title: Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens.
abstract: BACKGROUND
  In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.
  
  
  METHODS
  A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.
  
  
  RESULTS
  Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.
  
  
  CONCLUSIONS
  The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.
  
  
  CONCLUSIONS
  It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.
authors.affiliation: International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand. rapeepong@ihpp.thaigov.net.|Banphai Hospital, Banphai district, Khon Kaen, 40110, Thailand. rapeepong@ihpp.thaigov.net.
authors.forename: Rapeepong
authors.initials: R
authors.lastname: Suphanchaimat
authors.affiliation: Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand. kanang.kan@mahidol.ac.th.
authors.forename: Kanang
authors.initials: K
authors.lastname: Kantamaturapoj
authors.affiliation: International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand. weerasak@ihpp.thaigov.net.
authors.forename: Weerasak
authors.initials: W
authors.lastname: Putthasri
authors.affiliation: International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand. phusit@ihpp.thaigov.net.
authors.forename: Phusit
authors.initials: P
authors.lastname: Prakongsai
mesh_terms: D000328:Adult; D018864:Cultural Diversity; D003695:Delivery of Health Care; D005260:Female; D006282:Health Personnel; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014171:Transients and Migrants; D055815:Young Adult