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

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.