Brazil is to go ahead with a controversial plan to import 4,000 Cuban doctors to work in poor, remote regions of the country where the public health service struggles to field enough local doctors.
The first 400 Cuban medics will arrive as early as Monday, with another 2,000 due by October and the remaining 1,600 in the country by the end of the year.
President Dilma Rousseff first proposed turning to Cuba for help with the chronic shortages in the public health system in May but froze talks between the two countries in the face of resistance from Brazil's leading medical associations.
But the subsequent failure to hire sufficient doctors from other countries led to this week's agreement. Mayors from across Brazil asked the government to provide an extra 15,460 doctors to fill shortages.
But a federal programme named More Medics succeeded in filling only 1,618 places. Most of those entering the programme were Brazilian professionals with little of the expected interest from countries such as Argentina, Spain and Portugal materialising.
Brazil's foreign minister Antonio Patriota defended the plan to a congressional committee as a means of providing "the best possible medical services for the Brazilian population". But importing medics from the communist island has provoked the ire of right-wing congressmen, who have vowed to go to the supreme court to block the programme, with one denouncing it as "the exportation of ideology" and calling President Rousseff "Hitler in a dress".
Many of the country's medical associations are also opposed. Brazil's Federal Medical Council denounced it as "electioneering, irresponsible and disrespectful" and will seek to block it. It claimed the programme could let under-qualified Cuban doctors without knowledge of Portuguese "put at risk the health of Brazilians".
This week's agreement will see Brazil pay €156 million to the Pan-American Health Organisation, the regional branch of the World Health Organisation, for the Cuban assistance through to February. It in turn will pass the money onto the Cuban government which will pay the doctors' salaries. Under the scheme, each doctor earns a monthly salary of €3,060 but it is not clear if Cuba's government will pass all of this on to its doctors who go to Brazil.
Lack of funds for Brazil’s chronically understaffed public health system was one of the targets of mass street protests in June. The government struggles to hire medics to work in poor regions, unable to compete with the higher salaries and better conditions offered by private health plan providers.