Paying the doctor, not the intermediary, is the missing change
Uruguay decided that money should reach Cuban professionals directly; the measure should become a standard for any international health-cooperation program.
The clearest change in Uruguay's agreement with Cuba is who receives the money: the Social Security Bank, known as BPS, will directly manage each professional's social protection and stipend instead of channeling payment through an intergovernmental agreement. Uruguay will retain the Cuban ophthalmologists working at José Martí Eye Hospital, and authorities say care will continue without interruption.
Foreign Minister Mario Lubetkin presented the modification as an update agreed after talks with U.S. and Cuban representatives. Hospital director Alejandro Fischel confirmed the mechanism changed and said the brigade's daily work did not. That matters to patients but does not by itself define every worker's rights and obligations.
Sources give different personnel counts: Lubetkin cited 20 ophthalmologists, while Fischel described 10 doctors and 20 support workers, including technicians, nurses and others. The figures should not be added as though they measure the same thing. The official announcement concerns Cuban professionals, and available material does not uniformly explain which team members fall under each part of the new arrangement.
Individual amounts, contract terms and whether the stipend equals each professional's total compensation are not public. Precision matters: direct payment and social protection describe the channel and certain administrative components, but without additional documents they do not establish that every worker receives a complete defined salary or freely controls all funds.
The previous agreement involved transfers tied to cooperation between governments. Earlier reporting on the program quoted the BPS president describing up to $250,000 annually as reimbursement of expenses, not specialists' salaries, which the Cuban side managed. That background distinguishes institutional funding from individual compensation, but sources do not provide a public reconciliation of the old and new systems.
The review followed Washington's objections to Cuban medical agreements and Uruguay's inclusion in a U.S. report on forced labor in medical missions. Lubetkin denied receiving an official warning with the content attributed to the United States, although he confirmed the issue arose in bilateral contacts. Political pressure is context but does not alone prove the change's exclusive cause.
Allegations of income withholding and restrictions on Cuban professionals form part of a broader debate. A report cited in the sources records claims about medical missions, but it is neither a judicial ruling nor proof that every member of Uruguay's brigade experienced those conditions. Evaluation of the new mechanism should separate general concerns from verifiable working conditions at this hospital.
Assessing whether direct payment improves workers' position requires data not yet available: accessible contracts, amounts, frequency, social coverage, and rules for grievances or ending employment. Responsibilities among BPS, the hospital and professionals also need clarification. Without that information, the administrative change is verifiable, while its labor effect remains partly unresolved.
Continuity of care and protection of those providing it are compatible goals. Uruguay can sustain ophthalmic services while publishing clear payment terms, rights and responsibilities. For now, what is confirmed is that BPS will directly assume stipend payment and social protection while the brigade continues working; how much this changes each professional's economic autonomy still requires evidence.
