How Cuba Survived Sanctions and the Lessons for Zimbabwe

The US Economic Embargo on Cuba

The US economic embargo on Cuba was aimed at inflicting economic hardships on the Cuban people who were, in turn, going to overthrow the Fidel Castro government. The sanctions were caused by Castro’s rise to power and introduction of economic policies, which led to the nationalization of all foreign-owned companies in Cuba. The policies targeted particularly the sugar industries, refineries, telephone companies, and banks in which the USA had substantial ownership before the 1959 Cuban revolution. Nationalization was allegedly done without any due compensation to the owners of the properties in violation of international law (Jorge 2002: 2). It was US dominance in the Cuban economy and its treatment of Cuba as a client state that resulted in Castro having negative feelings towards it. The embargo was also entangled in the Cold War politics (Haney and Walt 2005: 11). While the US sanctions’ goals during the Cold War were predominantly intended to contain communism in Cuba, following the end of the Cold War, they shifted to target the promotion of democracy and human rights which also dismally failed (Rosenblum 2002: 18). Further exposing the regime change goal of the sanctions, the Helms–Burton Act of 1996 became hinged ‘…on presidential orders; it could be tightened or loosened at the president’s discretion as conditions warranted … no president was ready to relax the embargo until Fidel Castro and the existing regime fall from power’ (Leogrande 1997: 211). As such, the US embargo policy on Cuba was instinctive from both national interests and Cold War perspectives.

As of 1998, the economic embargo included, but was not limited to, the following restrictions: prohibition of any Cuban imports from the USA and its exports to Cuba and restriction of US citizens to travel freely to Cuba with a few exceptions. Again, economic embargo restricted transfer of money or property by US citizen to Cuba, and no US national was allowed to receive any property from Cuba or that country’s nationals. Also, technical data transfers between the USA and Cuba were restricted and no third country vessel was allowed in US ports for about 180 days after it had been in Cuba. More so, no aircraft going to Cuba, except those with the necessary licenses, were allowed to depart the USA, and countries that gave preferential treatment to Cuba were going to have their aid from the US cut. The US’s veto power in multilateral lending institutions to countries that trade with Cuba also put many countries at great risk of getting money from them. Subsidiary sales restrictions effected in 1992 under the Cuban Democracy Act had constraints that extended to the sale of medicine and medical equipment to Cuba. This was in violation of international law because it was aimed at dismantling the Cuban healthcare system, thereby causing unnecessary suffering to civilian people (Mason and Kimmerling 1998: 230–35). Beyond doubt, there were comprehensive sanctions imposed on Cuba which the country managed to withstand for 54 years.

Zimbabwean Sanctions Regime

The factors which led to the imposition of sanctions on Zimbabwe are a subject of contestation (see, e.g., Chingono 2010; Hove 2012; Ndawana 2018). It suffices to say that a mix of the Zimbabwean government’s deteriorating human rights record, and misgovernance during the implementation of the 2000s land reform exercise as well as conduct of elections marred by irregularities culminated in the tensions between Zimbabwe and the West which prompted sanctions. The Zimbabwe Democracy and Recovery Act (ZDERA) of 2001 primarily enunciated the US position against Zimbabwe’s access to foreign exchange (Public Law 107-99 2001). The Secretary of the Treasury was empowered to instruct the US executive director to any international financial institution to contest and vote against ‘(i) any extension by the respective institution of any loan, credit, or guarantee to the Zimbabwean government; or (ii) any cancellation or reduction of indebtedness owed by the Zimbabwean government to the United States or any international financial institution’ (Public Law 107-99 2001). From a policy perspective, ZDERA sought to ‘support the people of Zimbabwe in their struggle to effect peaceful, democratic change, achieve broad-based and equitable economic growth, and restore the rule of law’ (Ibid.). Through ZDERA the sanctions imposed on Zimbabwe were highly capable of causing collateral harm to the country’s citizens due to the government’s inability to access balance of payments support from the multilateral financial institutions.

While ZDERA did not begin as a sanction law per se as it took the carrot-and-stick method of offering financial benefits on the one side and clearly considering implementation of targeted sanctions on the other, the earnest implementation of targeted sanctions began in 2003 (Grebe 2010: 9–16). Through Executive Order 13288 of 2002, the then US President George W. Bush introduced an arms embargo and imposed financial sanctions against President Robert Mugabe and seventy-six other members of his government. Travel bans were extended to other Zimbabwean officials and businesspersons who benefited from business activity with the Zimbabwean government (Bush 2002). The US sanctions on Zimbabwe are still persisting evident in their extension by both Barack Obama and the current US President Donald Trump. The relentless extension of the sanctions is driven by the same persistent threat of the actions and policies of some Zimbabwean government officials and other persons weakening Zimbabwe’s democratic process or institutions, engendering the purposeful collapse of the rule of law, politically motivated violence and intimidation, and political and economic insecurity in the southern African region (The Zimbabwe Mail 2016).

On the other hand, EU sanctions were prompted by the Zimbabwe African National Union Patriotic Front (ZANU-PF) government’s failure to put an end to politically engineered violence, allowing unrestricted access to impartial election observers, safeguarding the right to freedom of the press, assuring an independent judiciary and ending illegal land invasions. This eventually led the EU to execute targeted sanctions on President Mugabe and twenty other government officials plus the imposition of an arms embargo just before the 2002 presidential elections (Grebe 2010: 8–11). Initially, the majority of the targeted individuals were government officials, although a small number comprised senior members of the security forces and their spouses. In 2009, about 203 individuals were on the EU sanctions list which also included forty entities that were known for supporting the ZANU-PF government activities (Council of the European Union 2009). When there was a semblance of restoring order during the Government of National Unity 2009–2013 (despite its failure to bring about democracy, rule of law, and free and fair elections as per the goals of the Global Political Agreement signed in 2008 [see, e.g., Hove and Ndawana 2016]) the EU Council decided to begin delisting the sanctioned people and companies. The recognition largely stemmed from the developments made towards dealing with the politico-economic crisis and in getting better the delivery of social services (Giumelli and Kruliš 2012: 171). As a result, Zimbabweans and businesses on the EU sanctions list significantly grew smaller only to remain with President Mugabe and his wife, Grace, until his fall in 2017.

Alternative Trade Partners and Energy Sources, Marginal Corruption, and Dual Currency System

The first response of Cuba to the US ban on imports of Cuban sugar in 1960 was to turn to the Soviet Union. Since that period, Cuba–Soviet Union trade accounted for about 80 per cent of all Cuba’s trade as of 1961 taking it from a mere 2 per cent in 1960 (Hove and Chingono 2013: 5). Thus, before the fall of the Soviet Union in 1991 it was Cuba’s largest trade partner. The trade relationship was even aided by the ideological compatibilities between the two countries during the Cold War era.

During the post-Cold War era, although Cuba continued trading with the Soviet Union’s successor state, Russia, it also traded with a several number of the Non-Aligned Movement member states that include Angola, Iran, Libya, Venezuela, and Zimbabwe (Ibid.: 6). Cuba’s strong relations with China and Venezuela also equally helped the country to maintain its stability after the fall of the Soviet Union (Comparative National Systems 2009: 11). As Elio Savon Oliva (20 January 2016), the former Cuban ambassador to Zimbabwe noted in an interview, some of these countries had shown half-hearted socialist or communist inclinations before the collapse of the Soviet Union. The longer many of these countries, among others, maintained and increased their trade relationship with Cuba, the more they also enabled, though not totally, the country to bust the US-imposed economic embargo. This was contrary to the US successive administrations’ confidence that the longer the sanctions were in place, the stronger their effect was going to be. In fact, it is this notion (though misguided) that the more economic sanctions are in place, the more they will work as the continued American sanctions on Zimbabwe also illustrate. Equally, Dominguez (1994: 165–76) argues that ‘the undervaluation of the utility of negotiation and the overvaluation of the utility of penalties’ has been a key weakness in USA–Cuba relations. Negotiation has more chances to practically accomplish US goals while exhortation and confrontation fails.

A mixed economy involving self-employment, black market, and tourism since 1992 enabled Cuba to survive the US embargo. Among other issues, unemployment was prevented, and the suffering of the majority minimized. Self-employment permitted by the Castro regime was motivated by the necessity to survive and enabled Cubans to embark on mostly formerly forbidden economic activities. As a result, ‘self-employment ceased to be viewed as “a necessary evil”’ as before, but as representing a useful way out within Cuban Socialism it was anticipated to significantly bring about the needed economic development (Concepción 2016: 1713). As Elio Savon Oliva noted in an interview,

The mixed economy measures were arrived at in the face of tough times following the isolation of Cuba after the collapse of the Soviet Union. While it meant reversal of some Socialist policies, it was necessary for the survival of the country despite the US economic embargo. A good example was the promotion of tourism which despite its negatives in the form of prostitution became a lucrative avenue to bring the much needed foreign currency and cash to the country.

While some observers viewed the Cuban tourism boom as representing a threat to the country’s socialist system, the country was in a position to absorb a surplus of tourists than it had done without necessarily jeopardizing the system (Wilkinson 2008). Thus, Western observations of Cuba’s tourist expansion failed to fully consider that its planned nature within a centralized state guaranteed that tourism delivered benefits that dwarfed the problems it created.

The Cuban government’s introduction of several policies to save and use energy efficiently in the face of its deficit greatly helped to enhance its development efforts. One interviewee, Tendai Njila (24 January 2016, a geologist who trained for a PhD in Cuba) said that among other measures, state fuel supply was reduced, plants’ operation hours were scaled down, household electricity consumption was decreased, and agricultural tractors were substituted with animals. Cuba had to necessarily save and rationalize all critical sectors in order for it to keep going, despite the embargo. Additionally, to solve the energy crisis in Cuba the government introduced Programa de Ahorros de Energia Cubana (PAEC) into practice in 1997. The policymakers were of the opinion that energy savings from proficient use was equivalent to energy generation. Purposely, the transportation sector put in place a set of measures that included upgrading international ports, improving public transport (buses and railways), and promoting the use of bicycles. Ride sharing became common in Cuba as a result of the shortage of fuel (Park 2010: 5). Moreover, Cuba’s energy deficit prompted the pursuit of other energy sources, such as producing electricity from biomass, biogas, wind, and solar, which greatly helped to mitigate the energy crisis (Ibid.: 6). The long-term goal of Cuba in exploring all these energy sources has been sustainable energy self-sufficiency (Alhajji and Maris 2004: 97).

In terms of corruption, Cuba was ranked 63rd out of 175 most corrupt countries in the world under Transparent International’s rankings in 2014 (Transparency International 2014: 5). According to Elio Savon Oliva, corruption in Cuba was encouraged by the difficult times during the special period (a period referring to the economic crisis that Cuba experienced in the 1990s following its breakup of ties with the Soviet Union following the latter’s disintegration) where officials felt they needed to hide or divert scarce commodities. The fight against corruption was taken seriously since 2000 and in 2011 anti-corruption efforts by President Raul Castro witnessed the arrest and imprisonment of many Cuban government officials and company executives on graft charges while many foreign businesspeople were forced out of the country (Hengsbach 2015). In addition, between 2010 and 2011 there was a marked improvement in auditing of state’s spending and state’s parastatals (Bertelsmann Stiftung’s Transformation Index [BTI] 2014: 26). This is remarkable because before 1990, corruption levels in Cuba have been low and after 1990 efforts to investigate it and arrest those found guilty demonstrated some level of seriousness in the country’s determination to control the vice (Dominguez 2004: 34). The fight against corruption has also been observed as one of the most politically attractive policies of the Cuban revolution at its inception (Casals and Diaz-Briquets 1999: 443).

However, a degree of corruption exists in Cuba. Apart from the propensity of individuals linked to the ruling party’s indulging in corruption in centrally planned economies due to the lack of deep public scrutiny, ‘economic systems that are hybrids of capitalism and planned socialism are a combination most conducive to corruption’ (Lotspeich 2003: 82–83). Indeed, ‘all else being equal, the potential for corruption increases when state monopoly and bureaucratic discretion over the allocation of goods and services are maximized, while accountability to the public is minimized’ (Henken 2008: 173). Although democracies are not corruption free, it is clear that corruption actually happened in Cuba which at first mirrored other centrally planned economies in Latin America and the Caribbean because Castro’s administration demonstrated an intricate web of patronage and negligible economic liberalization. Abuse of power and state capture following the partial liberalization of the economy carved a unique socialist type of corruption in the country (Erikson 2007: 11–13). This corruption revealed itself in the aptitude of the political elite and their families to rise further than equal distribution of limited goods and services by having access to far more than their share because of their positions and networks. These privileges included, but were not limited to, ‘access to housing, scarce imported goods, health services, recreational facilities, automobiles, and foreign trips’ (Casals and Diaz-Briquets 1999: 443). Nevertheless, the negligible levels of corruption and the determination by the Cuban leadership to fight it should be instructive for Zimbabwe to emulate and implement. Similarly, Cuba’s several policies such as pursuing a mixed economy, saving and using energy efficiently, and exploring a number of energy sources with the goal to achieve sustainable development and energy self-sufficiency represent further lessons for Zimbabwe.

Cuba also survived the US sanctions through the legalization of possession and use of foreign currency that began in 1993. This created a dual economy that allowed part of the population to receive remittances from abroad (García 2011). The country also embraced two currencies: the Convertible Peso (CUC) and the Cuban Peso (CUP). The CUC which is equal to the dollar in value was introduced in 1994 for use in the international market. The CUP is what Cubans use in their everyday lives to pay their utility bills and stock up. This dual currency system created a two-tier class system in Cuba, which favored those with access to the rewarding tourist sector through hotels, restaurants, and foreign trade. With the CUC, the state allowed its companies to import at a preferential exchange rate such as a dollar for a Cuban peso (Dreher 2009). The strategy of introducing the CUC was less traumatic than a drastic devaluation of the Cuban peso or a change in currency. It was supported by the reduction of the fiscal deficit by decreasing subsidies for unprofitable companies, increasing the prices and tariffs of non-essential goods services, removing a set of benefits, and instituting a new tax system (García 2011).

The use of foreign currency in the country, notwithstanding its negative effects, boosted foreign investment and allowed the most dynamic sectors of the economy to recover through a more efficient management of existing currencies. Likewise, the collection by the state of part of the convertible currency from the population was ensured by a system of ‘Tiendas de Recaudación de Divisas’ (TRD, literally: stores for the collection of foreign currency) at prices that comprised a high sales tax to safeguard their social redistribution. Measures were speedily taken to encourage better labor results through payment in hard currency (Ibid.). More so, free pricing markets were approved for the sale of agricultural and industrial products. Foreign currency payment systems were widened, and the devolution of business management was slowly introduced (Dreher 2009). Initially, this approach reinvigorated Cuba into the global economy, while maintaining a measure of economic stability and growth domestically. Also, it stimulated production in the then-emerging sectors of tourism and foreign direct investment and helped to reduce the large fiscal deficit, used international prices as a reference to set national prices, and develop internal markets (Doimeadios and Hidalgo 2014). The system of dual currency (the CUC and CUP) in operation within Cuba helped ensure that earnings from tourism would go toward funding programs in education and health. As the discussion below emphasizes, despite being a low-income country, the Cuban state accorded priority to programs in the social sector that helped nurture to a great extent, a more resilient Cuba. Health diplomacy, which was an offshoot of the investments made in the social sector, constituted an important element of Cuban foreign policy and its survival of the US economic embargo.

Although Zimbabwe in the face of economic sanctions also resorted to alternative trade markets largely with friendly countries in the region and beyond, particularly China and other East Asian nations through the ‘Look East’ policy pronounced in 2002, it had limited success. The Look East policy proved a critical factor in assisting Zimbabwe to render the sanctions on the targeted leadership worthless, especially with regard to dispelling any possible vote on Zimbabwe in the United Nations Security Council (UNSC). Indeed, in 2008 China with the assistance of Russia thwarted a UNSC resolution on Zimbabwe where the Chinese ambassador to the UN contended that, the better way to make progress on the Zimbabwean situation was not by securitizing it and meddling in the country’s domestic affairs, but through dialogue and mediation (Lynch 2009: 24). As a result, the ZANU-PF leadership mostly benefited from the Look East policy in which, among other issues, Beijing also chiefly supplied arms to Zimbabwe after the US and Western arms embargoes (Ratner 2011: 32). This largely helped in propping up the Zimbabwean leadership’s effort to reduce the potential effects of the EU and US sanctions on the country notwithstanding its disproportionate benefit to the political and security sector elite.

While Zimbabwe’s alternative trade partners helped to reduce the effects of the sanctions on the targeted leadership of the country, it was on the majority of Zimbabweans that the sanctions’ wrath and dehumanizing effects were mostly felt. The delivery of social services such as water and sanitation, health, and education became a nightmare and food production among other economic sectors faced serious challenges (Hove 2012: 73–74). The majority poor were not in a position to, among other activities, send their children to schools abroad to ‘friendly’ countries, travel to these countries for shopping and medication, which many of the targeted politicians and security sector elite afforded. Again, when investments were brought from China and other countries in many of the country’s economic sectors, especially the lucrative Chiadzwa diamond mining, it was the political and security sector elite, their friends and relatives who largely benefited (Hove and Chingono 2013: 13; see also, Moyo 2016; Towriss, 2013). Clearly, China and other countries assisted Zimbabwe to safeguard regime security cloaked in state security and sovereignty at the expense of human security.

Put together, both Cuba and Zimbabwe resorted to alternative trade partners in the face of economic sanctions, but Cuba experienced no widespread economic and social services delivery decline of the same magnitude as that experienced in Zimbabwe. Zimbabwe might learn from the Cuban experience where since mid-1993 the country’s survival was hinged on growing the flow of foreign exchange, lessening government expenses, and developing the supply of goods and services (Jatar-Hausmann 1999: 94). This was cautiously done and achieved devoid of endangering regime stability, despite that some of the ideas were opposed to the socialist ideology. However, that ideology informed pragmatic solutions must not be ignored but at the same time not overemphasized. The execution of uneven economic reforms revamping some sectors of the economy while leaving others untouched explains the Cuban regimes’ political survival strategy because it bolstered the power of the state and its hardliners with some gains on society (Corrales 2004: 35–65). Cuba is popularized for spending more resources on social development guided by its socialist leanings. For instance, the 2007 Cuban national budget expenditure on education, healthcare, housing and social security, and social assistance was almost half of the total budget at 48.6 per cent of the total national expenditure (Yamaoka 2009: 14). Accordingly, Cuba’s success in education and the health sectors, which gave the country an edge on the diplomatic front, further explains how it succeeded, whereas Zimbabwe did not in lessening the effects of sanctions on the ordinary people.

Before turning to Cuba’s success story in the social sectors of health and education and the lessons that can be gleaned by Zimbabwe, it is worth noting that while it was primarily the USA that imposed sanctions on Cuba, in the case of Zimbabwe there were many more countries involved including the USA, as mentioned earlier. This means that the stakes against Zimbabwe were stronger than those against Cuba. Given the USA and its Western allies’ dominance of the international political economy, the alternative trading partners, energy policies, marginal corruption, and dual currency system that were key for Cuba to survive US sanctions might have fared differently in Zimbabwe. Further, although the two countries’ challenges and responses in the face of sanctions were different, what also made the Zimbabwean case dire, unlike Cuba, is the fact that Zimbabwe was affected by several factors. First, Zimbabwe’s deteriorating economic position had long begun in the 1990s as a result of the loans it received from the International Monetary Fund (IMF) and the World Bank. Apart from leaving Zimbabwe with a huge debt burden, the Economic Structural Adjustment Program loans from the IMF and the World Bank worsened the prospects of Zimbabwe’s social and economic recovery instead of reviving them as per their goal (Mlambo 2017: 106–107). More so, Zimbabwe’s imprudent political choices including, but not limited to, the payment of unbudgeted gratuities to the war veterans in 1997, deployment of the Zimbabwe Defence Forces in support of Laurent Kabila in the Democratic Republic of the Congo’s civil war in 1998 (up to 2002), and the refusal by Britain and allies to finance the land reform in the absence of an audit on the government of Zimbabwe’s handling of the past land reform and the unplanned violent fast track land reform program introduced in 2000 worsened the prospects of the country’s social and economic recovery (Hove and Gwiza 2012: 282). Although Zimbabwe resorted to diamond sales to wage through periods of intense economic turmoil, the proceeds benefited a few instead of being channeled towards state coffers for investment in the social sector.

On the contrary, while Cuba, among other issues, embraced the US dollar, Zimbabwe resorted to multi-currencies including the US dollar in an effort to stabilize and revive the economy. The US dollar seemed useful in the short term in the two countries but had long-term negative consequences as both Cuba and Zimbabwe failed to keep it as a medium of doing business across their sectors amid growing inequalities between those with access to the US dollar and those without, including civil servants (see Chitiyo and Kibble 2014; Eckstein 2004; Southall 2017). Thus, one can say that dollarization had both negative and positive effects on the economy of the two countries.

Education

Cuba is most reputed for its education where, despite the US economic embargo, the country maintained 100 per cent literacy level which it picked from 72 per cent in 1959 (Malott 2007: 243). This was made possible by, among other issues, the Cuban government’s literacy campaign in 1961 which led to the teaching of the people in the rural areas how to read and write. In addition, the government’s allocation of at least 10–11 per cent of their gross domestic product to the education sector immensely aided the growth of the education sector (Garrett 2010: 71). Cuba’s education success story is also attributed to the country’s strong teacher education and life-long teacher training programs reckoned to be among the best globally. Groups of teachers met every fortnight to talk about strategies, problems, and the wide-ranging climatic differences of the learning milieu (Malott 2007: 243). Cuba has universal education from primary to tertiary education which made it obtain the highest mathematics and science scores in Latin America and the Caribbean and formed the bedrock for its generation of a first-rate cadre of scientists and doctors (Ibid.: 243–44).

Cuban education had the dual role of being the egalitarian leveler and social reproducer of labor which became so crucial in overcoming and pursuing other economic avenues. As Brian Musonza (3 January 2016), who trained physical education in Cuba, noted in an interview, all the schools in Cuba are state-owned and there is no room for the emergence of private schools at any level because of the free nature of education from kindergarten to doctorate level. Through the egalitarian role, Cuba’s education system saw the establishment of institutionalized links by teachers and the communities they work in (Malott 2007: 245). Teachers gained an understanding of the lives of students, problems, and possible resolutions. Significantly instructive to Zimbabwe is Carnoy’s observation about the uniqueness of Cuba’s education system that the students,

…attend school for a full day, unusual in Latin America, and the schools are intensely focused on instruction, staffed by well-trained, regularly supervised teachers in a social environment dedicated to high achievement for all. The Cuban system combines quality teaching, high academic expectations, and a tightly controlled school management hierarchy with well-defined goals and responsibilities. (Carnoy 2012: 74)

While critics view Cuba’s education system as having been used to indoctrinate the Cubans, it was highly successful in maintaining legitimacy (Malott 2007: 250). This was made possible by the country’s ability to maintain political and economic independence benefiting the Cuban people, evident in the gains attained in education and health sectors. As Njila said, all education whether liberal market-oriented or socialist-oriented involve some kind of indoctrination. To this end, Cuba’s educational policy focusing on the production of a scientific, technically literate population as the sole way out of underdevelopment (Leiner 1981: 209) is a good example for Zimbabwe, among other countries, to emulate.

As lessons, Zimbabwe among other third world countries under sanctions should prioritize the education sector in budget allocations with the government being the major contributor to it. The good performance of the education sector will serve to provide products and services for export to those countries in need of them in the form of bilateral arrangements, thereby earning the country the much needed products, be it oil as in Cuba’s case or foreign currency. Despite being known for having a good literacy record in Africa at 92 per cent (Shizha and Kariwo 2011: ix), the Zimbabwean government’s spending on education from kindergarten to university level has declined significantly over the years and individuals met their educational expenses (Mlambo 2013: 363). Ironically, this was reversing the gains made due to high budget allocations enjoyed by the education sector in the early years following the country’s independence and the compulsory free primary education policy initiated in 1987 (Ibid.: 363–64). Besides, the country grappled with high unemployment of its citizens (Lee 2003). Emulating the Cuban experience might ease some of the challenges still bedeviling the Zimbabwean government such as high unemployment of its graduates and the need for foreign currency, which can be solved by exporting the educated professionals to those countries in need.

Health

Cuba, despite the US economic embargo, is renowned for its healthcare system which is not solely a public good but a crucial export product. While it was deeply affected during the special period, health standards in the country did not deteriorate further due to the importance accorded to the sector and the far-reaching healthcare infrastructure plus medical workforce produced in the past decades (Diaz-Briquets 2002: 150). The average life expectancy in Cuba rose from 58 years in 1950 to 77 years in 2009 and the country was ranked 55th in the highest life expectancy ranking category, just six places after the USA (Garrett 2010: 61). The World Health Organization ranks Cuba second lowest in child mortality rate in the Americas, and even the USA is at the third place. Again, Cuba has the lowest HIV/AIDS pervasiveness per person (Ibid.). For that reason, Cuba has conquered all the critical areas of public health and medicine facing poor countries. Its indisputable success and achievements range from generating a towering class of primary care network and an unrivaled public health system, educating a skillful labor force, supporting a domestic biomedical research infrastructure, managing communicable diseases to attaining a decline in non-infectious diseases, and alleviating the crisis health needs of poor countries (Cooper, Kennelly, and Ordunez-Garcia 2006: 818).

These achievements, like those in education, were accomplished as a result of significant government spending on health. The inseparability of political decisions and resource allocation particularly in a command economy like Cuba points to the fact that Cuba’s success story in healthcare was a result of political will (Dunning 2001: 20). A combination of ‘the consolidation of state power, mass mobilization, and resolution of the contradiction between the private and public sectors’ proved key to Cuba’s success in healthcare provision (Waitzkin 1983: 235). The Cuban government budget allotted health funds which were only surpassed by education. For instance, in 2008 direct healthcare spending received nearly 16 per cent, US$7.2 billion, out of a total government budget of US$46.2 billion (Garrett 2010: 61). Notwithstanding the limits of political will as an explanation of Cuba’s achievements in health, ‘regardless of why certain public policies may become feasible, outcomes are not decreed they are achieved through policy implementation, and thus provide evidence base from which others can learn’ (Spiegel and Yasse 2004: 86). As a result, the country’s isolation by the USA and agents of globalization such as the IMF enabled it to escape the limits of options for building healthy public policies. In an interview, Indra Mugabe (2 February 2016 a Cuban married to Richard, a Zimbabwean who was trained as a mechanical engineer in Cuba) noted that ‘the success of the Cuban healthcare system was made possible by the principles of universal, equitable, and free access to quality care which were made a national priority strongly backed by central planning.’ Apart from the healthcare system, public health and preventive medicine, and promoting healthy lifestyles (McCloskey 2011: 88), Cuba was also committed to make available advanced secondary and tertiary care (Nayeri and Lopez-Pardo 2005: 811).

While some shortages of health services and resources were experienced in Cuba, equal access to healthcare, especially primary healthcare, was not disrupted even during the crisis period. Importantly, even during the crisis years Cuban spending on health was higher than on defense or internal order which also accounted for the country’s ability to maintain its healthcare system (Ibid.). Accordingly, Cuba is not a relevant example for misguided distribution and misallocation of resources in times of crisis accounting for the encountered shortages (Cooper, Kennelly and Ordunez-Garcia 2006: 822). Healthcare rather than defense or internal security was a key priority for government spending in Cuba, which increasingly singles out the country as a good model to Zimbabwe. This is increasingly critical given the importance of health and education to promote human security.

The achievements of Cuba in the health sector are further evident in the ability of the country to export health professionals to other countries in need. Through special bilateral agreements between Cuba and 77 other countries 37,266 of the 73,000 trained physicians certified to practice in Cuba are working outside the country (Garrett 2010: 69). In addition, since 1963, Cuba exported 126,321 health-care workers to 103 countries. This benefited the Cuban state because the arrangements brought two-thirds of the doctors’ overseas earnings to the state while one-third went to the individual (Bustamante and Sweig 2008: 237). Without ignoring the unequal distribution of what the Cubans earned abroad, the economic contribution of Cuba’s export of its medical personnel as well as biotechnology is estimated to have reached an equivalent of the income earned from tourism (Ibid.: 237–38). Thus, Cuba provides an inspirational and standard-setting vision of any government responsibility for both the health and welfare of its people. In this light, Zimbabwe, among other third world countries, under sanctions from the powerful countries need to have the political will to have their budget priorities in the health sector higher than other sectors and government being the major contributor. If a country’s healthcare system does well, its products will benefit the general populace and health personnel may be exported to those countries in need, getting desired products including foreign currency in the country. The Cuban experience also demonstrates that for Zimbabwe to thrive, there is need to strengthen health monitoring systems and redeploying health policy toward making best use of limited resources and giving emphasis to preventative instead of therapeutic medicine.

Overall, revealing the centrality of subaltern realism, the success of Cuba in education and health gave it an edge on the diplomatic sphere. Cuba has assisted many countries through various typologies such as disaster relief and medical training scholarships which in turn helped it to have their support in the UN General Assembly. In fact, the UN General Assembly since 1991 has approved every resolution opposed to the US economic embargo on Cuba (Sullivan 2015). Simply understood as the cooperation between countries to concurrently generate health benefits and get better relations (Feinsilver 2010: 85), medical diplomacy was critical for Cuba. Cuba’s medical assistance paid it off through the support it got both in the region and internationally and this was evident when the country was supported to lead the Non-Aligned Movement and the UN Human Rights Council (Wylie 2010: 12). Revealing the utility of Cuban soft power, soft balancing, and the fruits of deliberate policy choices, by 2010, Cuba’s oil-for-doctors program with Venezuela earned the country about US$7.5 million each day and approximately US$3 billion each year based on oil prices (Garrett 2010: 69). The medical diplomacy ‘...has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage’ (Ibid.: 69). Thus, Zimbabwe has many lessons to draw from Cuba’s diplomatic maneuvers. Evidently, Cuba demonstrated that medical diplomacy among other activities promoting solidarity and cooperation internationally can be emulated by other countries in their fight against unilateral sanctions imposed by powerful nations.