Since 2006, 50 Cuban doctors have worked in Pacific Island countries (PICs), while 250 Pacific islanders have studied medicine at the Latin American School of Medicine in Cuba, nearly doubling the medical workforce in some countries. Although Cuba has pursued an extensive South-South Cooperation (SSC) programme in health around the globe for 60 years, the relatively recent presence of Cuba in the Pacific is intriguing. The programme is based on what Cuba has called the "multiple coincidences" and shared experiences between Cuba and PICs as Small Island Developing States facing common challenges. Proponents argue Cuba's expertise in providing community-based and human-capital oriented care health care in low-resource environments could provide a suitable model for meeting the health goals and needs of PICs. Moreover, Cuba's medical cooperation is grounded in an ethics of solidarity and offers a clear example of social justice-oriented south-south cooperation which aims to both address immediate humanitarian need and to transform power structures that limit the accessibility and availability of sustainable health care within partner countries. Yet despite this there has been little research on Cuba's approach to medical cooperation in the Pacific. This paper addresses this gap, drawing on Maussian gift theory to argue that the Cuban 'gift of health' provides much needed capacity in health while building the dignity of both partners. As a theory of solidarity with distinct Pacific roots and which links clearly to the solidarity-based model of Cuban cooperation based on egalitarianism and relationship, gift theory provides an explanation for the presence of Cuba in the Pacific and highlights the importance of equitable relationships and dignity in development partnerships, providing theoretical roots to the idea that there might an alternative to traditional models of aid and development in the region.

Background: This paper responds to Asante et al (2014), providing an updated picture of the impacts of Cuban medical training in the Pacific region based on research carried out in 2019-2021, which focused on the experiences of Pacific Island doctors trained in Cuba and their integration into practice in their home countries. Methods: The research focussed on two case studies – the Solomon Islands and Kiribati. Study methods for this research included multi-sited ethnographic methods and semi-structured interviews as well as qualitative analysis of policy documents, reports, and media sources. Results: The Cuban programme has had a significant impact on the medical workforce in the region increasing the number of doctors employed by Pacific Ministries of Health between 2012 and 2019. Qualitatively, there have been some notable improvements in health delivery over this period. However, the integration of the Cuban-trained doctors into practise has been challenging, with criticisms of their clinical, procedural and communication skills, and the need for the rapid development of bridging and internship training programmes (ITPs)which were inadequately planned for at the outset of the programme. Conclusions: The Cuban programme in the Pacific is an important model of development assistance for health in the region. While Cuba’s offer of scholarships was the trigger for a range of positive outcomes, the success of the programme has relied on input from a range of actors including support from other governments and institutions, and much hard work by the graduates themselves, often in the face of conservable criticism. Key impacts of the programme to date include the raw increase in the number of doctors and the development of the ITPs and career pathways for the graduates, although this has also led to the reorientation of Cuban graduates from preventative to curative health. There is considerable potential for these graduates to contribute to improved health outcomes across the region, particularly if their primary and preventative health care skills are utilised.

Background This paper responds to Asante et al. (in Hum Resour Health, 2014), providing an updated picture of the impacts of Cuban medical training in the Pacific region based on research carried out in 2019–2021, which focused on the experiences of Pacific Island doctors trained in Cuba and their integration into practice in their home countries. Methods The research focussed on two case studies—Solomon Islands and Kiribati. Study methods for this research included multi-sited ethnographic methods and semi-structured interviews as well as qualitative analysis of policy documents, reports, and media sources. Results The Cuban health assistance programme has had a significant impact on the medical workforce in the Pacific region increasing the number of doctors employed by Pacific Ministries of Health between 2012 and 2019. Qualitatively, there have been some notable improvements in the medical workforce and health delivery over this period. However, the integration of the Cuban-trained doctors into practise has been challenging, with criticisms of their clinical, procedural and communication skills, and the need for the rapid development of bridging and internship training programmes (ITPs) which were inadequately planned for at the outset of the programme. Conclusions The Cuban programme in the Pacific is an important model of development assistance for health in the region. While Cuba’s offer of scholarships was the trigger for a range of positive outcomes, the success of the programme has relied on input from a range of actors including support from other governments and institutions, and much hard work by the graduates themselves, often in the face of considerable criticism. Key impacts of the programme to date include the raw increase in the number of doctors and the development of the ITPs and career pathways for the graduates, although this has also led to the reorientation of Cuban graduates from preventative to curative health. There is considerable potential for these graduates to contribute to improved health outcomes across the region, particularly if their primary and preventative health care skills are utilised.