Cuban authorities say they have eliminated more than 100,000 jobs in the nation's national health service, considered one of the pillars of the 1959 revolution.
The cuts come as the president, Raul Castro, tries to streamline government as part of a broader economic reform package.
The weekly newspaper Trabajadores said on Monday that 109,000 health care positions had been cut.
Two years ago, Cuba said more than 50,000 jobs in that sector had been slashed.
Most of the cuts came in less-skilled positions such as ambulance drivers and hospital support staff.
Cuba's health care sector is entirely run by the state. Authorities have said that like other areas of the economy it is plagued by inefficiency, redundancies and bloated payrolls.
President Castro in 2011 said he planned to cut half a million jobs from government payrolls, as the country moves away from a state-planned economy.
About 400,000 islanders are currently working independently of the state under Castro's reforms.