CUBA: The politics and economics of medical outreach

Cuba’s medical system with an enviable global reputation for innovation and quality of healthcare has been coming into the spotlight for other reasons.

The country’s medical diplomacy through which it sends health teams to assist other countries is now in the cross-hairs of US diplomatic and trade sanctions against Havana.

The scheme which mainly benefits poor nations struggling with healthcare delivery has also been a lifeline for the Cuban economy.

The US is accusing Cuba of using medical diplomacy to prop-up illegal regimes - a direct reference to Venezuela, the US’s arch-nemesis in the region.

At the same time, some independent reports suggest that all might not be well within the management of the programme by the Cuban authorities, with some suggestions of doctors being placed under undue pressure.

Cuba’s medical outreach and support programme has benefited many Caribbean and Latin American countries.

Its eye-care programme is well established and assistance in other areas of primary and critical healthcare delivery have been highly praised.

The programme has a presence further afield including Africa, Oceania, and even Portugal in the European Union.

Known by labels such as doctor diplomacy and medical internationalism, this magnanimous gesture is at its core a projection of ‘soft power’ by Cuba.

But it’s not just about ‘winning friends and influencing people’.

It has a strong economic element as not all of the services are delivered gratis.

The program is a highly-prized sector of the Cuban economy, bringing in an estimated US$ 6 billion annually, second only to tourism.

Cuba’s own form of on-island medical tourism offers high-quality medical care in a range of specialist services including cancer and AIDS treatment.

The country also known for its top-rate medical training.

But now, with tourism earnings now under increased pressure due to the Trump administration’s re-tightening of the trade embargo, the medical outreach scheme is as much about business - and economic survival - as it is about goodwill.

Up until recently, there were indications of an economic turnaround after some aspects of the US trade sanctions were relaxed by the former US Obama government.

Under President Trump though, the screws are being tightened with the threat that the sanctions could be worse than before.

The program itself is now being targeted as part of the political and trade pressure by the United States. It’s another blow to Cuba’s increasingly fragile economy.

In addition to the intensified pressure from the US, Cuba’s medical outreach program is now coming under scrutiny by some human rights groups.

They question the conditions under which some doctors are brought into the scheme.

There are charges that some doctors have been coerced into signing on and reports of defections.

Some doctors have told human rights agencies of less-than-ideal working and contractual conditions.

Since the inception of the medical outreach program over half a million Cuba medical personnel have been sent abroad to work in more than 160 countries.

At present, Cuba’s ‘medical internationalism’ has around 30,000 medical staff in over 50 countries.

The Cuban government has denied these allegations and points out that doctors are paid much higher wages on the scheme compared to being based in Cuba.

The government in Havana has accused the United States, particularly the Trump administration now, of not just seeking to strangulate its economy but to cripple the medical outreach program.

Cuban officials, and even some human rights groups, fear that the intensified economic squeeze would be devastating, not only for Cuba and its own in-country healthcare delivery, but for many of the countries it assists.