Cuban doctors in exile Lucio Enríquez Nodarse (Spain), Andrés Fidalgo (Cape Verde), and Miguel Ángel Ruano (Colombia) concurred in a debate organized by CiberCuba, stating that the reconstruction of the healthcare system in a post-dictatorship Cuba should be based on “a universal, public model financed by taxes,” but with “coexistence and strategic agreements with the private sector.”
During the gathering, Enríquez Nodarse emphasized that the Spanish experience shows that “a strong public system is not incompatible with private collaboration,” as long as there is clear regulation. “It’s not about dismantling the public sector, but about managing it professionally,” he stated.
The debate started from a shared diagnosis: the need for a structural transformation of Cuban healthcare based on principles of solid governance, professional management, and the fight against corruption. At this point, Ruano emphasized that "without clear rules and transparency, there will be no possible healthcare transition," while Fidalgo added that accountability must be "a cornerstone from day one."
The three specialists defended national uniformity in access. Enríquez Nodarse pointed out that Cuba should aim to implement a single health card that ensures equal coverage throughout the territory, although he acknowledges that it is not easy, as even Spain has not achieved complete uniformity across all its regions. However, he noted that it remains the system with the best overall results.
Spain was presented by consensus as the main benchmark for its combination of quality care and universal access. Enríquez Nodarse explained that the Spanish system, primarily funded through taxes, offers extensive coverage without forgoing agreements with the private sector. “This balance allows for reduced waitlists and the maintenance of universality,” he stated.
In the analysis of the Colombian case, Doctor Miguel Ángel Ruano explained that the mixed scheme in his country offers valuable lessons for Cuba. “Colombia shows that multiple actors can coexist under the same regulatory framework without losing the social orientation of the system,” he stated. However, he warned that health reforms in his country have faced resistance when perceived as overly centralized. “The Cuban transition will require political and social consensus, not impositions,” he emphasized.
Andrés Fidalgo highlighted Cape Verde's experience as an example of how private competition can drive improvements in the public sector. He explained that the involvement of private actors created incentives that raised health standards and indicators. “When there is regulated competition, the public system is compelled to improve,” he noted, emphasizing that the key lies in effective supervision and clear public health objectives.
With regard to Cuba, the three agreed that the priority must be human capital. Ruano stated that "without well-trained and motivated doctors, there is no system that can function," while Fidalgo emphasized the need to create working conditions that prevent talent from leaving. Enríquez Nodarse added that continuous education and the professionalization of hospital management will be crucial to sustain any model that is implemented.
This was perhaps the most controversial point of the debate because while Fidalgo believes that human capital is the most important factor and that Cuba possesses it, Ruano was emphatic in stating that he has no intention of returning to Cuba since he has built his life in Colombia, where he has his businesses. Moreover, he believes that many more doctors will follow the same path. However, Fidalgo argues that not all Cuban doctors have achieved a status like Ruano's, and he is convinced that they would choose to return to Cuba if there are incentives to do so.
In conclusion, the panel advocated for a roadmap that combines universality, public funding through taxation, and regulated participation of the private sector, with an emphasis on governance, transparency, and talent retention as the foundations of the health transition in Cuba.
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