Abstract
Background: Within the framework of a new national health program with emphasis on universal coverage strategies and in the context of revision/adjustments to the North American Free Trade Agreement (NAFTA/TEMEC), the present study aimed to identify barriers, facilitators and challenges for the development of strategies on social protection in the health of migrants and their families. Material and methods: Evaluative research based on a qualitative analysis with a cross-sectional design. The techniques of documentary analysis, applied political analysis (mapping of actors), in-depth interviews and case studies were used. In the first stage, key actors were mapped at the federal level and senior executives and health officials, federal deputies, senators and members of the Mexican foreign service were interviewed. In the second stage, field work was carried out in the state of Guanajuato and California; State health service officials, state government officials, municipal officials, health unit workers, representatives of CSOs and relatives of migrants were interviewed. The analysis of the interviews was carried out through the ATLAS-Ti software, as well as the mapping of actors and feasibility analysis through the POLICY MAKER software. Results: The main results allowed to identify indicators on barriers and facilitators regarding social actors, binational agreements under NAFTA/TEMEC, institutional spaces, interaction between social actors, as well as the impact and type of relations for a greater advance in binational health policies. Several obstacles were reported, including the fears that undocumented emigrants have in the U.S. of being arrested and deported if they use public health services in the U.S. The stakeholders also believed that many Mexican emigrants do not have a culture that values health insurance. Conclusions: In the context of reforms and adjustments of health systems that are being discussed in parallel in the revision and adjustments of NAFTA/TEMEC (United States of America, Mexico and Canada), the facilitators and barriers identified can be used to strengthen the development of bi-national strategies with different schemes of social protection in the health of undocumented migrants and their families on both sides of the border.