“We have no rights…”: barriers to primary healthcare for migrants in South Africa

Primary healthcare (PHC) is designed to provide equitable, first-contact healthcare for all individuals in South Africa, yet evidence suggests that migrants face substantial barriers to accessing such care. In a context marked by chronic staff shortages, language diversity, and ongoing medical xenophobia, understanding migrants’ experiences within PHC is critical to improving equitable health service delivery. This study explored the barriers that African migrants encounter when seeking PHC in Cape Town, South Africa. This qualitative study drew on semi-structured interviews with 31 adult migrants (18 women and 13 men) originating from Burundi, Rwanda, Zimbabwe, the Democratic Republic of Congo, Cameroon, and Gabon. Participants were recruited through a migrant-run refugee centre in Cape Town. Data were collected between October and November 2023 and analysed thematically using ATLAS.ti 24. Participants described multiple, intersecting barriers to PHC access and utilisation. These included documentation challenges, inconsistent enforcement of identity requirements, and out-of-pocket payments despite PHC’s intended free-at-point-of-use model. Language and communication barriers were pervasive, often resulting in migrants being denied care if they were unaccompanied by an interpreter. Experiences of discrimination and medical xenophobia, particularly from nursing and administrative staff, were widely reported and contributed to migrants’ mistrust of the healthcare system. The cumulative impact of these barriers led to treatment delays, reliance on self-medication, and deterioration in physical and mental health. Despite South Africa’s constitutional commitment to healthcare for all, systemic and attitudinal barriers continue to exclude migrants from equitable PHC. Ensuring the accessibility and quality of PHC requires policies that address medical xenophobia, promote language inclusivity, and clarify the rights of migrants to care irrespective of legal status. Investing in cultural competence and interpreter services at the PHC level may improve trust, communication, and early engagement with healthcare among migrant communities.