Brazilian flag transforming into medical symbol, representing healthcare challenges in the country.

Brazil's Healthcare Crossroads: Can It Recover from the More Doctors Programme Exit?

Lena Kashyap in Health & Wellness November 2025 • 4 min read.

"The withdrawal of Cuban doctors has left vulnerable populations in Brazil struggling to access healthcare. What's next?"

Brazil's ambitious More Doctors programme, designed to bring healthcare to the nation's most remote and underserved communities, has hit a major snag. The withdrawal of Cuban doctors, who formed a critical backbone of the initiative, has left a gaping hole in the country's healthcare system. This sudden shift raises critical questions about Brazil's ability to maintain healthcare access for its most vulnerable citizens.

For years, Brazil struggled to attract its own doctors to work in primary care settings in remote or impoverished regions. The More Doctors programme ingeniously addressed this by incorporating Cuban doctors to fill these critical gaps. Until recently, these doctors constituted a significant 52% of the program's workforce, totaling over 16,000 professionals dedicated to serving communities often overlooked by traditional healthcare systems.

The decision by the Cuban government to terminate its participation, citing concerns over comments made by Brazil's president-elect, Jair Bolsonaro, triggered a swift and significant healthcare crisis. As of December 15, 2018, all Cuban doctors had ceased their work and departed the country, leaving a void that Brazil is now scrambling to fill. This abrupt departure poses not only logistical challenges but also serious concerns about the continuity of care for those who rely on these services.

Why Brazil's Healthcare System Faces Unique Challenges

Brazilian flag transforming into medical symbol, representing healthcare challenges in the country.

Before the More Doctors programme, Brazil's doctor-to-population ratio was already a concern. The overall supply of doctors, at just 2 per 1,000 population, was noticeably lower than that of many high-income nations with universal healthcare systems. For comparison, the UK has 2.83 doctors per 1,000 people, Canada has 2.54, and Australia boasts 3.50.

However, the real issue in Brazil isn't just the overall number of doctors, it's the extreme uneven distribution. A staggering 42% of the population resides in areas with critically low doctor density—fewer than 0.25 doctors per 1,000 residents. This stark inequality highlights the core challenge the More Doctors programme was created to address: getting healthcare to those who need it most, regardless of their location or socioeconomic status.

Geographic Barriers: Remote and rural communities often lack basic infrastructure, making it difficult for doctors to access these areas.
Economic Disparities: Many underserved areas suffer from high poverty rates, making it difficult to attract doctors who may seek more lucrative opportunities in urban centers.
Limited Resources: Publicly funded primary care facilities in remote regions often lack the resources and equipment necessary to provide quality care.
Career Prospects: Some doctors perceive limited career advancement opportunities in rural areas compared to urban hospitals and private practices.

Doctor shortages in primary care directly contribute to poorer health outcomes and perpetuate health inequalities. The Family Health Strategy, an acclaimed publicly funded primary care initiative, has demonstrated the potential to improve health outcomes and reduce inequalities. However, its reach has been limited by the persistent lack of doctors in remote regions. The More Doctors program was designed to overcome this barrier.

Lessons Learned and Future Directions

The collapse of the More Doctors programme offers valuable lessons for policymakers worldwide grappling with similar challenges in recruiting and retaining doctors in underserved areas. While importing doctors can provide a temporary solution, a sustainable, long-term strategy requires addressing the underlying factors that drive inequalities in human resources for healthcare. This includes improving infrastructure, offering competitive incentives, enhancing career prospects, and addressing the social determinants of health in underserved communities.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/bmj.k5247, Alternate LINK

Title: The End Of Brazil’S More Doctors Programme?

Subject: General Engineering

Journal: BMJ

Publisher: BMJ

Authors: Leonor Maria Pacheco Santos, Christopher Millett, Davide Rasella, Thomas Hone

Published: 2018-12-18

Everything You Need To Know

What was the main goal of Brazil's More Doctors programme?

The main goal of the More Doctors programme was to extend healthcare access to Brazil's most remote and underserved communities. It specifically aimed to address the difficulty in attracting Brazilian doctors to work in primary care settings in these areas by incorporating Cuban doctors to fill the gaps. This initiative sought to bridge the healthcare gap and provide medical services to vulnerable populations often overlooked by traditional healthcare systems. Without it, the Family Health Strategy struggles to reach its potential due to shortages of medical personnel in remote locations.

Why did the Cuban doctors withdraw from Brazil's More Doctors programme, and what impact did this have?

The Cuban government decided to withdraw its doctors from the More Doctors programme due to concerns over comments made by Brazil's president-elect, Jair Bolsonaro. This withdrawal, completed by December 15, 2018, resulted in a significant healthcare crisis, leaving a void in the Brazilian healthcare system. The sudden departure of over 16,000 Cuban doctors, who constituted 52% of the program's workforce, created logistical challenges and raised serious concerns about the continuity of care for communities reliant on their services.

How did Brazil's doctor-to-population ratio compare to other countries before the More Doctors programme, and what was the primary issue?

Before the More Doctors programme, Brazil had approximately 2 doctors per 1,000 population, which was lower than many high-income nations with universal healthcare systems like the UK (2.83), Canada (2.54), and Australia (3.50). However, the primary issue wasn't just the overall number but the extreme uneven distribution of doctors. A significant 42% of the population lived in areas with critically low doctor density (fewer than 0.25 doctors per 1,000 residents), highlighting the need to address inequalities in healthcare access.

What are some of the key factors contributing to doctor shortages in underserved areas of Brazil, and how did the More Doctors programme try to address these?

Several factors contribute to doctor shortages in underserved areas, including geographic barriers (remote and rural communities lacking infrastructure), economic disparities (high poverty rates making it difficult to attract doctors), limited resources (lack of equipment in public facilities), and perceived limited career advancement. The More Doctors programme aimed to overcome these barriers by providing a temporary solution through importing doctors. However, long-term solutions require addressing the underlying factors, such as improving infrastructure and offering incentives.

What lessons can be learned from the collapse of the More Doctors programme for policymakers facing similar healthcare challenges worldwide, and what sustainable strategies can be implemented?

The collapse highlights that importing doctors, as done in the More Doctors programme, is only a temporary fix. Sustainable strategies require addressing the underlying factors that drive inequalities in healthcare resources. This includes improving infrastructure in underserved areas, offering competitive incentives to attract and retain doctors, enhancing career prospects for healthcare professionals in remote regions, and addressing the social determinants of health within those communities. A more comprehensive approach is needed, focusing on long-term investment and systemic changes to ensure healthcare equity.