Cuba & Global Health

Frequently Asked Questions

How are the agreements for Cuban doctors brokered?

How about the "doctors for oil" agreement between Cuba and Venezuela? How does that work?

How are Cuban health professionals posted abroad?  Do people get to choose where they go and for how long?

Do nurses and other health professionals serve internationally or only doctors?

What is Operación Milagro?

How much do Cubans working abroad earn? Who pays them?

How does the Cuban government benefit from sending doctors abroad?

Where do they get the medicines they bring to other countries?

Don’t a lot of Cubans “defect” from these programs?

How are the agreements to contract Cuban doctors brokered?

Cuban health professionals staff the health systems of other countries by virtue of government-to-government agreements. The agreements are based on requests from host countries.  These are finalized after a joint evaluation of what support a country's health infrastructure needs (physicians, nurses, technicians, medical educators, etc) and the Cuban capacity to provide it. In the case of disaster relief, these accords are usually fast-tracked according to circumstances on the ground.

Except for disaster situations, the bilateral accords usually cover a period of at least two years, providing a certain number of Cuban health professionals in the specialties and locations agreed upon.  The most common framework for assistance, now covering 70 countries, is through the Comprehensive Health Program (CHP). The CHP grew out of the medical relief teams Cuba dispatched to Central America and the Caribbean following Hurricane Mitch in 1998. The post-disaster scenario there made clear that more was needed than disaster relief, given the lack of health care to marginalized communities, motivating Cuban policymakers to launch an unprecedented program to bring primary health care to the region’s poor—later extended to South America, Africa, and Asia.  

The sustainability of the CHP is reflected in Havana’s Latin American Medical School (ELAM) and other medical education initiatives.  These offer scholarships to students from low-income families in the same countries served by Cuban physicians, with the aim that these new doctors will return to serve their communities upon graduation.   

The overwhelming majority of those working abroad are physicians: approximately 70% according to June 2006 figures. 

How about the doctors-for-oil agreement between Cuba & Venezuela? How does that work?

Doctors-for-oil is a fashionable misnomer that oversimplifies a highly complex regional barter and social development program, known as the Bolivarian Alternative for the Americas (ALBA).  This arrangement makes available Venezuelan oil at discounted prices to regional trading partners, who offset the savings with resources they have in abundance. In Argentina's case, it's beef and milk; in Cuba's case it's health professionals and medical educators. But the South-South initiative involves more than just barter trade, as it proposes new approaches for regional cooperation, integration, and social -- as well as economic -- development. Elimination of trade barriers, joint development projects, scholarships, literacy programs in many languages, a regional bank, and the regional television network, TeleSur, are already in place among full ALBA members (Cuba, Venezuela, and Bolivia) with other regional partners (the Caribbean nations, Argentina, Brazil, and Uruguay, among others) also taking part.  (For more on ALBA, see Venezuela’s Answer to “Free Trade”: The Bolivarian Alternative for the Americas by David Harris and Diego Azzi, Hemispheric Social Alliance).

How are Cuban health professionals posted abroad?  Do people get to choose where they go and for how long?

Cuban health professionals volunteer at their workplace, adding their name to the list of people willing to serve abroad. 

While international service is considered something of an honor and an adventure which provides some minimal financial remuneration, there are many health professionals who don’t join the ranks of the volunteers, primarily for personal and family reasons.

The volunteers do not generally get to choose the country where they'll be posted, since this depends on the kinds of professionals needed, language capabilities, and even gender in some cases.  However, arrangements may be made in certain circumstances -- for instance if spouses both volunteer and qualify for service, they may request and be posted to the same country. This is especially true for the Henry Reeve International Team of Medical Specialists in Disasters & Epidemics, which has served in disaster situations in Pakistan, Indonesia, Bolivia and Guatemala.

Volunteer posts are generally for two years with the option to renew. In the host countries, Cuban health professionals serve within public health systems, primarily in rural and remote communities, where they may be the first stable, reliable source of medical attention those populations have known.

Do nurses and other health professionals serve internationally, or only doctors?

Cuban medical cooperation is tailored to the host country's needs and can include physicians, nurses, technicians, biomedical engineers, and medical educators. In June 2006, 33% of Cuban health professionals posted overseas were technical personnel, including nurses. Additionally, in 2006, Cuba helped establish the Caribbean Nursing School in Dominica and is in the process of establishing another nursing school in Belize. This type of medical education cooperation, whereby Cuba provides professors, pedagogical frameworks, educational materials, and in-country training, is the cornerstone of Cuba's sustainability strategy for human resources for health. In keeping with this parable that "if you give a man a fish he eats for a day, but teach him how to fish and he'll eat forever," Cuba has helped establish medical schools in various countries of the Global South:

Countries with Medical Schools Established by Cuban Cooperation

Source: Vice Ministry for Education and Research, Ministry of Public Health, Havana

What is Operación Milagro?

"Operation Miracle" is a sight restoration program for the estimated six million people in the Latin American and Caribbean region with reversible blindness or vision loss who are too poor to pay for the surgery.  Under this program, begun in mid-2004, Cuban specialists had operated on 317,489 patients from 27 countries (including 69,000 Cubans) by July, 2006, and that figure climbed to over half a million by the first quarter of 2007. The program provides for Cuban ophthalmologists posted abroad to perform active screenings of patients for cataracts and other reversible vision loss conditions. Once identified, these patients are flown to Cuba accompanied by a family member, for the surgery and immediate recovery period; the Cuban government assumes all expenses. More recently, ophthalmology centers have been opened in Mali, Ecuador, and Bolivia, with support from those governments and the ALBA accords in the case of Ecuador and Bolivia (see FAQ above).

How much do Cubans working abroad earn? Who pays them?

Cuban health professionals posted abroad typically receive USD$150 to $200 a month, plus their regular salary in Cuban pesos. Additionally, their families back home receive a small, hard-currency monthly stipend.  These costs are shared by the Cuban and host governments.

How does the Cuban government benefit from sending doctors abroad?

The Cuban government benefits by fulfilling its stated commitment to solidarity with the developing nations of the world, while at the same time fostering professional and personal development in the country's health professionals.

At the same time, the medical cooperation program accrues goodwill around the world, especially with populations who may have never had health services before. South-South cooperation and integration is also strengthened by the Cuban assistance, which goes primarily to other developing nations.

In the case of the ALBA accords with Venezuela, Cuba receives oil on favorable trade terms in return for medical cooperation and other human resources support (see FAQ above).  Certain wealthier countries also request assistance from Cuban medical teams, for which they compensate the Cuban government.

Where do the Cubans get the medicines they bring to other countries?

In the case of long-term medical teams, the host countries normally provide the medicine disbursed by Cuban health professionals. In post-disaster situations, the Cubans may make available medicines from their national disaster stock, combining these with what the host country provides.

Don't a lot of Cubans "defect" from these programs?

Approximately 2% decide to leave the program altogether, according to Cuban government sources.  Other Cuban health professionals marry abroad, but either choose to continue to serve in the host country under the bilateral agreement, or return to Cuba with their spouses.

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©MEDICC, 2007