Abstract

Experiences with the Implementation of Cuban Health Cooperation Programs in Low and Middle-Income Countries: A Scoping Review

Njiriri F, Nyanchoka M, Nzinga J, Tsofa B
Wellcome Open Res. 2025;10

Permenent descriptor

BACKGROUND: Health systems in low and middle-income countries (LMICs) face chronic Human Resources for Health (HRH) shortages. This is especially worse in rural and primary healthcare settings. The Cuban government since 1960s has been implementing a policy strategy for producing healthcare workers for export, to boost their economy. Several LMICs have since established health cooperation programs with Cuba to import health workers to address their shortages. This review aimed to examine the emergence, design, utility, outcomes, and lessons learned from the implementation of these programs. METHODS: We conducted a scoping review using the Joanna Briggs Institute (JBI) methodology and searched for literature across four databases. Two independent reviewers screened the articles and selected relevant articles based on pre-defined criteria. We extracted data and synthesized findings using thematic analysis. RESULTS: We included 71 articles after screening 3509 articles. Cuban health cooperation programs have been implemented in many LMICs in South America, Africa, Southeast Asia, and the Pacific region. These programs are formalized primarily through bilateral agreements and implemented as exchange initiatives. This involves importing Cuban healthcare workers and sending collaborating country students to study in Cuba. These programs aimed to address HRH shortages and maldistribution, inadequate training capacity, and respond to medical emergencies in the host countries. Cuban healthcare workers, primarily family physicians, within the host countries; are deployed in primary healthcare settings, increasing the rural health workforce, and improving healthcare access and outcomes. These programs have faced several challenges including opposition from local medical professionals, underutilization due to poorly coordinated recruitment, and language barrier. CONCLUSION: Cuban health cooperations in LMICs have shown diverse results based on their structures. Long-term comprehensive programs have proven to be more successful in boosting the healthcare workforce and enhancing health outcomes. Key factors for optimizing HRH health cooperation include effective collaborative decision-making and need-based deployment. Health systems in many low and middle-income countries have inadequate numbers of healthcare workers, especially in rural areas and in primary healthcare settings. The Cuban government for many years has trained healthcare workers for export to boost its economy. Many countries have then collaborated with Cuba to send their healthcare workers to work in the collaborating LMICs to address these healthcare workers' shortages. This scoping review aimed to examine how these health cooperation programs between Cuba and LMICs have emerged, their intended goals, the implementation processes and lessons learned. The reviewers collected and analysed data from 71 articles. These health cooperation programs between Cuba and LMICs have been implemented in many countries in South America, Africa, Southeast Asia and the Pacific region. These collaborative programs aimed to address healthcare worker shortages and their uneven distribution between rural and urban areas, cater for inadequate training capacity and respond to medical emergencies such as Ebola and COVID-19 pandemic in the host countries. The programs have mainly been designed as exchange programs, importing Cuban healthcare workers and sending collaborating countries students to study in Cuba. The Cuban healthcare workers, within the host countries, have worked in rural areas, increasing the numbers of healthcare workers in these areas and contributing to improving healthcare access and outcomes. These programs faced several challenges such as opposition from the local healthcare workers, language barrier and underutilization due to poorly coordinated deployment. There is a need to involve key health stakeholders in decision-making and to ensure that healthcare workers are deployed where they are needed most.