The controversy that always surrounded the More Doctors program, especially regarding the partnership with Cuba, gains new contours and reinforces the perception that Brazilians were instrumentalized for ideological and diplomatic purposes. On Wednesday (13), the United States government revoked the visas of former employees of the Ministry of Health of Dilma Rousseff (2011-2016) management, in an action that reinforces the allegations that the program would have functioned as an “inconceivable diplomatic coup” and a Cuban labor exploration scheme.
Among those sanctioned by the US State Department are Mozart Julio Tabosa Sales and Alberto Kleiman, who acted in the management of Mais Médicos during the Dilma government. The accusation is serious: both are considered complicit of a “forced labor export scheme of the Cuban regime” because they “consciously paid to the Cuban regime which was due to Cuban health professionals.”
According to the State Department, the measure “sends an unambiguous message that the United States promote the responsibility of those that allow the forced labor export scheme of the Cuban regime.”
On the same day, the Federal Court of Audit (TCU) released a report pointing out serious flaws in the program, such as the absence of precise diagnosis about the real need for doctors and the lack of goals and indicators to measure the effectiveness of the initiative.
Launched in October 2013, Mais Médicos was presented as an action to supply the scarcity of health professionals in needy and remote areas in Brazil. However, recently revealed diplomatic documents show that the initiative came from the Cuban government itself, which saw in medical missions a source of income to support the dictatorship. The telegrams of the previously confidential Brazilian Embassy in Cuba confirms that Brazil accepted all the requirements imposed by Havana, including the obligation to return doctors to the island even if they wanted to stay in Brazil.
International agreement channeled billions to the Cuban regime
The main initial discord point was the amount paid to health professionals. The consensus was that the Cuban doctors would only receive between 15% and 25% of the amount, and the rest would be transferred directly to the regime’s coffers. To enable this model and circumvent the need for approval of the National Congress, the Dilma government articulated a triangulation with the Pan American Health Organization (PAHO), which served as a legal framework for hiring.
In practice, the program has gained a “friendly clothing” to cover up a behind-the-scenes agreement with one of the hardest Latin American dictatorships. The objective: finance the oppression led by the Castro family in exchange for the regime’s hostage of the regime. According to a report by the Senate Social Affairs Committee (CAS), between 2013 and 2017, the Brazilian government spent about $ 13 billion on the program, of which more than half – about $ 7 billion – were sent abroad to the agreement with Cuba.
In 2019, the Cuban doctor Tatiana Carballo reported BBC that landed in Brazil in 2014 after a 45 -day Portuguese course. It was placed on a plane by the regime, without detailed information about its destination. In Limeira (SP), she served 25 to 30 patients a day and received $ 1,200 per month, while colleagues from other nationalities earned $ 11,000.
Tatiana and three other Cuban doctors deserted from the program and filed a collective action against PAPS in the United States, accusing the organization of participating in an alleged work scheme analogous to slavery and human trafficking. They claim that PAHO has profited approximately $ 75 million and that the Cuban government retained about $ 1.3 billion with the model.
In 2021, US Secretary of State Antony Blinken said Cuba has profited from medical missions abroad for over a decade, confiscating documents and salaries of professionals.
MP approved in 2013 dismissed diploma revalidation and expanded the program scope
Another controversy involving the program was the dismissal of the revalidation of the Cuban doctors diploma. By the Provisional Measure (MP) sanctioned by Dilma, and approved in the Senate, these professionals could act for up to three years without the need for revalidation in Brazil. To continue beyond this period, they would have to integrate a “specific medical career”, whose regulation would depend on a future bill.
The regulation also transferred to the Ministry of Health the responsibility for the registration of foreign doctors, removing this function from the Regional Councils of Medicine (CRMS). On the councils it was only the supervision of acting within the program, while the exercise of medicine outside the Mais Médicos remained forbidden to these professionals.
Another relevant change included in the text was the hiring priority for retired doctors. In addition, MP brought structural changes in medical formation in the country. By the end of 2018, residency programs should guarantee annual vacancies equivalent to the number of trainees of the previous year. And the boarding school – a mandatory internship at the end of the course – started to allocate at least 30% of its workload to Primary Care and SUS emergency and emergency services.
Cuba ended a program after Bolsonaro’s victory
Following the election of Jair Bolsonaro in 2018, the Cuban regime announced the program’s departure from the president -elect: direct payment to doctors, revalidation of diplomas, capacity tests and permission to come from families. About 8.5 thousand Cuban doctors, who occupied almost half of the vacancies of the program, abruptly left Brazil. The withdrawal especially affected remote regions, urban peripheries and indigenous districts, creating an immediate assistance vacuum.
In response, the Bolsonaro government launched on August 1, 2019 the Medical Program for Brazil, with 18,000 vacancies – 7 thousand more than the previous model. The new proposal prioritized locations with higher care deficits, especially in the North and Northeast.
Among the changes introduced were:
- Hiring via CLT, replacing the temporary contracts of the previous model;
- Net salary of R $ 12 thousand, with bonuses of R $ 3 thousand for rural areas and R $ 6 thousand for riverside regions;
- Salary progression based on performance and quality indicators, with bonus between 11% and 30%.
Resumed by Lula, more doctors is once again questioned by TCU
In 2023, President Luiz Inacio Lula da Silva sanctioned the law that recreated the program, now called “More Doctors Program for Brazil”. The proposal provided for the prioritization of professionals trained in the country and the reduction of dependence on foreigners. The announcement opened 15 thousand immediate vacancies, added to another 13 thousand already occupied.
With four -year contracts, extendable for the same period, the new model stipulated a starting salary of R $ 12,800, with incentives of 10% to 20% for doctors in remote or vulnerable areas.
Despite the reformulation, the program became criticism again. A TCU report pointed out serious failures in the reactivation of policy: absence of clear diagnosis about the demand for doctors, lack of goals and cost-effectiveness indicators, and poor risk management.
According to Minister Jhonatan de Jesus, rapporteur of the audit, there was no proof of the lack of professionals in 2023, nor analysis of viable alternatives before the resumption of the project.
“Examination reveals satisfactory governance in coordination and monitoring, but relevant diagnostic weaknesses, alternative analysis, goals specification, cost-effectiveness and risk management. Such weaknesses do not configure unlawfulness, but can reduce public spending efficiency and transparency,” the minister wrote.
In response, the Ministry of Health said it works in partnership with federal universities to create indicators, simulate impacts and develop algorithms that prioritize more vulnerable areas. According to the folder, the program currently has 26,400 doctors operating in 4,500 municipalities and in all special indigenous sanitary districts, more than double recorded in 2022.
