The gift of health: Cuba’s development assistance in the Pacific

Abstract

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.

Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders’ Discussions, Challenges, Priorities and Solutions, 2015–2020

“…We identified 17 documents including five Pacific Heads of Health meeting reports [ 16 , 17 , 18 , 19 , 20 ], three Pacific Health Ministers meeting reports [ 5 , 8 , 21 ], six WHO Western Pacific Regional Committee meetings reports [ 22 , 23 , 24 , 25 , 26 , 27 ], and three peer-reviewed papers [ 1 , 10 , 28 ]. Across these documents, five main themes emerged.…”

“…Both options are expensive and logistically challenging. Initiatives to train Pacific Islander doctors abroad, notably in Cuba [ 28 , 35 , 36 ], have helped address human resources for health gaps and provide much-needed capacity in health. For example, the number of doctors in Kiribati increased from 18 to 51, with 23 of the new doctors Cuban trained.…”

“…In the Solomon Islands, the number of doctors in the same period grew from 79 to 170, with the return of 74 medical graduates from Cuba between 2014–2018, and another 34 expected to graduate by 2025. Cuban trained doctors also contributed to significant increases in the number of doctors in Tonga, Tuvalu, Vanuatu, and Nauru [ 28 , 37 ]. However, these initiatives are not without problems with delegates to the 2016 Heads of Health meeting raising concerns for the ‘job readiness’ of returning overseas educated doctors and the resource-intensive need to provide additional primary care-focused training and mentorship [ 10 , 17 ].…”

“We are the ones who will have to make the change”: Cuban health cooperation and the integration of Cuban medical graduates into practice in the Pacific

“…Discussion: Opportunities And Challenges For Pics Curative vs Preventative Focus Medical education at ELAM is strongly focused on family medicine and preventive medicine, and students receive extensive training in public health and the social and environmental determinants of health (Huish & Kirk, 2007). This re ects the value place on primary care by the Cuban government, and underpins the optimism with which the offer of Cuban training was received by Paci c island governments (Asante et al, 2014;McLennan et al, 2020). However, on their return home the graduates nd themselves in a system that often remains very centralised.…”

“…Cuba has a reputation for having a relatively well performing health system that provides Cubans with better access to healthcare and longer life expectancies than many developed countries (McIver et al, 2021, p. 94). Cuba's Ministry of Health recognizes the value of primary care in bolstering the total strength of health systems, and this belief is deeply grounded into the nature of its cooperation with other countries (Huish, 2013;McLennan, Huish, & Werle, 2020).…”