CUBA 2.0 · HEALTH SYSTEM

Health System.

Health will be a universal service of the utmost quality, guaranteed to every citizen at no cost, at every level of care.

Pay the people who heal. Stock the pharmacies. Rebuild the hospitals.

Tentative · Phases I–II
$28B
USD

Health reconstruction envelope — the higher end of a $14–28B range.

That is the CUBA 2.0 commitment — from the family doctor to the operating room. Today the system is far from it. Cuba trained more doctors per person than almost any country — 9.5 per 1,000 in 2021 (World Bank) — yet a physician earns about $10 a month, pharmacies cover a fraction of the essential-medicines list, and the official count of doctors has fallen by more than 34,000 since 2021. The Salary Structure set medical pay in dollars. This page sets out the rest.
Illustration of CUBA 2.0 health professionals — doctors and nurses walking a hospital corridor in Cuba
Illustration — CUBA 2.0 health professionals.
71,635
Doctors in 2025, down from 106,131 in 2021.
Source: MINSAP AES 2025; ONEI AEC 2024.
9.9
Infant deaths per 1,000 births in 2025 (official), up from 4.0 in 2017.
Source: MINSAP AES 2025, Cuadro 11.
$700–$1,500
Monthly physician band (M5), paid in USD.
Source: CUBA 2.0 Salary Structure.
$28B
Health reconstruction envelope, Phases I–II — tentative.
Source: CUBA 2.0 estimate — see What it could cost.

Working draft. Not an offer.

02 / 07 · THE WORKFORCE

A system losing its doctors.

Cuba counted 106,131 physicians in 2021. In 2025 the Ministry of Public Health counted 71,635 — a third fewer in four years — and 134 residents per doctor. Official counts include doctors serving abroad, so fewer are treating patients on the island.

Physicians in Cuba, 2021–2025

Headcount · official figures
2021
106,131
2022
94,066
2023
80,763
2024
75,364
2025
71,635

Source: ONEI, Anuario Estadístico de Cuba 2024 (2021–2024, as reported by Diario de Cuba and CiberCuba); MINSAP, Anuario Estadístico de Salud 2025 (preliminary), Cuadro 103 (2025).

Cuba today in red, CUBA 2.0 in blue, others in gray.

Physicians

Monthly USD midpoint · own scale
Cuba today
$10 · 7,045–8,880 CUP
CUBA 2.0
$1,100108× today
DR
$2,075
Jamaica
$3,900
Costa Rica
$6,525
USA
$22,994

Nurses, mid-level

Monthly USD midpoint · own scale
Cuba today
$9 · 6,740 CUP
CUBA 2.0
$50058× today
DR
$830
USA
$8,129

Nominal midpoints in USD, not PPP. Each chart has its own scale, so bar lengths are not comparable across charts.

Cuba today = 2026 state base pay (MTSS Res. 17/2026) at 780 CUP = 1 USD. CUBA 2.0 and other countries: CUBA 2.0 Salary Structure.

Sequential, not all at once. Health pay raises begin about 18 months after the CUBA 2.0 program starts. Workers then move to the Medical bands M1–M8 gradually, one group at a time, each after a performance evaluation.
03 / 07 · OUTCOMES & SUPPLIES

The numbers are slipping.

Officially, infant mortality fell to 4.0 per 1,000 live births in 2017 and 2018. In 2025 the Ministry reported 9.9, and maternal mortality of 44.1 per 100,000 births. A 2018 peer-reviewed study estimated that correcting for reclassified neonatal deaths would put a reported rate of 5.79 at 7.45–11.16.

Infant mortality, 2015–2025

Deaths per 1,000 live births · official
2015
4.3
2016
4.3
2017
4.0
2018
4.0
2019
5.0
2020
4.9
2021
7.6
2022
7.5
2023
7.1
2024
7.1
2025
9.9

Source: MINSAP, Anuario Estadístico de Salud 2025 (preliminary), Cuadro 11; MINSAP and ACN on 2025 maternal and infant results. Study: Berdine, Geloso & Powell, Health Policy and Planning 33(6), 2018.

Medicines on the shelf

651
Medicines on Cuba's basic list (250 imported, 401 made locally).
Source: government report via ACN, Sept 2025.
364
Of those out of stock — 56% of the list.
Source: government report via ACN, Sept 2025.
32%
Of demand met by pharmacies (Health Minister, July 2025).
Source: National Assembly session, as reported by Periódico Cubano.
0
Private pharmacies open, three months after they were authorized.
Source: EFE via DW, Oct 2026 (36 projects under review).
Illustration of a stocked CUBA 2.0 pharmacy in Cuba, with a pharmacist
Illustration — a stocked pharmacy.
Illustration of a re-equipped operating room in a CUBA 2.0 hospital
Illustration — a re-equipped operating room.
04 / 07 · HOW CUBA COMPARES

Cuba and its neighbors.

Cuba still reports more doctors per person than any neighbor. But people in Costa Rica and Puerto Rico live longer, and a Cuban physician earns a fraction of a Dominican one.

IndicatorCubaDom. Rep.Costa RicaPuerto Rico
Life expectancy, 2024 (years)78.373.981.081.9
Infant mortality per 1,000, 2024 (UN modeled)6.8official 2025: 9.927.79.17.12023
Physicians per 1,0009.520212.420232.72022—
Health spending, % of GDP, 20239.4%4.6%6.9%—
Physician pay, monthly USD$10$2,075$6,525—

Source: World Bank WDI — life expectancy, infant mortality, physicians, health spending; Puerto Rico infant mortality: PR Dept. of Health via March of Dimes PeriStats; physician pay: CUBA 2.0 Salary Structure. — = no comparable series.

05 / 07 · MEDICAL MISSIONS

Doctors as an export.

Medical services are Cuba's largest source of foreign currency. Health and social-care services earned $4.88 billion in 2022 — 69% of all services exports. The U.S. State Department reports that the state keeps most of each worker's salary abroad.

$4.88B
Health and social-care services exports, 2022.
Source: ONEI, via NODAL.
69%
Share of Cuba's services exports, 2022.
Source: ONEI, via NODAL.
22,000+
State-contracted workers abroad (end-2023), 75% medical.
75–90%
Share of salaries retained by the state.
CUBA 2.0 POSITION
Medical missions will be considered case by case.
06 / 07 · THE PLAN

Six moves to rebuild care.

1

Pay in dollars — step by step.

From about month 18 of the program, health workers move to Medical bands M1–M8 ($200–$5,000 a month) gradually, each group after a performance evaluation.

2

Open the medicine supply chain.

Duty-free essential medicines, licensed private pharmacies and importers, and fast registration of medicines already approved by recognized regulators.

3

Rebuild hospitals and polyclinics.

Re-power and re-equip the 148 hospitals and 451 polyclinics, starting where doctors are scarcest: Artemisa, Mayabeque and Isla de la Juventud.

4

Universal care, private choice.

Care stays free at every level. Licensed private clinics and insurers may operate alongside it, as an option, never a requirement.

5

Count honestly.

Independent health statistics, with every fetal and neonatal death published, so policy rests on real numbers.

6

Bring doctors home — and connect them.

A return path for Cuban doctors abroad, and national telemedicine on one digital health record.

Facilities and provincial doctor ratios: MINSAP, Anuario Estadístico de Salud 2025 (preliminary). Bands: CUBA 2.0 Salary Structure. Proposals under review.

Illustration of a rebuilt CUBA 2.0 hospital in Cuba, with solar panels and an ambulance
Illustration — a rebuilt CUBA 2.0 hospital.
Illustration of a CUBA 2.0 polyclinic in Cuba, with a nurse and an ambulance at the entrance
Illustration — a CUBA 2.0 polyclinic.
07 / 07 · THE BUDGET

What it could cost.

In the CUBA 2.0 sequencing, hospitals and clinics are rebuilt in Etapa 2 — Energy, Health & Infrastructure: hospitals re-equipped and staffed to restore care. A first, tentative sizing:

ComponentTentative
Hospitals rebuilt and re-equipped47,417 beds × $345,000 per bed (IDB-financed regional hospitals, Guyana, 2025)$16.4B
Polyclinic network451 polyclinics × $5M (CUBA 2.0 working assumption)$2.3B
Health pay raises, phased in from month 1812.5% of 365,515 workers move to M-band midpoints each quarter, over eight quarters (months 18–42)$2.8B
Medicines, supplies and upkeep, first two yearsDominican-level spending ($489 per person × 10.94M people) net of staff pay ≈ $2.9B a year$5.8B
Power resilience and digital healthCUBA 2.0 working assumption$0.6B
Total — tentativeHigher end of a $14–28B range · about 11% of the ~$250B program$28B

Source: beds, workers — MINSAP, Anuario Estadístico de Salud 2025 (preliminary); cost per bed — Guyana Ministry of Health (IDB loan, $79.7M for 240 beds); per-person spending (2023) and population (2025) — World Bank WDI (health spending per person, population); bands — CUBA 2.0 Salary Structure.

How the pay raises phase in

Raises start around program month 18. Each quarter, one evaluated group of about 12.5% of health workers moves to its M-band midpoint; after eight quarters (month 42) every group has moved. The cost counts the band pay of workers already moved and does not net out current peso pay, which keeps the estimate at the high end.

QuarterProgram monthsShare movedCost in quarter, USD B
Q118–2112.5%0.08
Q221–2425.0%0.15
Q324–2737.5%0.23
Q427–3050.0%0.31
Q530–3362.5%0.38
Q633–3675.0%0.46
Q736–3987.5%0.54
Q839–42100%0.61
Total, months 18–422.76 ≈ 2.8

Working assumption: the 12.5%-per-quarter pace. Full bands are reached only from month 42, consistent with the phased payroll in the Salary Structure.

The $14–28B range

ComponentHigher end (used)Lower end
Hospitals47,417 beds × $345k$16.4B$8.2Bhalf the beds
Polyclinics451 × $5M (assumption)$2.3B$1.1Bhalf
Pay raises, from month 1812.5% of workers per quarter$2.8B$1.4Bhalf the pace (6.25% per quarter)
Medicines, supplies and upkeep2 years × $2.9B$5.8B$2.9B1 year
Power resilience and digital healthassumption$0.6B$0.3Bhalf
Total≈ $27.8B → $28B≈ $13.9B → $14B

Working assumptions, not sourced: $5M per polyclinic and $0.6B for power resilience and digital health. The $28B is a CUBA 2.0 estimate, not part of a published breakdown of the ~$250B program. Tentative figure, sized at the higher end. Pay raises start around month 18 and reach full bands gradually. All projections are illustrative.

SOURCES

Where the numbers come from.

  1. MINSAP, Anuario Estadístico de Salud 2025 (preliminary) — physicians 2025, infant and maternal mortality, beds, hospitals, polyclinics and health workers.
  2. ONEI, Anuario Estadístico de Cuba 2024 — physicians 2021–2024, as reported by Diario de Cuba and CiberCuba.
  3. MINSAP and ACN — 2025 maternal and infant health results.
  4. Berdine, Geloso & Powell (2018), Health Policy and Planning 33(6) — reclassified neonatal deaths.
  5. World Bank WDI — life expectancy, infant mortality, physicians per 1,000, health spending, % of GDP, health spending per person, population.
  6. March of Dimes PeriStats — Puerto Rico infant mortality (PR Dept. of Health data).
  7. ACN, Sept 2025 — Cuba's basic medicines list and shortages.
  8. Periódico Cubano — Health Minister at the National Assembly, July 2025.
  9. EFE via DW, Oct 2026 — private pharmacies.
  10. ONEI via NODAL — health services exports, 2022.
  11. U.S. State Department, 2024 TIP fact sheet — Cuba's labor export program.
  12. Guyana Ministry of Health — IDB-financed regional hospitals, cost per bed.
  13. CUBA 2.0 Salary Structure — Medical bands M1–M8 and pay comparisons.

Cuban official statistics have known gaps. Figures are as published; CUBA 2.0 estimates are labeled as such.

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Part of the CUBA 2.0 program

Pay in dollars, medicines on the shelves, hospitals rebuilt, and a way home for Cuba's doctors. Read the full program and its two phases.

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