[Healthcare access through community-based health insurance among Senegalese migrants].

Objective: To evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants.

Method: Data were retrieved through qualitative techniques, semi-structured interviews (n=14) and discussion group (n=10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine.

Results: The lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance.

Conclusions: This study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.