An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam

Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software.Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare.Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities.Generally, migrant and ethnic minority populations perceive worse health than majority host populations [1,2]. Community perceptions of heath, such as cultural health beliefs and differences in understanding of diseases, have been linked to poor health care access [3-5]. However, little is known about the enablers and barriers in access to healthcare experienced in migrant and ethnic minority groups, even less so among recent sub-Saharan African populations [2,6]. There is also evidence that many ethnic minority groups are often dissatisfied with the host country's healthcare system due mainly to language and cultural barriers which affect their quality of healthcare [5,7]. The Global Consultation on Migrant Health has identified these barriers as contributing to limiting migrants' access to healthcare [8]. The growing numbers of ethnic minorities in Europe demands an understanding of their health status and needs t