Undocumented immigrants’ and immigrant women’s access to healthcare services in the Basque Country (Spain)

Figures & data

Table 1. Summary of the conceptual frameworks guiding the thesis

Multi-level access to healthcare	Person-centred access to healthcare	Right to health
Entitlement level Written, formal instruments that have a direct bearing on the available healthcare services for immigrants. Conventions, charters and national or regional laws and policies		Entitlement to receiving healthcare as timely and appropriate medical care and underlying determinants of health Obligations of social actors on the right to health Guiding principles of the right to health
Access level The gateways to reach healthcare and the extent to which migrants are able to receive the healthcare services that they are entitled to Related to the factors that inhibit or facilitate the realization of their entitlement	Dimensions of accessibility and related abilities: Approachability. The extent the health services and the way to reach them can be identified. Related to the ability to perceive need for care Acceptability. Cultural and social factors that make persons to accept different aspects of the service. Related to the ability to seek care Availability. Physical existence of the healthcare resources with sufficient capacity to produce services and being reachable in a timely manner. Related to the ability to reach healthcare Affordability. Economic capacity for people to spend resources and time on accessing healthcare. Related to the ability to pay and generate economic resources Appropriateness. Fit between services and patients’ needs, given the technical and interpersonal quality of the services. Related to the ability to engage in healthcare	Characteristics of health systems to fulfil the right to health: Available. Sufficient in quantity Accessible physically, financially and based on non-discrimination Of good quality. Scientifically and medically appropriate Acceptable. Respect of ethics and being gender sensitive and culturally appropriate
Appropriateness level Healthcare services’ ability to integrate an effective assessment of health needs of immigrants Related to the content of the received healthcare services and the extent they are responsive to the particular needs of immigrants

Table 2. Summary of the aims and methods of the three sub-studies included in the doctoral thesis

	Part I	Part II
Objective	To assess the impact of the implementation of more restrictive conditions for accessing public healthcare services for immigrants stated in the new Basque Decree 114/2012 on the number of consultations of undocumented immigrants at a primary healthcare free clinic	To determine the perception of healthcare professionals working in free clinics on the barriers and facilitators in the access by immigrant women and undocumented immigrants to healthcare services in the Basque Country	To analyse Sub-Saharan African immigrant women’s perceptions and experiences on access to appropriate healthcare services in the Basque Country
Sample andAnalysis	Number of healthcare consultations (n = 9272) from Jan 2007 to July 2017 (intervention on 1^st trimester of 2013) Segmented time series. Negative binomial regression adjusted for seasonality, % of registered immigrants and unemployment rate	11 individual interviews with healthcare professionals working in free clinics in the Basque Country Qualitative content analysis	14 interviews with women from 8 Sub-Saharan African countries who have used healthcare services in the Basque Country Qualitative content analysis

Table 3. Characteristics and diagnoses of the patients at the free clinic (January 2007 to June 2017)*

	MEN	WOMEN
Total	7134 (76.94%)	2138 (23.06%)
Attending first time	40.03%	49.58%
REGIONS
Latin-America	7.04%	56.55%
North Africa	54.34%	18.06%
Eastern Europe	3.22%	7.32%
Asia	2.65%	0.57%
Rest of the world	1.67%	0.49%
DIAGNOSES
Respiratory system	18.43%	10.10%
Digestive system	14.31%	10.16%
Tegumentary system	13.08%	6. 57%
Musculoskeletal system	14.68%	10.53%
Genitourinary system	2.90%	14.73%
Others	36.60%	47.90%

*Data was only available for new patients and those patients who maintained the same diagnose as in the previous consultation, representing a total of 4,707 people

Table 4. Socio-demographic characteristics of the participants of qualitative studies (Part II)

Healthcare professionals´ characteristics
	Primary health attention free clinic		Sexual and reproductive health free clinics
			Centre 1	Centre 2		Centre 3
Occupation	(4) physician (1) nurse (1) midwife		(1) nurse (1) psychologist	(1) physician (1) nurse		(1) physician
Works/Has worked in the public healthcare system	(4) physician (1) nurse (1) midwife			(1) physician		(1) physician
Years of experience in the free clinic	(3) +10 (1) 2 (1) 4 (1) 9		(2) +10	(1) 1 (1) +10		(1) 8
Immigrants women´s characteristics
Migration status		Documented (10) of which have been undocumented before (4)			Undocumented (4)
Country of origin		Cameroon Guinea Bissau (2) Senegal Angola (3) Central African Republic Democratic Republic of Congo Gambia			Democratic Republic of Congo (2) Nigeria Cameroon
Type of residence permit		Regrouped by husband (4) Asylum-seeker (2) Others (4)			None (4)
Use of Public Health System		Whenever it was needed			1 time (1) 2 times (2) 3 times (1)
Use of other health services		Free clinic before having Health Card (2) Private health services (1)			Free clinic (4)
Possession of Health Card		10			None (4)
Age		25 to 35 (3) 36 to 60 (6) More than 60 (1)			25 to 35 (3) 36 to 60 (1)
Language used in the interview		Spanish (9) French (1)			French (2) English (1) Swahili (with translator) (1)
Time in the Basque Country by the day of the interview		Less than 6 months (1) 6 months-1 year (1) 1–5 years (2) More than 5 years (6)			Less than 6 months (2) 6 months-1 year (2) 1–5 years More than 5 years
Job		Employed (6)			None (4)

Figure 1. Number of consultations for men and women at CASSIN from January 2007 to June 2017

Table 5. Segmented negative binomial regression results expressed as rate ratios (95% CI in brackets) of the number of consultations at a free clinic by sex (January 2007 to June 2017)

	Baseline level	Pre-intervention	Intervention	Post-intervention
Men	193.23 (147.58, 253.01)	0.99 (0.98, 1.02)	0.65 (0.46, 0.91)	1.01 (0.99, 1.02)
	205.15 (130.37, 322.87)^a	1.02 (0.99, 1.04) ^a	0.60 (0.42, 0.84) ^a	1.01 (0.99, 1.03) ^a
Women	44.92 (34.35, 58.74)	0.98 (0.96, 1.00)	2.64 (1.78, 3.91)	1.00 (0.99, 1.02)
	56.99 (30.18, 107.64)^a	0.98 (0.95, 1.01) ^a	2.87 (1.80, 4.58) ^a	0.99 (0.96, 1.04) ^a

^aAdjusted for unemployment, seasonality and percentage of documented migrant population