Analysis of policy implications and challenges of the Cuban health assistance program related to human resources for health in the Pacific

Abstract

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.

O desafio do Programa Mais Médicos para o provimento e a garantia da atenção integral à saúde em áreas rurais na região amazônica, Brasil

“…Similar experiences have also been observed in other countries [24][25][26] It is important to add that this study has limitations regarding the definition of the user population that participated. The users were selected in the health units which may, to some extent, have had a bearing on their positive assessment of the program's implementation and satisfaction with the care provided by the MDP physicians, since the interviewees were using the health services.…”

“…In the case of rural populations, various studies have mentioned the issue of shortages of professionals to work in these areas, as well as barriers related to the distance from the health units, which hinders the population's access to health care 24,33 . For this reason, Cuban physicians are generally assigned to distant and remote rural areas, i.e., to locations where it is difficult to provide doctors 34 .…”

Retaining doctors in rural Timor-Leste: a critical appraisal of the opportunities and challenges

“…The Cuban-trained doctors could easily face opposition from a medical council regarding their competence, as observed in several other countries. 20 In the absence of an operational medical council, Timor-Leste has not encountered any public opposition to the Cuban-trained doctors -although there was, initially, some passive opposition to the Cuban Medical Brigade. 21 A medical council for Timor-Leste is in the pipeline.…”

What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey

“…The private health system is not very well developed in Timor-Leste, particularly in rural areas. In 2011, there were 26 private health facilities in Timor-Leste, mostly in urban areas [6]. Government health workers are officially prohibited from private practice in Timor-Leste.…”

“…There are also some concerns about the quality of care of the Cuban-trained doctors [6]. A study was conducted on the use of medicine and adherence to the clinical guidelines by non-physician heath workers (e.g.…”