Adopted by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007,
reaffirmed with minor revision by the 207th WMA Council session, Chicago, United States, October 2017 and revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023
A lack of physicians, especially in vulnerable and peri-urban areas, is a worldwide phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health personnel. The implementation of programs, such as the More Doctors Program (PMM), in deprived areas in Latin America and the Caribbean has provided doctors to support primary health care which would otherwise not be carried out due to the shortage of doctors.
In particular, the PMM has provided a great number of foreign doctors, predominantly from Cuba, to work in the primary health care systems where the distribution of primary care physicians was insufficient.
Specifically, during the COVID-19 pandemic, Cuba has sent thousands of Cuban doctors abroad, to meet the demands of many countries. In addition, international health establishments, such as the Pan American Health Organization, have facilitated the placement of Cuban doctors.
However, programs like the PMM also give cause for concern:
- Potential health benefits are undermined due to the widespread allocation of doctors to non-priority areas and local substitution effects.
- The Cuban government keeps three-quarters of the health personnel’s salaries, and many doctors complain of dreadful working conditions.
- Documented reports reveal arrangements between the Cuban government and certain Latin American and Caribbean governments to bypass credentialing systems established, to verify physicians’ credentials and competence and protect patients. As a result, patients may be put at risk by unregulated medical practices and unqualified physicians.
Recalling its Statement on Ethical Guidelines for the International Migration of Health workers, whereby “Physicians who are working, either permanently or temporarily, in a country other than their home country should be treated fairly in relation to other physicians in that country” and that bilateral agreements require “due cognizance of international human rights law, so as to effect meaningful co-operation on health care delivery”, the WMA:
- Condemns any policies or actions by governments that subvert or bypass the accepted standards of medical credentialing and medical care;
- Calls on the governments to work with medical associations within the region on all matters related to physician certification and the practice of medicine and to respect the role and rights of these medical associations and the autonomy of the medical profession;
- Urges, as a matter of utmost concern, governments to respect the WMA International Code of Medical Ethics, the Declaration of Madrid on Professionally-led Regulation, the Declaration of Seoul on Professional Autonomy and Clinical Independence and the Statement on Ethical Guidelines for the International Migration of Health workers;
- Calls for adequate and sustainable investment in national health care systems and medical education as a matter of priority to ensure that the highest standard of care is available to the entire population.