A qualitative study identifying barriers and policy solutions for healthcare access among migrants and Maya populations in Belize

Abstract

Abstract Background Despite constitutional guarantees of healthcare access, migrant and Maya populations in Belize face significant barriers at the health facility level. Foreign nationals (11.5% of the population) and Maya communities (9.8%) constitute a substantial share of Belizeans. Yet current strategic health plans lack systematic consideration of these differential access patterns. Existing research has focused on community-level barriers, leaving the facility itself underexamined. This study identifies facility-level barriers across these districts and develops context-specific solutions with potential for adaptation in comparable multicultural health systems. Methods The study combined a narrative literature review, semi-structured interviews with 67 participants, and structured direct observation of patient journeys at five health facilities in Belize. Data were collected in September 2025, with maximum variation sampling across migration status, gender, ethnicity, and professional roles. Analysis used a hybrid coding approach combining deductive codes from the World Health Organization accessibility framework with inductive codes emerging from fieldwork. Results While Belize’s health system provides formally free care regardless of nationality or ethnicity, significant barriers persist within facilities. Hidden costs arise from extensive waiting times and financial barriers (including transportation expenses and medication costs), which can drive patients to seek care across the border. Communication barriers affect elderly Maya populations speaking Q’eqchi’ or Mopan, with interpretation remaining informal and unsystematic. System navigation is hindered by limited multilingual information about services and procedures. Patient feedback mechanisms, available only in English and lacking anonymity, limit the voice of the populations most affected. Perceived discrimination primarily stems from interpersonal dynamics during registration, exacerbated by chronic staff shortages. Conclusions Healthcare inequities affecting migrant and Maya populations in Belize do not stem from formal exclusion. Rather, they emerge from the cumulative effect of structural, linguistic, cultural, and resource barriers encountered throughout their journeys to and through the health system. A three-layered framework is proposed, combining facility environment improvements, staff capacity development, and community-based solutions anchored by Community Health Workers, offering actionable pathways that strengthen universal access while addressing the specific gaps that disproportionately affect these populations. Clinical trial number Not applicable.