The Ministry of Public Health of the Republic of Cuba, committed to the solidarity and humanistic principles that have guided Cuba’s medical co-operation for fifty-five years, has been participating in the programme More Doctors for Brazil since its inception in August 2013. This initiative, launched by Dilma Rousseff, who was at that moment president of the Federal Republic of Brazil, pursued the double purpose of guaranteeing medical assistance to the majority of the Brazilian people, following the principle of universal health coverage promoted by the World Health Organisation.
The programme had planned the inclusion of Brazilian and foreign doctors who would go to work in poor and remote areas of that country.
Cuba’s participation in this programme was arranged through the Pan-American Health Organisation, with one distinctive feature, for it was intended to fill the vacancies left by doctors from Brazil and other foreign countries.
During these five years of work about 20,000 Cuban co-operation workers have assisted 113 million patients in more than 3,600 municipalities. They managed to provide health coverage for up to 60 million Brazilians at a time when they accounted for 80 per cent of all the doctors who were taking part in the programme. More than 700 municipalities were able to count on a doctor for the first time ever.
The work of Cuban doctors in areas of extreme poverty, in the favelas of Rio de Janeiro, São Paulo, São Salvador da Bahia and the thirty-four special indigenous districts, particularly in Amazônia, was largely recognised by the federal, state and municipal governments of that country and its population, 95 per cent of which expressed their acceptance, according to a survey carried out by the Federal University of Minas Gerais at the request of the Ministry of Health of Brazil.
On 27 September 2016 the Ministry of Public Health, in an official statement issued on a day close to the expiry date of the agreement and amidst the events associated with the legislative and judicial coup d’état against President Dilma Rousseff, announced that Cuba “would continue to honour its agreement with the Pan-American Health Organisation for the implementation of the programme More Doctors, provided that the guarantees offered by local authorities were maintained,” something that has been so far respected.
Jair Bolsonaro, president of Brazil, who has made direct, contemptuous and threatening comments against the presence of our doctors, has declared and reiterated that he will modify the terms and conditions of the programme, in complete disregard of the Pan-American Health Organisation and the agreement reached by that organisation with Cuba, since he has questioned the qualification of our doctors and has conditioned their permanence in the programme to a process of validation of their titles and established that contracts will only be signed on an individual basis.
The announced modifications impose conditions that are unacceptable and fail to ensure the guarantees that had been previously agreed upon since the beginning of the programme, which were ratified in 2016 with the renegotiation of the Terms of Cooperation between the Pan-American Health Organisation and the Ministry of Health of Brazil and the Cooperation Agreement between the Pan-American Health Organisation and the Ministry of Public Health of Cuba. These unacceptable conditions make it impossible to maintain the presence of Cuban professionals in the programme.
Consequently, in the light of this unfortunate reality, the Ministry of Public Health of Cuba has decided to discontinue its participation in the programme More Doctors and has so informed the director of the Pan-American Health Organisation and the political leaders of Brazil who founded and defended this initiative.
The decision to call into question the dignity, professionalism and altruism of Cuban co-operation workers, who, with the support of their families, are at present offering their services in sixty-seven countries, is unacceptable. During the last fifty-five years a total of 600,000 internationalist missions have been accomplished in 164 countries, with the participation of 400,000 health workers, who, in quite a few cases, have fulfilled this honourable task more than once. Their feats in the struggle against the Ebola virus in Africa, against blindness in Latin America and the Caribbean and against cholera in Haïti, as well as the participation of twenty-six brigades of the Henry Reeve International Contingent of Doctors Specialised in Disaster Situations and Great Epidemics in Pakistan, Indonesia, Mexico, Ecuador, Peru, Chile and Venezuela, among other countries, are worthy of praise.
In the overwhelming majority of the missions that have been accomplished, all expenses have been covered by the Cuban government. Likewise, 35,613 health professionals from 138 countries have been trained in Cuba, at absolutely no cost, as an expression of our solidarity and internationalist vocation.
All Cuban co-operation workers have preserved their posts and their full salary in Cuba, together with all due labour and social benefits, just like the rest of the workers of the National Health System.
The experience of the programme More Doctors for Brazil and Cuba’s participation in it shows that it is indeed possible to structure a South-South Cooperation Programme under the auspices of the Pan-American Health Organisation. In order to promote the achievement of its goals in our region the United Nations Development Programme and the World Health Organisation have described it as the main example of good practices in triangular co-operation and the implementation of the 2030 Agenda and its Sustainable Development Goals.
The peoples of Our America and from all over the world know that they will always be able to count on the solidarity and humanistic vocation of our professionals.
The Brazilian people, who turned the programme More Doctors into a social achievement and from the very beginning have trusted Cuban doctors, recognised their virtues, and appreciated the respect, sensitivity and professionalism with which they have assisted them, will understand who are to be held responsible for our doctors not being able to continue offering their fraternal contribution in that country.