BackgroundCuba has extended its medical cooperation to Pacific Island Countries (PICs) by supplying doctors to boost service delivery and offering scholarships for Pacific Islanders to study medicine in Cuba. Given the small populations of PICs, the Cuban engagement could prove particularly significant for health systems development in the region. This paper reviews the magnitude and form of Cuban medical cooperation in the Pacific and analyses its implications for health policy, human resource capacity and overall development assistance for health in the region.MethodsWe reviewed both published and grey literature on health workforce in the Pacific including health workforce plans and human resource policy documents. Further information was gathered through discussions with key stakeholders involved in health workforce development in the region.ResultsCuba formalised its relationship with PICs in September 2008 following the first Cuba-Pacific Islands ministerial meeting. Some 33 Cuban health personnel work in Pacific Island Countries and 177 Pacific island students are studying medicine in Cuba in 2010 with the most extensive engagement in Kiribati, the Solomon Islands, Tuvalu and Vanuatu. The cost of the Cuban medical cooperation to PICs comes in the form of countries providing benefits and paying allowances to in-country Cuban health workers and return airfares for their students in Cuba. This has been seen by some PICs as a cheaper alternative to training doctors in other countries.ConclusionsThe Cuban engagement with PICs, while smaller than engagement with other countries, presents several opportunities and challenges for health system strengthening in the region. In particular, it allows PICs to increase their health workforce numbers at relatively low cost and extends delivery of health services to remote areas. A key challenge is that with the potential increase in the number of medical doctors, once the local students return from Cuba, some PICs may face substantial rises in salary expenditure which could significantly strain already stretched government budgets. Finally, the Cuban engagement in the Pacific has implications for the wider geo-political and health sector support environment as the relatively few major bilateral donors, notably Australia (through AusAID) and New Zealand (through NZAID), and multilaterals such as the World Bank will need to accommodate an additional player with whom existing links are limited.
Recruitment by wealthy countries of health personnel from developing countries is threatening the viability of crucial health programs in poor countries, especially in sub‐Saharan Africa.
Australia has participated in this “brain drain”, although the extent and impact of this on different countries has not been adequately assessed.
Australia depends on overseas‐trained doctors to fill vacancies in public hospitals and private practice, particularly in rural and outer suburban areas where locally trained professionals are reluctant to work.
Australia should adopt national strategies to minimise harm and maximise benefits of skills migration; concerted international action will also be required.
This paper presents a snapshot of job vacancies in the public health workforce labour market. The analysis is based on 404 advertised public health jobs appearing in the press, and on-line job alerts over a 2-month period in mid 2003. The analysis reveals who was seeking employees, what formal qualifications and competencies were required, what salary and other conditions of employment were offered and where the vacant jobs were located. The study demonstrates the heterogeneity of the public health workforce, which limits definition of clear practice boundaries and complicates workforce planning. The findings further demonstrate the benefit of reviewing both the demand and the supply side of the labour market, and point to the value of repeated surveys of advertised jobs as part of an ongoing public health workforce monitoring and planning process.
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