Health support for people on the move: a qualitative exploration of civil society organizations’ roles and obstacles along the Balkan route

Abstract

People on the move (POTM) are individuals in ongoing migration processes, often facing significant health risks and structural barriers to equitable access to essential services despite international frameworks recognizing healthcare rights. Civil society organizations (CSOs) play a key role in addressing these gaps. This study examines CSOs’ health support for POTM from the perspective of CSO workers, using the Balkan Route as a case study. This qualitative study included CSO staff providing health-related support to POTM along the Balkan Route. Participants were recruited through purposive and snowball sampling across 11 countries. Data were collected between March and May 2024 through semi-structured, in-depth interviews addressing healthcare access, service gaps, CSO roles, challenges, and institutional relations. Interviews were analyzed using qualitative content analysis. Fifteen CSO workers from 11 countries participated, representing local, national, and international CSOs. Analysis identified four main categories: (1) Structural and Sociopolitical Context (2), POTM (3), National Healthcare Systems (4), CSOs. Participants described fragmented migration governance, limited health system capacities, discrimination, and legal barriers as key determinants of healthcare access. POTM experienced cumulative health risks and multiple structural, administrative, and communication barriers. Although states were viewed as primarily responsible for healthcare provision, participants consistently reported that CSOs filled critical gaps by delivering health-related services, facilitating access through mediation, and advocating for more equitable healthcare. However, these roles were constrained by unstable funding, workforce shortages, political pressures, and ethical tensions regarding the substitution of state responsibilities. Trust and collaboration between CSOs, healthcare providers, public authorities, local communities, and POTM emerged as essential for effective healthcare support. CSOs are central to healthcare in supporting healthcare access for POTM, particularly through their mediating role between migrants, healthcare systems, and public authorities. Strengthening trust-based collaboration while preserving CSO independence and maintaining state accountability may contribute to more equitable healthcare access in migration contexts.