CUBAN DOCTORS IN PORTUGAL

UNCLAS SECTION 01 OF 02 LISBON 000614 SENSITIVE SIPDIS E.O. 12958: N/A TAGS: SOCI ECON PGOV PO SUBJECT: CUBAN DOCTORS IN PORTUGAL LISBON 00000614 001.3 OF 002 SUMMARY -------------- ¶1. (U) Portugal's thirty-year-old public health system is facing organizational and administrative changes as part of the government's health care reform. One of the biggest challenges is the shortage of family physicians, particularly in rural areas. Recruiting foreign doctors is a temporary solution, but the arrival of 44 Cuban doctors has generated some opposition from Portuguese health professionals. We do not view this as a change in Portugal's policy regarding Cuba but rather as a practical short-term solution by the Portuguese government to Portugal's continuous shortage of family practitioners. End Summary. SHORTAGE OF DOCTORS -------------- ¶2. (U) In 2005 Prime Minister Jose Socrates initiated reform of Portugal's public health system with the aim of improving primary care services. After four years, however, the number of family physicians is still insufficient. In 2007 Portugal had 38,399 physicians, according to the Portuguese Medical Board; OECD registered 3.5 physicians per 1,000 people. With a population of 10.6 million, the challenge is even greater due to an anticipated significant decrease in the total number of family doctors over the next few years. ¶3. (U) Most of the physicians are concentrated in the metropolitan areas of the country, leaving rural areas largely unattended. Two of the regions suffering most from a shortage of doctors are rural inland Alentejo and southern coastal Algarve. Both regions have low population density and low socio-economic levels. RECRUITING FOREIGN DOCTORS -------------- ¶4. (U) With an inadequate number of Portuguese family practice doctors, the Government has turned to recruitment of foreign doctors, as recommended by the Lisbon Regional Health Authority's Hospitals Governance Report released earlier this year. The report also recommended that the Health Ministry promote the return of Portuguese doctors practicing abroad, encourage delay of retirement of practicing family doctors, re-hire retired doctors, and increase the annual number of vacancies for hospital internships in family medicine. ¶5. (U) The number of foreign doctors is increasing. According to the Portuguese Medical Board, in 2007, Portugal had 3,656 foreign doctors, most of them from the European Union. (Many are Spanish due to the close border, language, recognition of Spanish medical degrees in Portugal, and ease of certification.) Portugal also has Uruguayan and Brazilian doctors. CUBAN DOCTORS ARRIVE IN PORTUGAL -------------- ¶6. (U) Under a cooperative agreement signed June 2009 between Portugal and Cuba, 60 Cuban doctors arrived in August 2009. Of the 60, 44 have completed the bureaucratic process of obtaining local certification, including official recognition of their medical degrees and certification by the Portuguese Medical Board. They have been placed in southern health care centers: 24 in Alentejo, 18 in Algarve and two in the Lisbon metropolitan area. ¶7. (U) The agreement establishes employment contracts of up to three years with a 40-hour work week and the option of up to 24 hours per week in the ER. The Portuguese government pays 1,500 to 2,000 euros per month per doctor directly to a Cuban state service provider, which in turn pays the doctors' salaries to their families in Cuba. (The Cuban doctors are not accompanied by their families in Portugal.) Portuguese municipalities provide fully furnished housing, while the Regional Health Authorities pay for all utilities. Upon their arrival, the doctors took Portuguese language classes and health information systems training. They each receive between 300 and 500 euros per month which is deducted from their monthly salary. (The current minimum salary in Portugal is 450 euros per month.) ¶8. (SBU) Antonio Camilo Coelho, former mayor of Odemira municipality in Alentejo, confirmed that the doctors' arrival was welcome given Odemira's aging population (he estimated that 65 percent of the population is over 40 years old). He noted that Odemira, after four unsuccessful recruitment efforts in 2008, finally managed to recruit 17 doctors, including five Cubans, to fill the 23 slots allocated by the Alentejo Regional Health Authority. According to Coelho, the doctors were well received and are successfully integrating into the community, are pleased to be working in Portugal, and have no plans for family members to join them. LISBON 00000614 002.3 OF 002 ¶9. (U) The arrival of the Cuban doctors generated considerable local media attention, most of it positive. However, doctors and medical students associations and the Portuguese Medical Board warned the Portuguese government that the doctors may lack qualifications to practice family medicine despite their ten years of experience. The Portuguese Medical Board argued that bringing in Cuban doctors was not the most appropriate solution. In early November, an independent doctors union sent a letter to PM Socrates demanding clarification of the Cuban doctors' labor contracts. COMMENT -------------- ¶10. (U) Portugal does not have strong commercial or cultural ties to Cuba but follows the EU policy on engagement with Cuba. The recruitment of Cuban doctors does not appear to be an attempt to strengthen or otherwise alter its relationship with Cuba but rather represents a practical arrangement to address a shortage in the Portuguese health care system. We note that Portugal has successfully sought doctors from other countries, including Spain, Brazil, and Uruguay, but that Cuban doctors may be a more attractive option due to their lower expectations and demands, including salaries, relative to doctors from other countries. Recruitment of Cuban doctors has helped alleviate the problem of the shortage of family practitioners, at least in the short term. But despite its seven medical universities, Portugal continues to face a long-term shortage, particularly in rural areas. A broader solution will require greater investment in health education to generate more home-grown doctors, who will be key to full implementation of the GOP's national health reform program. BALLARD