostitution, drugs, and crime; and the rise
in school dropout rates, are all relatively new and thus malleable to strong interventions.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

During the crisis, Cuba kept to its priorities
of sustaining universal access to a full
array of social benefits. Here a mother
mixes the daily milk ration for her child in
a neighborhood in Central Havana.

AN CAB

ALLERIA/O

AM AMERICA

• Cuba has essentially sound service systems that are merely in need of adaptation. The

challenge is not to construct new ones, but rather alter and improve the ones that
exist. As we have shown, there are indications that these adjustments are beginning
to take place:

> recognition that services need to improve;

> growing acceptance and practice of collaboration and horizontal integration;

> growing recognition of the importance of differentiated approaches to working

with individuals, families, and communities.

• There is a growing practice in participatory methods that could be effective in involving

users in decision making.

• There is experience in identifying community needs and the needs of families in ways

that are valid and that involve the user.

• There are mechanisms in place – although they need to be perfected – to monitor the

quality of services at the community level through the Popular Councils.

Finally, Cubans, because of their level of education, have a capacity for innovation and
transformation that should not be underestimated. This was demonstrated during the
1990s in a major transformation of the economy, as well as the smaller transformations
that brought about the community development movement, the urban agriculture
movement, the application of alternative sources of energy and environmentally sound
agricultural practices, and so many other innovations that were part of the experience of
the “special period.”

Nevertheless, major challenges remain:

• Critical choices will surely have to be made to address budgetary issues posed by

“safety net” entitlements. Cuba does not have infinite resources but faces an escalating
set of demands. The highest values of the revolution ensure that every effort will be
made to maintain the current coverage and to protect the most vulnerable. But, if the
needs continue to expand, the setting of priorities will become critical.

• There is every indication that Cuba is choosing to slowly transform its systems by

increasing efficiency rather than by privatizing services or reinventing whole new
structures. In this process, there are several key questions:

> Cuba has a long history of successful practice in the delivery of health, education,

and other services. But theirs is an expensive approach. Systems rely heavily on
highly trained personnel, for example, the deployment of family doctors.
The new economic environment requires considerations of efficiency as well as
effectiveness. How flexible is the current service structure to redesign service
modalities and practices?

CHAPTER 5: SOCIAL DEVELOPMENT: LOOKING FORWARD

Cubans survived the special period by
inventing what they did not have. Here a
clean up brigade fuel a homemade debris
blower for street cleaning.

AN CAB

ALLERIA/O

AM AMERICA

Can the prevailing tendency to organize services strictly along sectoral lines, for example,
solely within the field of health, yield to effective horizontal collaboration in the design
and delivery of more efficient services? Can a centralized structure see the validity of
cross-sector collaboration? How can collaboration be promoted among service systems
(particularly at the point of service)? And how can collaboration be promoted between
service systems and local governments and community-based organizations?

> Our best knowledge about what it takes to design effective service delivery is to

pay attention to the needs of and feedback from users. Cuba has very little experience
with gathering and applying user input. What would be the new points of contact
between the policymakers, planners, and professionals in the service systems and
the users?

The difficult challenges facing Cuba as it moves forward are not unlike those facing
social benefits systems everywhere: budget-buster pension and health costs, increasing
demands due to economic crisis, demands to improve both efficiency and effectiveness.
All face the challenge of engaging the participation of consumers and require the
development of effective mechanisms for monitoring access, reach, and quality of services
at the community level, particularly for vulnerable groups. But, unlike the people of
many other countries, Cubans face these challenges as a people who have constructed a
society that is equitable and humane. Those values and that experience inspire and
inform new systems as Cuba moves into the future.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

ENDNOTES

Oficina Nacional de Estadísticas, 1998, p.99.

Alcock and Craig, 2001, p. 20.

Comisión Económica para América Latina y el
Caribe, 2001, Ch. 4, p. 5.

In 1958, there was only one rural hospital on
the island and 60% of Cuba’s physicians and
62% of hospital beds were in Havana, according
to Mesa-Lago, 1981, p. 169.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 79.

Segre, Coyula, and Scarpacci, 1997, p. 129.

Mesa-Lago, 1981, p. 164.

According to data from the Centro de Investi-
gaciones de la Economía Mundial (2000, p.
63), in 1959, the share of income of the highest
20% was 25.5 times that of the lowest (57.9%
compared to 2.1%). Economist Angela Ferriol
(1997, pp. 94-95) estimated that in 1996 the
income of the highest 20% was 6 times that of
the lowest.

At present, the participation of women in the
labor force stands at 41% compared to12% in
1959, according to a 1996 report of the Centro
de Investigaciones de la Economía Mundial (p.
73). This reports also points out that 53.6% of
Cuba’s university graduates are women (1996, p.
74) as are 28% of the delegates to the National
Assembly (2000, p. 208) and 13% of those in
the Central Committee of Cuba’s Communist
Party (2000, p. 208).

All figures are from United Nations Development
Programme, 1999, pp. 127-148.

Although a full assessment is not possible with
available data, there is indication that in 1959
some aspects of social development were
already advanced in Cuba compared with Latin
America and the Caribbean as a whole. For exam-
ple, World Bank Development Indicators (2002)
show that infant mortality was lower and life
expectancy was higher in Cuba than in the region
as a whole. But primary school enrollments were
just minimally higher and secondary school
enrollments were significantly lower in Cuba than
in the rest of the region.

The private practice of medicine is restricted to
physicians who were private practitioners at the
time that health care was socialized in 1961.
Doctors who began their practice after that time
are not permitted to practice privately.

Ministerio de Salud Publica, 2000

Estimates of coverage vary, but most assess-
ments agree that coverage is almost complete
in urban areas and is rapidly growing in rural
areas.

Centro de Investigaciones de la Economía
Mundial, 2000, pp. 99 and 101.

Domínguez (1978, p. 223) places diarrheic
diseases as the seventh cause of death, listing
cerebrovascular diseases as the third and
influenza and pneumonia as the fifth. Here we
use Cuban statistics.

For comparison with Latin America, see World
Bank, 2001. Minimum age to enter the labor
force in Cuba is 17 years, according to Centro
de Investigaciones de la Economía Mundial,
2000, p. 64.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 82.

Lutjens, 2000, pp. 56-57.

World Bank, 2001.

In contrast, only 25% of the United States
population over 25 has a college degree.
(Cuban statistics report only on the percent-
age of workers.)

Centro de Investigaciones de la Economía
Mundial, 2000, pp. 66, 75, 201.

Mesa-Lago, 1997, p. 505.

Mesa-Lago, 1981, p. 170.

World Bank Indicators, 2001.

United States Department of Commerce, 2001.

Benitez Perez, 1999, p. 49.

Benitez Perez, 1999, p. 51.

Del Rio, 2001; Segre, Coyula, and Scarpacci,
1997, pp. 231-32.

ENDNOTES

Among the factors believed to have con-
tributed to the neuropathy epidemic were
nutritional deficiencies in protein, B vitamins,
and antioxidants and smoking, aggravated by
increased physical activity and heat. See, e.g.,
Barnouin et al., 2001; Barry, 2000; Tucker and
Hedges, 1993.

Ciudadelas date back to the last century and
were always housing for the very poor. Ciu-
dadelas are made up of a series of rooms in
which several families live. They share water
and a common bathroom, which are usually
located outside. It is common to find ciudade-
las in the oldest sections of Havana.

Interviewed in March 2001.

González, 1997 p. 220.

Cuba did not encourage investments in some
its basic industries, such as sugar production
or of the biotechnology and pharmaceutical
industries, which continued to receive support
and to be under the control of the state
because of their potential to generate foreign
exchange.

Oficina Nacional de Estadisticas, 1999 p. 103

Self-employed workers are not guaranteed a
unemployment or a retirement pension.

Cuban officials emphasize that the private sec-
tor has been “permitted” but not promoted,
providing the context for the government’s
very ambivalent relationship with the internal
private sector.

Quoted in Snow, 1998

Oficina Nacional de Estadísticas, 2001, p. 40.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 66.

Oficina Nacional de Estadísticas, 2001, p. 41.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 84 reports that about one-
third of those teachers later returned to the
education field.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 72.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 93.

Interview with Zulema Hidalgo, Taller de
Atarés, La Habana, March 2001.

Ferriol (2001) reports that the food available
through the ration card provides 65% of the
required nutrition.

Sinclair and Thompson, 2001, p. 28, quoting
Grogg, 2000.

World Bank, 2001.

Mendoza Diaz, 2002, p. 13. Dropout and
“special” school figures are from Lutjens,
2000, pp. 56-57.

Although there are new “actors” in the provision
of some services, such as those provided by
religious organizations or by self-employed
persons, the vast majority of the services are
delivered by the government. Examples of the
new “actors” range from Caritas Cubana, a
non-governmental organization affiliated with
the Catholic Church that provides social services
and distributes medications, to some programs
funded through collaboration with international
non-governmental organizations, to self-
employed persons who provide, for example,
care for the sick, elderly or disabled at home
or provide academic support for children.

For a description of the electoral process in
the Popular Power, see Dilla Alfonso and
González Nuñez, 1995.

For an analysis of the problems facing munici-
palities, see Dilla, 1995.

Roman, 1999, p. 164

Roman, 1999, p. 157.

Interview with Jesus Ramos, Secretary of the
Provincial Assembly of Popular Power for the
City of Havana, March 2001.

To Peter Roman in 1988, reported in Roman,
1999, p. 164

Comité Estatal de Estadísticas, 1988, p. 415.

Sinclair and Thompson, 2001, p. 10.

Oficina Nacional de Estadísticas, 1999,
p.318-19.

This compares with 6% among Costa Ricans
and 28% in the Dominican Republic. United
Nations, 2001, pp. 163 and 257-58.

Sinclair and Thompson, 2000, p. XX.

Centro de Investigaciones de la Economía
Mundial, 2000, p. 106.

Oficina Nacional de Estadísticas, 2001, p. 122.

Barnouin et al. 2001, p. 275.

CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE

ENDNOTES

Ferriol, 2001.

Ferriol, 1997, p. 97.

Grupo de Investigaciones Sociológicas (ACC),
1996.

Example taken from Centro de Investigaciones
de la Economía Mundial, 2000, p. 106.

Taken from Céspedes Roig, Mato Guerra, and
Rojas Rojas, 1999.

La Hoz Padilla y Reyes Herrera, 1999, p. 30.

de Urrutia Barroso, n.d., p. 9.

de Urrutia Barroso, n.d., p. 96.

The opening of the Social Work Training
Schools came at a time in which, due to the
economic crisis, university enrollments hit
their lowest levels in two decades. Hundreds of
students who would otherwise have attended
one of Havana’s several institutions of higher
education were denied admission. Their only
options to attain a university education were
special programs in the armed forces or
through independent study. Its first group of
students were youngsters ages 16–22 that
had graduated from pre-university high
schools and not attained admissions. Upon
completion of social work training, students
are eligible for admission at a university.

Because of the success of the training of social
workers, similar programs now train teachers,
art instructors and computing instructors.

Pérez Montalvo, 2002.

Grupo de Investigaciones Sociológicas (ACC),
1996.

Dilla Alfonso, 1998, p. 46.

Dilla, Fernandez y Castro, 1998, p. 65.

100

Interview with Joel Diaz and with Taller de
Transformación de Atarés in 1994.

101

Roman, 2000, p. 215.

102

A comment by the chairperson of the Grupo
Ministerial de Trabajo con las Comunidades, a
multi-ministerial task force focused on the
work at the community level, as quoted in
Grupo de Investigaciones Sociológicas (ACC),
n.d. (1996).

103

Cruz Hernández, 1997, pp. 202-16.

Snow, 1998 reports than 1.4 million of Cuba’s
4 million workers receive part of their salary in
dollars.

A small percentage of state workers laboring in
key industries receive a small part of their
salaries in “dollar equivalents,” some in the form
of a card (similar to a debit card) which they can
use in the stores that sell only in dollars.

The Helms-Burton Bill prohibited the remittances
to Cuba from the United States but these were
restored by President William Clinton in 1998.
Americans can send a person in Cuba up to
$300 quarterly

Snow, 1998

Ares Muzio, 1998, pp. 61-62.

Benítez Pérez, 1999, p. 30.

Lutjens, 2000, p. 63.

Segre, Coyula, and Scarpacci, 1997, p. 229.

González, 1995; Ferriol, 1997 and 2000; and
Cano y Dávalos, 2000. Discussion on these
themes can be found across last years in
TEMAS and in the publications of Cuban aca-
demic institutions such as Instituto Nacional
de Investigaciones Económicas, Centro de
Investigaciones Psicológicas y Sociológicas,
and the University of Havana, among others.

World Bank, 2001.

Mesa-Lago (1998, p. 864) estimates that by
1993 “real wages” were 25% lower than they
ad been in 1989; by 1995, he estimates, they
were 46% less.

Centro de Investigación de la Economía
Mundial, 2000.

Oficina Nacional de Estadísticas, 1996, pp. 85
and 99; 1999, pp. 82 and 93.

Comisión Económica para América Latina y el
Caribe, 2001, Ch. 4, p. 17.

Comisión Económica para América Latina y el
Caribe, 2001. p. Ch. 4, p.2.

Comisión Económica para América Latina y el
Caribe, 2001. p. Ch. 4, p. 5.

Comisión Económica para América Latina y el
Caribe, 2001. p. Ch. 4, p.5.

Centro de Investigaciones de la Economía
Mundial, 2000; p. 102

116

See, for example, Grupo para el Desarrollo
Integral de la Capital, 2000, 1999, 1999(a);
Oliveras Gomez, 1999; Uriarte Martín y Fer-
nandez Pérez, 1998.

117

Interviewed in March 2001

118

For example, the GDIC has “accompanied” the
development of the Talleres with ongoing
technical assistance since 1988 and during the
1990s developed a process of capacity build-
ing that included periodic seminars, analysis,
and publication of best practices. The Martin
Luther King Memorial Center has provided
direct training to activists and community
leaders since 1993. Based on Pablo Freire’s
theories on popular education, the center has
developed a set of training modules that
focuses on integration, communication, and
group work and on planning/design/evalua-
tion of educational activities. CIERI was early
in its support of the community planning work
of the Popular Councils and Municipalities.
The University of Havana supported the devel-
opment of several community projects
throughout the city.

119

Interviewed by Mensaje de Cuba, 1998, p. 4.

120

Interviewed March 2001.

104

See e.g., Brigos, 2000; del Rio Hernandez,
2000; Roman, 2000.

105

Inteviewed in March 2001.

106

Republica de Cuba, Gaceta Oficial de la
Republica, 25 July 2000

107

In 1998, for example, there were 170 experi-
ments of this type being funded through inter-
national collaborations, according to Caño
Secade, 1998, p. 67.

108

Grupo de Investigaciones Sociológicas, 1996.

109

See Oliveras Gomez, 1999.

110

Interview with David Diaz Carbo, March 2001.

111

These are processes that incorporate the per-
ceived needs of those affected by the plan and
give them decision making power in defining
the problem, designing the solutions, execut-
ing the plan, and overseeing the results

112

Barbon y Mora, 2000.

113

Republica de Cuba, Gazeta Oficial de la
Republica, 25 Juliy 2000.

114

Interview with David Diaz Carbo, March 2001.

115

Interviewed in March 2001.

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CUBA – SOCIAL POLICY AT THE CROSSROADS: MAINTAINING PRIORITIES, TRANSFORMING PRACTICE