Created in 2013 by the Dilma Rousseff administration with the aim of sending healthcare professionals to remote areas of the country, the More Doctors Program employs 18,240 professionals—8,332 of them being from Cuba. Many have started to go home as Havana declared it is withdrawing from the program after President-elect Jair Bolsonaro imposed many conditions for its continuation. The list includes the taking of equivalency tests to attest that the Cuban doctors are indeed capable of working in Brazil, and that they receive the entirety of their salaries (75 percent of which currently stays with the Cuban government). Moreover, Mr. Bolsonaro said that the doctors’ must be allowed to bring their families, something that Havana does not accept.
While there is a point in wanting the Cuban doctors to get their full salaries—some of them consider themselves “slaves”—Mr. Bolsonaro’s words indicate that his beef with the program is more ideological human rights-based. Moreover, losing these professionals will deeply affect millions of Brazilians who risk not being covered by the public healthcare system.
Today, Cuban doctors work in 1,600 municipalities and occupy positions that Brazilian professionals refuse to take. In 2017, for example, the Ministry of Health opened 2,320 jobs within the More Doctors Program; a total of 6,285 Brazilians applied for the positions, but only 1,626 actually showed up to work and a third of them abandoned their posts before a full year.
Several areas risk falling into a “state of public calamity,” according to the Brazilian Association of Municipalities (ABM). “Cuban doctors have acted in peripheral areas of metropolitan regions, in indigenous districts, in small towns, and remote areas. For most of these places, the arrival of Cuban doctors represented the first time a healthcare professional ever set foot in the region. Brazilian doctors refuse to go and live in these areas, even if the salaries offered are high,” said a letter from the ABM to the president-elect.
Concentration of doctors in big urban centers
In January 2018, the University of São Paulo released a report on the demographics of Brazilian healthcare professionals. According to the document, 55 percent of Brazilian doctors work in state capitals, where only 24 percent of the population resides. “While there are 5.07 doctors per 1,000 residents in state capitals, the rate in the countryside drops to 1.28,” says the report. In the state of Amazonas, for instance, 93 percent of doctors are located in state capital Manaus, the home of only half of the state’s total population.
Who are the new Brazilian doctors?
In order to establish a profile of new Brazilian doctors, the report conducted 4,601 interviews. They show that the doctor population is not exactly the most diverse, explaining the massive concentration of healthcare professionals in wealthier areas.
The majority of people finishing medical school are white, single, childless, and were financially dependent on their parents during their college years. Most studied in private schools and followed preparatory courses in order to pass their university entrance exams. Their parents, unsurprisingly, also completed higher education.
- 77.2 percent of new Brazilian doctors self-declared as white (the rate reaches 90 percent in the Southeast);
- Mixed-race people amount to 16 percent;
- Blacks are fewer than 2 percent.