"The team's ambition level never fell, in spite of the fact that quite a few obstacles appeared during the project period.  The project team's positive attitude, great enthusiasm, project management skills and ability to improvise served to overcome these" - Alexandre Alencar, Senior Project Manager at NNHF

In an otherwise well-functioning health care system, the Cuban haemophilia care infrastructure is very limited. There is only one referral centre for specialised haemophilia care. Transport to the centre as well as treatment is free of charge, but those in need of specialised treatment are not always referred.

Using this objective as a starting point, over a three year period the project team worked to:

• Establish the Instituto de Hematología e Immunología (IHI), the project’s partner organisation, as a national reference point for haemophilia
• Enter into dialogue with the Cuban Ministry of Health
• Update guidelines on treatment of haemophilia
• Produce information leaflets for people with haemophilia and their families
• Establish patient registries at the IHI as well as in two regions
• Ensure the IHI had the necessary equipment for accurate diagnosis
• Deliver a national workshop on haemophilia diagnosis and treatment
• Set up two regional haemophilia centres in Pinar del Rio and Villa Clara

"We have seen local care improve through the development and distribution of treatment guidelines, because these ensure referrals to specialists when needed, says Dr D Almagro. Referrals are also supported by improved links between IHI and local haematology centres. In general, access to care in the two provinces has grown.

"We see a considerable increase in the number of patients cared for and consulted by physicians and specialists," says Prof Ballester. "This is reflected by an increase of 90% in the total number of coagulation essays realised," he continues. None of this would have been possible without the huge dedication of Prof. José M. Ballester Santovenia, Prof. Delfina Almagro, Dr. Dunia Castillo, Mrs. Walkyria Cao and their teams at the IHI.

Demonstrating unfaltering commitment to the project, the team not only met all project objectives but have secured a sustainable future for comprehensive haemophilia care in Cuba. The team was successful in gaining the support of the Ministry of Health, which has now taken on the task of extending the methodology for establishment of provincial centres of expertise for the remainder of the country, starting with the two central provinces of Sancti Spiritus and Cienfuegos.