A qualitative exploration of healthcare needs and challenges in accessing services among rural migrant workers in Odisha, India

Internal migration in India is a growing phenomenon driven by rural distress, employment opportunities, and economic disparity. Migrant workers, particularly from states like Odisha from India, often engage in informal and precarious work across states. Thy are facing significant barriers in accessing health services both at their destinations and upon return to their source village. This study explores the healthcare needs, expectations, and challenges faced by out-migrant male workers from rural area of southern Odisha, India with a focus on understanding their lived experiences and structural barriers to care. A qualitative study was conducted using five Focus Group Discussions (FGDs) with out-migrant male workers and 15 in-depth interviews (IDIs) with migrant workers and healthcare providers. Additionally, key informant interviews were held with returnee migrants, family members, and an Employee State Insurance (ESI) official. Data were thematically analysed to identify core themes and cross-cutting patterns. The study findings revealed a dual burden of occupational and chronic illnesses among out-migrant male workers, poor continuity of care, and limited access to preventive services. Barriers included economic constraints, rigid work hours, inadequate health infrastructure at both source and destination locations, and linguistic or cultural exclusion. Systemic issues such as non-portability of benefits, weak inter-state coordination, and lack of official registration further exacerbated their healthcare vulnerability. Migrant workers remain disconnected from routine health systems, highlighting an urgent need for migrant-inclusive health policies. Integration into existing national programs, digital interoperability, cross-state recognition of entitlements, and employer accountability through schemes like ESI are essential to ensure equity and resilience in public healthcare delivery.