The U.S. Department of State revealed a new $61.5 million initiative aimed at assisting Caribbean nations in hiring healthcare professionals directly. This approach ensures that wages are fully received by the workers themselves, bypassing any state intermediaries.
This announcement came during the U.S.–Caribbean Dialogue held in Washington and was chaired by Under Secretary of State Christopher Landau on Wednesday, October 15. Attendees included high-level delegations from 15 regional countries such as Jamaica, Belize, Barbados, Trinidad and Tobago, and Haiti.
Dubbed ASPIRE (Strategic Partnership of the Americas for Independent Regional Health Excellence), the program aims to help Caribbean governments develop self-sufficient healthcare workforces through ethical hiring practices and fair compensation directly paid to each healthcare worker.
The funding for this program still requires Congressional approval, indicating a political commitment rather than immediate financial disbursement.
ASPIRE is part of a broader diplomatic effort to counter Cuba's medical missions model, criticized by Washington, the Inter-American Commission on Human Rights (IACHR), and various human rights organizations as a form of forced labor and human trafficking.
Reports highlight that the Cuban government retains between 60% and 97.5% of payments made by host countries for each professional, generating an estimated $5 billion to $6 billion annually, according to Prisoners Defenders.
In April 2026, the IACHR released a comprehensive 199-page report based on testimonies from 71 professionals across 109 nations, recommending that American states withdraw from Cuba's medical missions program.
Throughout 2026, at least ten countries in the region either terminated or declined to renew their agreements with Cuba, including Jamaica, Guatemala, Honduras, Guyana, Antigua and Barbuda, Bahamas, Dominica, and Grenada.
The most notable case was Jamaica, ending a longstanding agreement in March that dated back to 1976, prompting Cuba to withdraw 277 professionals from the country. Jamaica subsequently enabled the direct and individual hiring of Cuban doctors under its local labor laws, a model ASPIRE seeks to fund and replicate throughout the Caribbean.
In July, the U.S. imposed sanctions on Cuban Health Minister José Ángel Portal Miranda and the Central Unit for Medical Cooperation, labeling the program as "forced labor" and "human trafficking."
Meanwhile, Belize continues to delay its decision regarding the future of the 92 Cuban professionals in its medical brigade.
ASPIRE is a component of a larger U.S. commitment to the Caribbean, exceeding $340 million, as detailed by the Department of State. This package also includes $175.8 million for digital connectivity via submarine cables, $37 million for critical infrastructure and combating illegal fishing, and $66 million for security cooperation and anti-narcotics efforts.
This dialogue fulfills a promise made by Secretary of State Marco Rubio to CARICOM leaders during their February 2026 meeting in Saint Kitts and Nevis, and Washington has announced plans to host a Caribbean Investment Summit in early 2027 to link U.S. businesses and financiers with regional partners.
U.S. Initiative for Direct Healthcare Worker Salaries in the Caribbean
What is the purpose of the ASPIRE program?
ASPIRE aims to help Caribbean governments build self-sufficient healthcare workforces through ethical hiring and direct payment of fair wages to healthcare professionals.
Why is the U.S. opposing Cuba's medical missions?
The U.S., along with various human rights organizations, criticizes Cuba's medical missions as a form of forced labor and human trafficking, citing that the Cuban government retains a significant portion of the wages paid by host countries.
What other commitments has the U.S. made to the Caribbean region?
In addition to ASPIRE, the U.S. has committed over $340 million to the Caribbean, funding projects like digital connectivity, critical infrastructure, and security cooperation.