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Feature Global Health

Brazil strives to replace its More Doctors programme for underserved regions

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m537 (Published 20 February 2020) Cite this as: BMJ 2020;368:m537
  1. André Biernath
  1. São Paulo
  1. andre.biernath{at}gmail.com

An innovative programme called More Doctors, which aimed to bring Cuban doctors to underserved areas in Brazil, attracted a series of compliments, criticism, debate, and controversy in its four years. André Biernath tallies up the results

In September 2018 the residents of São José village, an indigenous settlement in Brazil’s state of Maranhão, lived in a spiral of medical uncertainty. Maranhão is marked by drought and lacks basic services such as water and sanitation. The only health centre near São José had just one doctor, José Domingues (name changed to protect identity). He had come from Cuba as part of a programme created by the Brazilian government. His three year contract was now finished, and he was ready to return to Cuba in a few days.

After that, however, anyone who got sick was out of luck. There were no plans to replace Domingues. In November 2018 the country’s recently elected president, Jair Bolsonaro, posted a message on his Twitter account1 saying that the government now required the More Doctors programme (Programa Mais Médicos; PMM) to subject its doctors to the same tests as other foreign doctors, pay them more, and allow the doctors to bring their families.

Thus ended—or radically changed—one of Brazil’s most comprehensive efforts to bring doctors, health teams, and outpatient clinics to underserved regions.

The idea

More Doctors was created in late 2013, during the first presidency of Dilma Rousseff. It was designed to tackle a problem that affects many nations, rich and poor: the misallocation of health professionals. While some places in Brazil have doctors to spare, others, especially rural areas, lack trained specialists to meet demand. Places such as São José village have no doctors at all.

In 2013, some 1200 cities in Brazil had a shortage of doctors. The north (the poorest region) …

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