A victory by Jair Bolsonaro in the second round of the Brazilian presidential election could endanger the Más Médicos (More Doctors) program, which currently staffs 8,500 professionals from the island, and constitutes a significant source of revenue for the Cuban government.
During a campaign event in the state of São Paulo last August, the Liberal Social Party’s (PSL) candidate for the presidency said he was going to "expel" Cuban doctors from Brazil.
"Any foreigner who comes to work here in the field of Medicine has to pass the revalidation exam. We cannot be hiring people from Cuba without, at least, verifying that they really know how to do their jobs profession," said Bolsonaro, referring to the national exam for the revalidation of medical degrees issued by foreign institutions of higher learning.
It is not the first time that Bolsonaro has mentioned the issue. At the end of 2017 he tweeted: "The Federal Supreme Court decided to keep Más Médicos. In practice this represents more than 1.3 billion for the Cuban dictatorship, to maintain agents in our country who have not demonstrated their capacity and aptitude, while our doctors are neglected and can't work."
Shortly before, in response to a complaint filed by the Brazilian Medical Association, the Federal Supreme Court (TSF) approved the Más Médicos program, considering it in accordance with the Constitution, even though it exempts those working under its umbrella from having to revalidate their degrees in Brazil, and allows, as in the case of Cubans, the hiring of doctors for lower-than-average salaries, with most of the money going to the island's government, to the detriment of its professionals.
Conditions of semi-slavery
It is precisely these two points of the Más Medicos program – exemption from revalidation and the retribution of the Cuban doctors – that have sparked controversy since it was launched in 2013 by former president Dilma Rousseff in order to alleviate the lack of doctors in the most disadvantaged regions of the country.
The remuneration, over $3,000, does not go directly to the Cuban doctors, but rather to the Government of Cuba, which keeps 75% of it.
Professionals also suffer surveillance and limitations imposed by authorities on the island. Brazilian doctors and politicians, meanwhile, have described these practices as constituting "semi-slavery".
Thus, some 200 Cuban professionals have filed lawsuits to throw off their extricate themselves from the authority of the Pan American Health Organization (PAHO) and the Cuban Government, the bodies through which they are hired.
This is a situation that led to a momentary suspension of the program between Havana and Brasilia, in April of 2017, when the Cuban government refused to send another 710 doctors, citing concern that the Brazilian justice system might not accept Cuba's requests for permanent residence for its physicians in the country.
After a meeting with the PAHO in May of the same year, the Cuban authorities decided to resume the contracts.
Is the end of the program nearing?
According to data from 2017, Más Médicos currently serves 4,058 municipalities and 34 indigenous districts in Brazil, with a total of 18,240 doctors, of whom 8,500 are Cubans.
In 2016 President Michel Temer enacted a law that extended for another three years the stays of foreign doctors in the country, without requiring them to revalidate their degrees.
Since then the Brazilian Health Ministry has opted to freeze the Cuban figure, and to assign them, in practice, to posts that are rejected by Brazilian professionals.
Havana's recent financial difficulties have also sown doubts as to the continuation of the program.
Thus, in September the government of Michel Temer threatened the Cuban regime that it would stop paying for the country's doctors if Havana did not settle its arrears, coming to some 17.5 million dollars owed to Brazil’s National Bank of Economic and Social Development (BNDES).
Since 1998 the BNDES has financed about 880 million dollars in infrastructure and exports by Brazilian companies to the Island. Havana's debt is estimated at around 597 million dollars.
In May the Cuban government decided to postpone the payment of its debts without negotiating with the bank, citing "climatic and financial issues." After the Brazilian announcement, however, it expressed a willingness to search for solutions, according to BNDES President Dyogo Oliveira.
In any case, the extension of the Más Médicos program expires in 2019, and the next Brazilian president will have to decide what to do with it: keep it as is, modify the contracting conditions, or simply cancel it.
This decision will determine the fates of the thousands of Cuban professionals in the South American country.
Bolsonaro's latest statements in this regard are not very auspicious for the government on the island: "We are going to put an end to the Forum of San Pablo. With the revalidation, we are going to expel Cubans from Brazil."