INTRODUCTION:
Socially marginalised individuals in South Africa may be deemed unworthy of scarce resources to promote health and treat illness. Perceptions of patients’ relative worthiness impact health-seeking behaviour and outcomes: those deemed unworthy may receive inferior care or be denied health services altogether. Current in-service learning strategies to address unequal treatment in the Primary Health Care facility have not resolved the problem. There is a gap in the literature regarding why perceptions of patient worthiness persist among clinicians in the Global South, and among nurses in particular.

METHODS:
This study utilised a critical participatory action research methodology whereby a group of nurses and cross-border migrants - a socially marginalised population in South Africa - engaged in dialogue and critical reflection over one year.

RESULTS:
Findings indicate that perceptions of worthiness are informed by sociocultural and historical factors that promote the practice of shifting blame for systemic failures onto individuals. Worthiness determinations on the part of clinicians, support staff, and patients from the general population justify dehumanising actions that harm socially marginalised patients, maintain social and institutional hierarchies, and preserve the unequal status quo.

CONCLUSIONS:
Shifting perceptions of socially marginalised people from stereotypic characters to dynamic individuals is humanising and, therefore, vital to dissuade the practice of triaging patients based on perceived worthiness. Critical reflection on problematic assumptions, motivations, and beliefs through dialogue provides an alternative to traditional in-service training; it holds promise as a strategy to deter worthiness determinations and counter the motive to justify unequal systems. Facilitators of dialogue-based strategies must foster a learning environment where participants feel free to listen and speak without judgment. Providing opportunities for learners to consider the perspectives of others through narrative or theatrical activities is equally essential if perceptions of worthiness are to shift.