BackgroundMigrants in Mexico are entitled to care at all levels, independently of their migration status. However, previous studies show that access to care is difficult for this population. As the movement of in-transit migrants and asylum seekers has been interrupted at the Mexico-United States border by migration policies such as the “Remain in Mexico” program, and by border closures due to the COVID-19 pandemic, the Mexican health system has the challenge of providing them with health care. Levesque et al.'s framework, according to which access occurs at the interface of health system characteristics and potential users' abilities to interact with it, is a useful theoretical tool to analyze the barriers faced by migrants.ObjectiveThe objective of this article is to analyze the barriers to access the public Mexican health system, encountered by migrants in cities in Mexican states at the Mexico-United States border during the COVID-19 pandemic.MethodsData came from a multiple case study of the response of migrant shelters to health care needs during the COVID-19 pandemic. The study consisted of a non-probability survey of migrants with a recent health need, and interviews with persons working in civil society organizations providing services to migrants, governmental actors involved in the response to migration, and academics with expertise in the subject. We analyzed the quantitative and qualitative results according to Levesque et al.'s framework.Results36/189 migrants surveyed had sought health care in a public service. The main limitations to access were in the availability and accommodation dimension (administrative barriers decreasing migrants' ability to reach the system), and the affordability dimension (out-of-pocket costs limiting migrants' ability to pay). Civil society organizations were a major source of social support, helping migrants overcome some of the barriers identified.ConclusionsWhile Mexico's health regulations are inclusive of migrants, in practice there are major barriers to access public health services, which might inhibit migrants from seeking those services. In order to comply with its commitment to guarantee the right to health of all persons, the Mexican health authorities should address the implementation gap between an inclusive policy, and the barriers to access that still remain.

Assessing COVID-19 vaccination uptake of transborder populations is critical for informing public health policies. We conducted a probability (time-venue) survey of adults crossing from Mexico into Guatemala from September to November 2021, with the objective of describing COVID-19 vaccination status, willingness to get vaccinated, and associated factors. The main outcomes were receipt of ≥1 dose of a COVID-19 vaccine, being fully vaccinated, and willingness to get vaccinated. We assessed the association of outcomes with sociodemographic characteristics using logistic regressions. Of 6518 participants, 50.6% (95%CI 48.3,53.0) were vaccinated (at least one dose); 23.3% (95%CI 21.4,25.2) were unvaccinated but willing to get vaccinated, and 26.1% (95%CI 24.1,28.3) were unvaccinated and unwilling to get vaccinated. Those living in Mexico, independent of country of birth, had the highest proportion vaccinated. The main reason for unwillingness was fear of side effects of COVID-19 vaccines (47.7%, 95%CI 43.6,51.9). Education level was positively associated with the odds of partial and full vaccination as well as willingness to get vaccinated. People identified as Catholic had higher odds of getting vaccinated and being fully vaccinated than members of other religious groups or the non-religious. Further studies should explore barriers to vaccination among those willing to get vaccinated and the motives of the unwilling.

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Background Cross-border use of health services is an important aspect of life in border regions. Little is known about the cross-border use of health services in neighboring low- and middle-income countries. Understanding use of health services in contexts of high cross-border mobility, such as at the Mexico-Guatemala border, is crucial for national health systems planning. This article aims to describe the characteristics of the cross-border use of health care services by transborder populations at the Mexico-Guatemala border, as well as the sociodemographic and health-related variables associated with use. Methods Between September-November 2021, we conducted a cross-sectional survey using a probability (time-venue) sampling design at the Mexico-Guatemala border. We conducted a descriptive analysis of cross-border use of health services and assessed the association of use with sociodemographic and mobility characteristics by means of logistic regressions. Results A total of 6,991 participants were included in this analysis; 82.9% were Guatemalans living in Guatemala, 9.2% were Guatemalans living in Mexico, 7.8% were Mexicans living in Mexico, and 0.16% were Mexicans living in Guatemala. 2.6% of all participants reported having a health problem in the past two weeks, of whom 58.1% received care. Guatemalans living in Guatemala were the only group reporting cross-border use of health services. In multivariate analyses, Guatemalans living in Guatemala working in Mexico (compared to not working in Mexico) (OR 3.45; 95% CI 1.02,11.65), and working in agriculture/cattle, industry, or construction while in Mexico (compared to working in other sectors) (OR 26.67; 95% CI 1.97,360.85), were associated with cross-border use. Conclusions Cross-border use of health services in this region is related to transborder work (i.e., circumstantial use of cross-border health services). This points to the importance of considering the health needs of migrant workers in Mexican health policies and developing strategies to facilitate and increase their access to health services.