Healthcare access among migrants in Morocco: perspectives of migrant communities, primary healthcare professionals and civil society actors

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INTRODUCTION: Morocco's position at the crossroads of Africa and Europe has made it a major transit and destination country for migrants. While migrants are entitled to free emergency and primary healthcare services, some challenges persist. This study aimed to explore the experiences of migrants in accessing healthcare services and to identify recommendations for improvement. METHODS: This multisite qualitative study was conducted across five cities in Morocco between May 2023 and January 2024. Data were collected through semi-structured interviews and focus group discussions with 34 migrants, 17 migrant community leaders, 5 representatives of civil society organisations (CSOs), and 8 healthcare professionals. Migrants were recruited with the support of a Moroccan CSO, and primary healthcare professionals were recruited in health centres. Data were analysed using a hybrid thematic analysis approach, guided by Levesque's Patient-Centered Access to Care framework. RESULTS: We found that fear of costs, negative perceptions about the healthcare system, misconceptions about entitlement to services, cultural norms and health beliefs influenced participants' health-seeking behaviours. Most reported free and easy access to primary healthcare, but administrative barriers, language challenges and medication costs persisted despite entitlement. Some migrant participants showed limited understanding of care pathways, leading to delays in care-seeking and fear of service denial-especially in the absence of peer accompaniment. Financial and administrative barriers were greatest at higher levels of care, posing challenges for uninsured migrants who formed the majority of participants. CSOs provided important support services but faced limits due to inconsistent funding and heavy centralisation. CONCLUSION: Morocco has become a global and regional champion in migrant health, through major policy and programmatic efforts. Yet, economic and sociocultural barriers still limit full service utilisation. Ongoing national reforms offer a chance to leapfrog towards universal health coverage through innovative migrant-inclusive health insurance schemes and empowered community actors.

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