Grupo de Pesquisa "Política e Política Pública de Saúde"/CNPQ
Research Group "Politics and Public Health Policy"/CNPQ
Publicação de pequeno artigo sobre o Programa Mais Médicos no BJGP (British Journal of General Practice).
April 24, 2015
REGULATING FOREIGN RECRUITS INTO PRIMARY CARE IN BRAZIL
Brazil’s National Health System (Sistema Unico de Saude — SUS) is enshrined in the 1988 Constitution as a legal obligation for the state to provide to all its citizens. With an integrated public health and primary care programme at its core, the Family Health Strategy (Estrategia Saude da Familia) has provided comprehensive primary care services to well over 100 million people through 35 000 family health teams and 250 000 community health workers in a little over two decades.1 Its impact on equity and key population health outcomes is impressive.2,3 Successive governments have worked hard to encourage the expansion of primary care training and education in universities and medical schools. However, recently the expansion has plateaued and residency programmes in family medicine, established to fuel the expansion, struggle to fill their places.
On 22 October 2014, it was 1 year since President Dilma Rousseff signed Law No. 12 871, enabling Brazilians qualified abroad and foreign medical doctors to work in Brazil’s national health system.4 The purpose was to decrease the shortage of medical doctors in priority regions and to strengthen the provision of primary care. So far, it seems to have been successful. As of 18 February 2015, 14 462 doctors have been recruited through the More Doctors programme in 3700 municipalities (34 of which are in indigenous populations).5 Priority was given to returning Brazilians who graduated overseas, and retirees, but subsequent phases were expanded to include applications from foreign graduates.
Currently, almost 80% of the More Doctors recruits are from Cuba.5 Recruits are only allowed to work in primary care and under the supervision of local Higher Education Institutions and Medical Schools.
At first sight, this would not be particularly controversial. In the UK, for example, nearly 20% of all doctors have trained abroad. However, the More Doctors programme in Brazil has raised serious concerns. The professional medical associations have fought it, protested against it, and even sued the government in the Supreme Court. Their concern is that the More Doctors recruits do not need to revalidate their medical diploma through the usual channels, and argue that it is unethical to permit a doctor to practise medicine without having first established whether he/she is competent to do so. In addition, the Cuban doctors’ salaries are paid first to their government: they receive only a proportion of this payment, leading some to describe their recruitment as ‘slave labour’.6 Others have noted that the More Doctors programme is a covert attempt to secure Brazil’s economic interests in Cuba. The doctors’ salaries provide over US$250 million per annum in hard currency to Cuba, easing inflation, while Brazil positions itself as a preferred partner for major economic redevelopment programmes.7 If true, then this is a particularly good example of health diplomacy.