Farmworkers face barriers to care, including limited availability of healthcare services in rural areas, cost, transportation, clinic hours, and language. Few farmworkers are eligible for public assistance programs and the majority lack health insurance. To reduce these barriers and make your clinic more accessible, NCFHP recommends the following:
Outreach and enabling services – Outreach involves leaving the clinic to find migrant and seasonal farmworkers in the community who have not yet been connected to any healthcare or other services. Enabling services are the services needed to help those farmworkers meet their basic needs, including their need to access healthcare. Enabling services include, but are not limited, to providing patient transportation, medical interpretation, patient education and case management. The goal is to facilitate healthcare delivery and improve health conditions for migrant and seasonal farm worker. Enabling services have been found to increase the number of migrant and seasonal farmworkers, as well as other disenfranchised and/or hard to reach populations, that access migrant and community health centers and other agencies. They ensure linkages and communication between healthcare agencies and farmworkers and provide needed services that address the barriers farmworkers face. A farmworker health program must be aware of what enabling services are needed in his/her area and seek to provide them. Provision of these services should be monitored and documented to determine reach and effectiveness.
Accessible clinic hours – farmworkers work long hours Monday through Saturday, from early morning until past sundown, or often until as late as 7 or 8pm. To be accessible to farmworkers, a clinic needs to have late evening and/or Sunday hours available and make sure that farmworkers know that these clinic hours are available.
Sliding fee services – Cost is a major barrier to healthcare services for farmworkers. 85% of farmworkers in the U.S. have no health insurance, and nine out of ten children in farmworker families are uninsured. Many live significantly below the federal poverty line and nearly five out of ten farmworker households in NC cannot afford enough food for their families. In order for services to be accessible to farmworkers, a clinic needs to have services available at a low cost (or no cost).
Language-appropriate services – a large percentage of farmworkers are monolingual Spanish-speakers, others may be bilingual or speak one of a number of indigenous languages such as Mixteco or Haitian Creole. In order to make sure services are accessible, language-appropriate services should be available from front desk staff to providers and all staff in between (whether this means having bilingual staff, interpreters, or a language line available).
Culturally appropriate services – Services should be not only linguistically accessible but also culturally appropriate. Although a provider may speak a patient’s language or use an interpreter, it does not mean that they understand their culture. Having culturally-appropriate services includes understanding farmworkers’ cultural background as well as their occupational risks, housing conditions, and barriers to care. Culturally appropriate services will include enabling services to address social determinants of health and outreach workers who can seek out farmworkers and build trust and help bring them to the clinic.
Continuity of care – Continuous care means that farmworkers have the opportunity to develop a relationship with a primary care provider. It also means ensuring that farmworkers are not lost to follow-up after referral for specialty care or hospitalization. A mechanism should be in place for tracking the care of the patient and for transferring records to another site or securing another provider when possible as patients prepare to migrate. Nationwide referral directories such as Migrant Clinicians Health Network case management service are available to assist in this process (https://www.migrantclinician.org/services/network.html) Hospital-based care may or may not be provided directly, but firm arrangements should be made for referral of those requiring hospitalization. Continuous care would include involvement of the outreach worker and primary care provider in discharge planning and follow-up care.