Perceptions of and barriers to equitable healthcare access for undocumented populations in Belize: a qualitative study

Background Belize is primarily a destination country for migrants transiting through Central America. The impact of legal status on health access in Belize is under-researched. In October 2023, the Belize government removed medical fees in public hospitals to increase accessibility for all residents regardless of legal status. This study aims to qualitatively explore patterns of healthcare access for undocumented individuals compared to Belizean nationals in two historically under-resourced districts of Belize. Methods 60 semi-structured qualitative interviews were conducted exploring healthcare utilization, access, and barriers to care for undocumented populations between September to October 2024. Key informants, including health administrators, health providers, and public health workers were recruited through purposive snowball sampling. Undocumented participants and Belizean nationals were recruited through respondent-driven sampling via public health workers. Interviews were audio recorded, transcribed and translated as applicable. Transcripts were deductively and inductively coded for qualitative content analysis by two independent coders using Dedoose. Results 17 public health workers, 5 health providers, 4 health administrators, 19 undocumented and 15 documented individuals were interviewed across 14 rural villages and 3 towns in Southern Belize. Irrespective of documentation status, long wait times, staffing and medication shortages, limited and expensive transport to health facilities, and language barriers for Spanish and Kek’chi speaking individuals were significant obstacles. For undocumented participants, these existing challenges were compounded by lack of formal employment and resultant impoverishment, misinformation regarding healthcare access, marginalization by clinic staff, fear of deportation, and subsequent reluctance to seek government-provided health services and preference for free, NGO provided care. Conclusions Understanding how undocumented individuals in Belize access health services is crucial for enhancing their health outcomes and accurately assessing healthcare utilization and costs, especially amid government efforts to expand healthcare access. Study findings will enable more strategic resource allocation and ensure undocumented populations are included in national healthcare improvement plans.