Improving access to care for low-wage migrant workers in the Gulf: a system dynamics informed scoping review

Abstract Background Low-wage migrant workers (LWMWs) comprise the majority of the population across Gulf Cooperation Council (GCC) countries but experience significantly worse health outcomes than domestic citizens. The barriers to accessing care by this population have not been comprehensively reviewed. Here, we synthesise evidence on barriers to healthcare access for LWMWs across GCC countries and identify a set of remedial actions. Methods We conducted a scoping review following JBI and PRISMA-ScR reporting standards. We searched PubMed, CINAHL, Scopus, Overton, Google Scholar, and relevant organisational repositories for studies published between January 2015 and September 2025. Eligible studies reported barriers to healthcare access for LWMWs in the GCC. Barriers were analysed thematically and with a system dynamics approach to explore the two-way relationships between the factors that influence access to care and identify nodes for action. Barriers were also structured within the AAAQ framework and matched to remedial actions. Findings Twenty-eight documents covering 69,988 workers (1% female) from 13 countries were included. Nineteen themes were identified across five domains: costs, health insurance access and coverage, employment, individual factors, and systems navigation. Employer dependency and kafala-like systems emerged as central structural determinants of care access. The linked remedial actions clustered around four actor groups: destination governments, employers, healthcare providers, and sending governments. Interpretation Despite substantial reforms across GCC countries, many LWMWs continue to experience significant structural barriers to healthcare access. To mitigate this, the evidence supports coordinated responsibilities across the four actor groups. Remedial actions could include providing comprehensive and affordable insurance, active outreach, multilingual information and independent helplines/services, and stronger enforcement of labour laws.