ABSTRACT
This chapter looks at a more micro-level examination of social relations underlying the Cuban health system, which presents many findings that challenge the usual portrayals of the system in the literature. It reveals the sometimes coercive means through which compliance with health goals is achieved and some of the adverse effects of this coercion affecting individual patients and health workers. The chapter aims to evaluate the extent of negotiation between central decision-makers and the Cuban population in the health decision-making process. It examines participatory arrangements in the health sector. The political dominance of government elites in setting the health agenda can have immobilizing effects on subordinate actors in the system in ways that are counterproductive to improving health care quality. The chapter outlines and discusses what the Cuban interviewees mentioned as foremost concerns Cuban health services. The Cuban health system can be correctly described as characterized by cooperative relationships and wide-ranging popular participation.
