Accessibility of healthcare services for seasonal migrant farmworkers in Spain: barriers and facilitators identified by professionals

Introduction

In Europe, Spain has the highest percentage of migrants working in agriculture. Seasonal migrant farmworkers (SMFs) are a vulnerable group in the labor market as they often work in precarious situations that may impact their health. Although all migrants with municipality registrations, including those in irregular situations, should have access to healthcare according to Spanish law, some barriers limit access to care for migrants. This study aimed to identify barriers and facilitators to SMFs' accessibility to healthcare services at the healthcare system level.

Methods

We conducted semi-structured interviews among a purposive sample of 92 professionals from the health and social support system who work with this population in four regions of Spain. Using Atlas.ti web, we analyzed the transcriptions using a thematic content analysis approach.

Results

The main barriers identified were administrative, geographical, time, financial, and healthcare system capacity. Subsequently, SMFs may use emergency care to enter the healthcare system and, for non-urgent issues, some of them were using other people´s documents when using healthcare facilities. Facilitators identified were reducing administrative barriers, providing patient-centered care, and supporting services provided by NGOs.

Conclusion

To increase access to healthcare services, more flexibility is required regarding issuing municipality registrations and healthcare cards and appointment schedules. Some of the administrative barriers identified in this study are rooted in municipal authorities not consistently complying with recommendations and regulations by the Spanish government. Therefore, consistent compliance by public officials throughout all regions would be the first step in increasing access to healthcare.