CUBA STANDARD — In a move that considerably broadens Cuban health service exports and generates hundreds of millions of dollars in revenues, the Brazilian health ministry and the Pan American Health Organization (PAHO) agreed Aug. 21 to contract 4,000 Cuban doctors as a backbone for a fast-expanding medical program in needy regions of Brazil.
Brazil agreed to pay Cuba, via PAHO, 10,000 reais ($4,000) per doctor each month. While the Cuban government will retain much of the doctors’ pay, it will be higher than in previous missions abroad. According to BBC correspondent Fernando Ravsberg, Cuban volunteers expect to be paid $1,600 a month, a considerable amount in the Cuban context.
The Cuban doctors will be contracted collectively through the Cuban government for three-year terms, to fill “vacancies not chosen by Brazilian and foreign professionals” in individual recruitment efforts under Brazil’s Mais Médicos program, a press release by Brazil’s health ministry said.
“Through this agreement with PAHO, we will broaden the number of doctors specifically in those municipalities which have the biggest difficulties in bringing professionals,” Brazilian Health Minister Alexandre Padilha said.
The Cuban doctors are supposed to fill gaps in Brazil’s public healthcare system until the country’s medical schools produce enough Brazilian doctors fit and willing to serve in areas of poverty.
The agreement with Cuba covers 2,000 fewer doctors than initially announced. The announcement in May to contract 6,000 Cuban doctors triggered protests among local physicians, adding the issue to a wave of street protests in Brazil in June. Reacting to the protests, the Brazilian government temporarily suspended the negotiations.
Even so, the PAHO-Brazil agreement is a major breakthrough for Cuban efforts to diversify its for-pay medical service exports. While service exports a decade ago surpassed tourism as Cuba’s largest hard-currency generator, by far most of the healthcare exports are under agreements with oil-rich Venezuela. More than 20,000 medical personnel from Cuba work in Venezuela, or in third countries under programs funded by Venezuela.
The Brazilian agreement comes on the heels of an expansion of Cuban medical service programs in South Africa, Saudi Arabia, Qatar, Portugal and Algeria. Also, Norway and Brazil have funded medical relief efforts involving Cuban doctors in Haiti.
According to the Brazilian health ministry, Mais Médicos was able to hire only 1,096 Brazilian and 243 foreign doctors during a first wave of individual recruitment in July, far below the program promoters’ ambitions to deploy some 15,000 doctors in underserved areas of the country. The program, officially launched July 8 by President Dilma Rousseff, is part of a broad effort to improve healthcare for the most vulnerable segments of the Brazilian population. Mais Médicos is part of a $5.6 billion investment through 2014 to expand public healthcare in Brazil.
During the wave of street protests in June, which targeted bad public healthcare among others, Rousseff promised emergency measures to provide medical services to Brazilians “as fast as possible” and increased the budget for Mais Médicos from $3.55 billion to $5.61 billion.
A PAHO official quoted by the Brazilian press release emphasized that the Cuban doctors participating in the program are experienced primary care physicians who have worked in Portuguese-speaking countries before. Eighty-four percent of the first 400 Cuban doctors have more than 16 years experience; they are “professionals used to cities with inhabitants in a vulnerable situation,” according to the press release.
“We are certainly bringing a very well-prepared group to Brazil,” said Joaquín Molina, PAHO representative in Brazil.
After a three-week accreditation process, the Cuban doctors will receive a permit to practice primary care during three years in Brazil.
In a first stage, 400 Cuban doctors will be sent to more than 700 municipalities mostly in the poor North and Northeast; the first doctors are scheduled to arrive as early as this week. Brazil will pay Cuba, through PAHO, $209 million by February 2014 to cover this first phase. In the next stages, Cuban doctors will fill vacancies left open after individual recruitment efforts close. A second wave of recruitment began Aug. 19.
PAHO will continue to search for recruitment alternatives in other countries as well.
Brazilian physicians’ organizations immediately attacked the program after the government announced it; the doctors’ criticism targeted mainly the hiring of foreign doctors and was amplified by street protests and physicians’ strikes in June.
Arguing that bad healthcare in Brazil is not caused by a lack of doctors, but due to insufficient resources for hospitals and clinics, two physicians’ organizations, CMF (Conselho Federal de Medicina) and Fenam (Federação Nacional dos Médicos) sued the ministries of health and education over Mais Médicos. Foreign doctors who didn’t study in Brazil should pass a challenging exam and prove they master the Portuguese language, the organizations maintain. Brazilian courts have thrown out two of five lawsuits against Mais Médicos.
Mais Médicos is supported by the Brazilian Association of Municipalities (ABM), which argues that the lack of doctors in poor areas makes it necessary to recruit foreign doctors for “immediate solutions.”
According to government surveys, there are only 1.8 doctors per 1,000 inhabitants in Brazil, representing a deficit of 50,000 doctors. The deficit is most pronounced in the Northeast, the Amazon region, and in poor suburbs of Rio de Janeiro and São Paulo.
Cuba has 6.7 doctors per 1,000 inhabitants; many of the country’s physicians specialize in rural and low-income medicine.
