OBJECTIVE: This study evaluates 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: A mixed methodology was used. A cross-sectional survey was first administered to Senegalese immigrants (n = 277), and they were asked about their visits to the doctor, use of emergency services, and hospitalization. A phenomenological approach was then used with key informants (n = 28). In the interviews, additional information, such as barriers and role and contribution of tontine to accessibility, was explored.

RESULTS: In the previous year, 57% had visited a doctor and 41% an emergency department. The main reasons for hospitalization was pregnancy (32.5%) and surgery (30%). At least 25% of the sample reported having never visited the doctor. Language difficulties, time constraints, and undocumented migrant status were major barriers to accessibility. Also, Senegalese migrants consider that public health care does not take into account the importance for them to follow treatment close to their relatives or to have 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

DISCUSSION: Since the literature on this topic is limited, and undocumented migrants are often underrepresented in conventional health surveys, the results of this study provide new evidence on the use and access to health services of this population group. Also, the results of this study help to understand the functions and contributions of a type of health financing existing in the immigrant community for its consideration in decision-making on health policy at both the national and international levels.