Five weeks after Cuba decided to pull out of Brazil’s More Doctors program, leaving medical vacancies across some of the country’s neediest areas, only 69 percent of the spaces have been effectively restaffed.
The Ministry of Health set a deadline of December 12 for the 8,411 Brazilian applicants to show up to their new posts, but were forced to extend the term twice due to the unimpressive numbers. The final deadline passed on Monday. By this morning, only 5,972 doctors have turned up to work in the program, meaning 29 percent have chosen to abandon the places they were awarded.
Brazil’s lauded More Doctors program was thrust into crisis last month when the government of Cuba announced it was sending its professionals home, due to promises made by president-elect Jair Bolsonaro to toughen up the rules of selection.
The program was instated in 2013 to expand medical care in the country’s neediest areas, inviting foreign doctors to come and work in Brazil. At the time of Cuba’s decision, over half of the 16,000 participants in More Doctors were from the island nation.
Jair Bolsonaro, a staunch opponent of Cuba and fiercely anti-immigration, proposed that all foreign doctors who participated in the program would have to undergo revalidation exams in order to stay in the country. Referring to the Cuban doctors, he once stated that “we don’t even know if they really are doctors.”
Initial optimism turns to pessimism
With Cuba’s decision to exit the program, Brazil’s Ministry of Health announced an emergency procurement process to fill the vacancies left behind. The response was astounding, with the ministry website receiving over 30,000 applicants for just 8,517 spots. However, with the deadline for doctors to show up to work having passed, there are still 2,545 vacancies remaining.
There are also concerns that among the accepted applicants, many of them are already working in the public health service and simply moving from one job to another, meaning the overall deficit of public doctors is not reducing.
Municipal health departments found that from the total number of accepted applicants (not discounting those who did not show up to their posts), 2,844 already worked in public family health units, and many more worked in different sectors of the public system.
In the northern state of Roraima, 84 percent of applicants already worked in the public health service. The situation is also severe in the states of Acre and Rio Grande do Norte, where 76 and 70 percent of “new” doctors migrated from existing public health programs, respectively.
Coupled with the no-shows, the outlook is grave indeed. In the town of Tucuruí, in the state of Pará, only nine of the 13 available vacancies were filled, only five doctors actually showed up, and three of those were existing public sector professionals. The municipality is home to over 100,000 people.
Why haven’t the doctors shown up?
The reasons for no-shows are varied but are largely due to the difficulty in accessing the clinics, especially when they are located in Brazil’s North region. In many municipalities, the only means of access is via riverboat, which can take hours and, in some cases, over a day to arrive. When applicants realize just how unfeasible it is to reach their jobs, they inevitably give up.
What’s more, many of these doctors work on call in other clinics, meaning it can be difficult to marry their two responsibilities, especially with the increased demand caused by existing vacancies and other no-shows. There are now fears that even among those who have shown up to work, more and more will resign due to these difficulties.
The last time the Brazilian government issued a procurement process for More Doctors vacancies, in 2017, we witnessed a similar situation. 6,285 Brazilian doctors applied for 2,320 spots; only 1,626 showed up to work, and 542 quit within their first year.