Last summer, long before before Brazil was demolished 7-1 by Germany in the World Cup, the country faced a crisis of another sort. Millions of citizens marched in cities across the country to demand wholesale reforms to the country’s crippled public health care system, which faced huge shortages of doctors and a failing infrastructure.
That’s when the tiny island nation of Cuba stepped in to this neglected area of the world’s seventh-largest economy.
Under Brazil’s Mais Médicos (“More Doctors”) program, which pays foreign physicians to work in underserved areas of the country, Cuba sent 4,500 doctors to rural areas in the Amazon and to the underserved slums known as favelas in its booming cities. The move angered Brazil’s doctors’ unions, who protested outside hospitals, and the Brazilian Medical Association filed a lawsuit in the country’s Supreme Court questioning its existence. Protestors denounced the program as only a temporary solution to a systemic problem, saying the changes should come internally, not by importing doctors.
Brazil currently has 1.9 physicians per thousand people, according to the World Bank, one of the lowest doctor-to-patient ratios in the world. In the country of roughly 200 million, the disparity is so pronounced that some remote areas have virtually no doctors to serve patients. Cuba, on the other hand, has 6.7 physicians per thousand people, the highest number of doctors in proportion to population in the world, and some of the lowest annual costs for medical care.
Financial rewards for both countries
Despite the lack of popular support, the Mais Médicos program was a win-win for both countries. Cuba received $270 million dollars a year from the Brazilian government, hard currency that Havana desperately needs to ease inflation. The deal further enhanced the prestige of Cuba’s long-heralded international medical program, which exports doctors every year to developing countries. And as well as easing its medical crunch, Brazil increased its already privileged access to one of the world’s last untapped markets. Cuban president Raúl Castro has in recent years implemented gradual reforms to the state-controlled economy, and Brazil has positioned itself as a major player in the country’s redevelopment.
Brazilian exports to Cuba have quadrupled over the past decade to $450 million a year, mostly in agriculture, as the country has become a top food supplier to Havana. But Brazil’s most lucrative project in Cuba is a $900-million two-phase modernization of the Port of Mariel by the construction behemoth Odebrecht. Cuba’s only deep-water port is located 30 miles north of Havana, and it is there that Cuba will establish a special economic zone that will be open to non-state owned companies. When that happens, Brazilian companies appear to be first in line.
“The project has depended on important financing from the Brazilian government at advantageous terms,” said president Castro at a ribbon-cutting ceremony this past January to open the port’s first phase. “And it has not only been a great help in building the container terminal, but also in other public works such as highways, networks, rail lines and dredging the bay.”
An increase in doctors means political rewards for Rousseff
Brazilian president Dilma Rousseff this year faces reelection in what looks likely to be the fight of her life. Corruption, government mismanagement of the economy, and soaring inflation are just some of the problems saddling her administration. Brazilians are also still angry about how much the government spent to host the FIFA World Cup, estimated at $11.3 billion dollars in public spending alone—the most expensive in tournament history. With her eroding popularity, Rousseff’s best hope is to reach the poorest Brazilians that have long been the backbone of her Workers Party.
By sending these long-neglected citizens doctors and essential medical care through the Mais Médicos program, she may well reap the benefits at the ballot box. Rousseff has pointed to the program as evidence that she responded to last summer’s nationwide protests. And although it has faced some problems, most Brazilians appreciate its results.
Will the program last?
A March nationwide poll showed national approval of the program at 67%. Support is highest in the country’s poor northeast, at 72%, where the most doctors are concentrated. In fact, the program has been so popular there that other states are copying it. In the state of Sao Paolo, the leading opposition PSDB (Partido da Democracia Social Brasileira) party has sent doctors into the state’s interior to reach its poorest residents.
President Rousseff remains unpopular amongst the country’s middle class. That won’t matter, however, if she can win the hearts and minds of the poorest Brazilians, who still make up a majority of the electorate.
Dilma, as she is affectionately known amongst her supporters, can only hope that these voters will come out in droves and give her the victory that the Seleção couldn’t give the nation on the football pitch. Cuba will be watching, too.