Millions of Brazilians Lose Healthcare

Cuba’s health ministry rejected Jair Bolsonaro’s comments against the 20,000 Cuban health professionals that serve in Brazil as 'contemptuous and threatening’. They will now be stopping the programme that brings medical care to areas of extreme poverty in Brazil.

Background

Jair Bolsonaro, a far-right lawmaker and former army captain, defeated leftist Fernando Haddad in Brazil’s runoff elections late in October, receiving about 55 per cent of the vote.  Bolsonaro’s win marks a diametrical shift for Brazil, a nation dominated for most of the past decade and a half by the leftist Workers Party, while the President-elect is known for his protectionist policies. Bolsonaro, who takes office on 1 January, said in an interview this month that the 11,420 Cuban doctors working in poor and remote parts of Brazil could only stay if they received 100% of their pay and their families could join them.

Cuban doctors work in dozens of countries, some without cost to their hosts and others where Cuba charges a fee per doctor, most of which it says goes to keep the free national health system in Cuba functioning. The billions of dollars in revenues represent the most important source of export earnings for the communist-run government.

Since the Brazilian program, called “More Doctors”, was started in 2013 by the leftist former president Dilma Rousseff, about 20,000 Cuban health professionals have served in Brazil, including in 700 municipal districts that had never had a resident doctor. Under the terms of the current agreement with Cuba, which is overseen by the World Health Organisation, Havana receives the bulk of the doctors’ wages.

Analysis

Cuba announced on Wednesday that it will pull thousands of its doctors out of Brazil in response to president-elect Jair Bolsonaro's "direct, contemptuous and threatening" remarks about its medical aid programme.

The far-right leader has repeatedly criticised the Communist-run island's More Doctors programme, which sends thousands of Cuban doctors to work in deprived areas of Brazil, and said his government would introduce changes.

Bolsonaro has been scathing about Cuba's management of the five-year-old programme, known in Brazil as "Mais Medicos", saying the doctors received only a quarter of what Brazil was paying the Cuban government for their services. His government would counteract that by directly hiring doctors who wanted to remain in the country, but would first demand they submit to a "capacity test”. The Cuban health ministry angrily accused Bolsonaro of questioning its doctors' qualifications, and said all Cuban cooperation workers had been paid "their full salary in Cuba”.

Bolsonaro responded on Twitter, saying "We made continuity of the More Doctors programme conditional on a capacity test, (payment of) full salary to Cuban professionals, most of which is currently going to the dictatorship, and the freedom to bring their families. Unfortunately Cuba did not accept.”

Critics say the restrictions on the doctors bringing their families with them was designed to prevent them from emigrating.

In another tweet, he accused Cuba of exploiting its citizens by not fully paying their salaries and said Havana was "irresponsibly" ignoring the negative impacts its decision will have on Brazilians.

Cuban President Manuel Diaz-Canel jumped to the programme's defence, paying tribute on Twitter to the doctors' "dignity, deep sensitivity, professionalism, dedication and altruism."

They had "rendered a valuable service to the people of Brazil," he added.

Bolsonaro later said on Wednesday that he will grant asylum to any Cuban national who asks for it.

The programme has been in place since August 2013, and since then nearly 20,000 Cuban doctors have treated 113.5 million Brazilians, according to the ministry.

In its strongly worded statement, Cuba said the conditions being imposed by Bolsonaro, who takes office on January 1, were "unacceptable".

Cuban doctors, currently serving in 67 countries, have brought medical care to areas of "extreme poverty" whether in Rio de Janeiro's favelas, Sao Paulo, Salvador de Bahia or the 34 Special Indigenous Districts, particularly Amazonia.  20,000 Cuban doctors have worked in Brazil as part of the program over the last five years, treating more than 113 million patients. Brazilian authorities say more than 60 million Brazilians who did not have access to a doctor now do as a result of Mais Medicos.

Assessment

Our assessment is that Bolsonaro’s position on the Mais Medicos doctors has two aspects to it: one is to take a political stand against Cuba and its socialist government, and the second is to put a dent in Cuban revenues from the programme. We believe that it would be regrettable if his own citizens were deprived of affordable healthcare as a result of Bolsonaro’s political posturing.