Health is wealth and documents are the currency: exploring the role of NGOs in facilitating healthcare access for undocumented migrants in the Netherlands - a qualitative study

Abstract

Background Undocumented migrants (UMs) in the Netherlands face significant barriers to accessing healthcare despite legal entitlements to ‘necessary medical care.’ Non-governmental organisations (NGOs) play a critical role in facilitating healthcare access for UMs, yet empirical research on their contributions remains limited. This study aims to explore how NGOs perceive their role in facilitating healthcare access for UMs in the Netherlands and how these perceptions align with their actual practices. Methods The research employs a qualitative exploratory design, conducting twelve semi-structured interviews with professionals from various NGOs supporting UMs in the Netherlands. Thematic analysis was used to identify key roles and strategies employed by these organisations. Results The data revealed four main roles: (1) mediating, (2) educating, (3) advocating, and (4) delivering services. The findings suggest that while Dutch NGOs appear to share a common goal of facilitating healthcare access for UMs within the existing Dutch healthcare system, some of their strategies exist outside the regular system, thereby creating a parallel system. This parallel system subsequently results in a discrepancy between how NGOs perceive themselves (i.e., the role they think they should take) and the role they play in practice. Findings further suggest that the Dutch NGOs in this study face a humanitarian-equity dilemma, where limited resources and high pressure from UMs’ immediate needs lead them to prioritize direct assistance over addressing systemic issues. Consequently, many NGO strategies offer temporary solutions that help individual cases but fail to integrate UMs into the regular healthcare system sustainably. Conclusions Dutch NGOs play a critical role in facilitating healthcare access for UMs in the Netherlands. Despite their invaluable efforts in addressing immediate needs, NGOs risk legitimizing a parallel system that allows the state to retreat from its welfare duties. To facilitate lasting change, NGOs should focus more on educational and advocacy roles and collaborate to reduce costs and enhance effectiveness. This strategic shift is essential for creating sustainable, inclusive health care solutions that ensure UMs are integrated into the regular healthcare system, thereby upholding the principles of equity and justice.