Calabria's partnership with Cuban doctors: challenges and solutions
Authors: Francesco Pata, Daniele Paglione, Elvis Pardo Olivares, Ernesto Casamayor Callejas, Bruno Nardo
Journal: The Lancet (2024)

Analogous to health-care systems in high-income countries, the Italian National Health System (Sistema Sanitario Nazionale) is grappling with its most severe crisis since its inception in 1978.1Ricciardi W Tarricone R The evolution of the Italian National Health Service.Lancet. 2021; 398: 2193-2206Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar A gradual increase in costs and the subsequent containment measures, combined with the decentralisation of the health-care system in the 2000s which essentially resulted in the creation of 20 distinct health-care systems (one for each region), has led to fragmentation and heterogeneous health-care provision— a problem that became starkly evident in 2020 during the COVID-19 pandemic.1Ricciardi W Tarricone R The evolution of the Italian National Health Service.Lancet. 2021; 398: 2193-2206Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 2Toth F How health care regionalisation in Italy is widening the North-South gap.Health Econ Policy Law. 2014; 9: 231-249Crossref PubMed Scopus (65) Google Scholar The historical disparity between northern and southern regions of Italy has grown, and the scarcity of coordination between hospital and territorial services has created a substantial gap in health-care coverage. Moreover, numerous training positions in surgical and emergency specialties remain unfilled, primarily due to the unattractive quality of life and the risk of litigation. Currently, one in four medical training places is at risk of going unassigned.3Il Sole 24 OreMany medical specialization scholarships risk remaining unassigned.https://www.ilsole24ore.com/art/parte-rilevante-borse-specializzazione-mediche-rischiano-restare-non-assegnate-AFjVHEBBDate: Oct 9, 2023Date accessed: November 3, 2023Google Scholar Calabria, one of Italy's poorest regions with a population of 2 million, is dealing with a profound health-care crisis. Each year, more than €200 million is spent on passive health-care mobility, with one in five Calabrians seeking medical treatment in other Italian regions, particularly in the north. Furthermore, an increasing number of doctors are leaving the hospitals to work in the private sector due to better working conditions. Many hospital job positions remain vacant, resulting in staffing shortages across various departments. Approximately 2500 additional doctors would be necessary to ensure the normal operations of the regional health-care system..4La RepubblicaHere are the Cuban doctors who will save Calabrian healthcare: "give us 3 months and you'll see".https://www.repubblica.it/cronaca/2023/01/02/news/calabria_medici_cubani-381774979/Date: Jan 2, 2023Date accessed: November 3, 2023Google Scholar This necessitates an already overburdened staff taking on additional shifts or the hospital using costly locum doctors, who are sometimes doctors who have already retired.5Paterlini M Italy calls on retired doctors to fill health worker gap.Lancet. 2019; 3931492Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar To address this issue, in 2022 the Government of Calabria entered into an agreement with the Cuban Government to hire 497 Cuban doctors by 2024. Since January, 2023, 270 Cuban doctors have already been employed with annual contracts and have been assigned to the majority of Calabrian hospitals, primarily in emergency, surgical, and anaesthesiology services. Their presence has prevented the closure of many services, and the official recognitions already received from local institutions and patient associations show the positive impact of their work on local communities. Other Italian regions are also considering similar solutions to prevent service disruptions. The existence of a reverse flow of health-care resources from low-income countries to high-income countries represents a new dimension of the systemic crisis in high-income health-care services and warrants further analysis. We declare no competing interests. The evolution of the Italian National Health Service40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. Full-Text PDF