Community Based Participatory Research to Evaluate Access to Healthcare for Migrants in Belize: A Qualitative Research Study

In Belize, Central America, migrant farmworkers toil long hours in dangerous jobs for the agricultural industry but are excluded from healthcare since the National Health Insurance (NHI) plan was instituted, which covers only Belizean citizens and residents.

During the summer 2008, I proposed an internship to evaluate access to healthcare for migrants in the rural district of Stann Creek, Belize. Issues of concern included a lack of safe water and sanitary infrastructure, inadequate clinics, and a lack of access to healthcare for migrants. Instead, the Ministry of Health desired an evaluation of satisfaction with the NHI plan. In order to achieve my goals and my sponsor's I conducted exploratory qualitative research, utilizing the CBPR method. Forming partnerships with local community nurses and leaders, open ended surveys, key informant interviews, and evaluations of health clinics were conducted throughout Stann Creek. Utilizing all interview and survey responses, I designed an instrument that measures satisfaction with NHI but also addresses community concerns and infrastructure issues, including access to clean water. Access to healthcare for migrant workers was addressed by including them in the research, including their responses as choices in the instrument, and addressing their concerns in a report to the Ministry. Through this process, I learned it is important to be flexible in the field, include the community as a partner, and give vulnerable populations a voice. The instrument created through this research has been adopted by the Ministry of Health as part of its new patient intake procedure for Belize.