Cuba First Offered Physicians To Brazil, Official Documents Show

Negotiations under the Rousseff administration were carried under secrecy to avoid negative reactions from the Brazilian medical community

Marcelo Soares
São Paulo

Cables from the Brazilian embassy in Cuba show how the Cuban government negotiated with Brazil to create the "Mais Médicos"(More Doctors) program. Classified as confidential and kept in secrecy for five years, they have now been released and show a partially different story from the one presented to the Brazilian population.

The cables show, for example, that Cuba proposed the program and the two countries had to negotiate for a year before President Dilma Rousseff presented in 2013.

The negotiations were kept in secrecy to avoid negative reactions from the Brazilian medical community. It was during these meetings that Cuba presented the demands that are now being criticized by president-elect Jair Bolsonaro. His public statements about the program made Cuba withdraw from Mais Médicos.

President Dilma Rousseff pose for pictures with physicians from the Mais Médicos program in Brasília, April 2016 - Pedro Ladeira/Folhapress

The Rousseff administration wanted to avoid having to pass a bill through the Brazilian Congress, so it decided, at the last minute, to include the Pan American Health Organization (PAHO) in the partnership. Brazil would pay PAHO, which in turn would contract Cuba to provide the physicians.

In 2011, the Cuban government formed private companies, like Comercializadora de Servicios Médicos Cubanos (SMC), to export labor and medical supplies. Medical services are one of the leading Cuban exports; Cuba has such agreements with 60 countries.

In 2012, a delegation led Ministry of Health secretary Mozart Sales went to Cuba. The group included Alberto Kleiman, then an officer for international relations for the Ministry. Currently, Kleiman is PAHO's director for international affairs and partnerships. 

The documents show that the Brazilian delegation accepted all of Cuba's demands, but the negotiations hit a roadblock when they reached compensation terms.

"The Brazilian side proposed US$ 4,000 (US$ 3,000 for the Cuban government and US$ 1,000 for the physician)," said the memo describing the meeting. "The Cuban side, however, said it was expecting US$ 8,000 per physician and counter-offered US$ 6,000 (US$ 5,000 and US$ 1,000 for the professional)."

The Cuban authorities demanded that all physician evaluations to be done in Cuba and Brazil would limit itself to "acclimate the doctors, for the most part, to the language, to work practices and to the local law."

Brazil accepted all demands. The idea was to sign a commercial agreement to purchase medical services, not a bilateral cooperation between countries.

Everything was almost settled when the contract hit two roadblocks. The first was the price; Cuba agreed with US$ 5,000 per month per physician, but the Brazilian government wouldn't go over US$ 4,000. The second roadblock had a legal nature. Without a bill approved by the Brazilian Congress, enacting the agreement would be a hard thing to do.

That's when the PAHO came in as an intermediary, "turning the service agreement into international cooperation in the medical field," said the memo. Cuban officers didn't like the solution, because the payments would go through Washington, were the PAHO headquarters are located. Alexandre Padilha, then Minister of Health, proposed that funding to be transferred between PAHO's offices without passing by the United States.

A meeting to give the contract its final shape happened in Havana, which was also documented in a foreign service cable. A few days later, the cooperation agreement for Mais Médicos was signed between Brazil and PAHO.

Translated by NATASHA MADOV

Read the article in the original language