29 Structural compensation and participatory approaches: a way to improve access to health care for undocumented migrants? A scoping review

Abstract PTH 9: Miscellaneous 2, B302 (FCSH), September 5, 2025, 11:30 - 12:24 Aims Across Europe, non-profit organisations provide health care to undocumented immigrants (UDM), filling the gaps left by national healthcare systems. This approach is referred as ‘“structural compensation”. Integrating beneficiaries in developing interventions can be a source of effectiveness, but evidence shows that UDM involvement is difficult. This scoping review aimed at identifying best practices related to participative approaches in structural compensation interventions targeting UDM. Methods This scoping review follows the PRISMA guidelines. Four electronic databases were searched in June 2024. Nine studies met the final inclusion criteria. An analytic framework was developed based on the literature related to participatory approaches in health. This served to critically reflect on the integration of participative approaches and on the missed opportunities in the interventions. Results Findings showed a limited but varied use of participatory approaches at the different stages of the development of the structural compensation interventions, but UDM were only at the initiative of the project in 1 intervention. UDM were never involved in the implementation and only 1 intervention included them in the intervention. Missed opportunities were found when UDM or community organisations could have been involved in designing the intervention but were not. the structural compensation organisations could be facilitators to support the participation of UDM. Conclusion As UDM are insufficiently involved in the development of the interventions, there is a risk that these interventions are not adapted to their needs and miss their objective of compensating the gaps of the national health system. But, involving UDM should consider their personal priorities before striving for involving them at any cost. Community-based organisations and proxies could be an alternative way to better integrate UDM needs in these interventions. Structural compensation interventions could perform better if they integrate more participatory approaches in their development.