THE parlous state of public health care tops opinion polls of Brazilian voters’ concerns. Street protests in June were sparked by a rise in bus fares, but the low quality of hospitals and clinics was among the demonstrators’ main complaints. The constitution guarantees the right to free, state-provided health care. But two-fifths of Brazilians are not covered by local primary care, relying instead on chaotic hospital emergency rooms. A quarter go private. The proportion of total health spending that is public is lower than in the United States, which does not aspire to universal public provision.

President Dilma Rousseff’s answer is Mais Médicos (“More Doctors”), a crash programme to recruit thousands of foreign doctors to work in poor and remote areas shunned by locals. On August 23rd the first of them arrived. About 200, mostly from Argentina, Portugal and Spain, have been offered three-year contracts in family medicine. They will earn 10,000 reais ($4,250) a month, plus board and lodging. Some Cubans have also turned up, the first of 4,000 doctors the government hopes to hire from the island by December.

Brazil has proportionately fewer doctors than many richer countries (see chart). And most are in big cities, often in private practice; too few are general practitioners. It is shorter still of nurses: one for every two doctors, while in efficient health-care systems the ratio is three to one. Those nurses are used poorly, too—largely because of lobbying by doctors. In 2002 their professional associations managed to halt training for nurses in diagnosing and treating common childhood illnesses. In 2009 they got a law passed forbidding anyone but doctors to prescribe any type of drug. The original plan had been to use federal cash to lure Brazilian doctors to poor municipalities. But despite the unusually high salaries on offer, only 938 signed up for the 15,460 jobs offered. Most of the 3,511 municipalities that wanted doctors were disappointed. Many countries struggle to lure doctors to poor or remote areas where they will have little chance to train further and specialise, or to practise privately on the side. Brazil finds it particularly hard: offering to pay off student loans, a common carrot in the United States, does not apply, since the public universities that train most of the doctors charge no fees. Most medical students are from better-off families and have few links to deprived communities. For Cuba, the deal represents a handy source of hard currency. It overproduces doctors and nurses, and has long sent them abroad, for humanitarian or propaganda reasons. Increasingly, it is charging for them. Venezuela provides Cuba with a massive subsidy under the guise of paying for the services of 30,000 doctors and other professional staff. Brazil insists no subsidy is involved. But the size of the planned contract, worth around $150m a year, makes it valuable for Cuba, whose government keeps about two-thirds of the salaries of its doctors working abroad.

The new arrivals have been exempted from the usual test required of foreign-trained doctors, but they are unable to work except in their assigned clinics. Even so, Brazil’s medical associations want to block the import of foreign doctors. They argue that the Cubans’ lower pay and inability to choose where to work are “analogous to slave labour”. That is overblown. Yet Brazil’s strict labour courts may decide that the inter-governmental deal under which they were hired counts as “outsourcing”, which they frown on.

The doctors’ leaders also say that since the foreigners’ degrees will not have been revalidated, they will be practising illegally. The education ministry suspects that the revalidation test has been made needlessly difficult in order to keep foreigners out. Less than 10% pass it (though Cubans do somewhat better than average). The ministry recently tried to give the test to final-year Brazilian medical students. But too few turned up on the day to provide a decent sample.