INTRODUCTION:
Access to healthcare is a fundamental human right, yet, for many marginalized populations around the world, this right remains hard to achieve1. In some countries, migrant domestic workers (MDWs) are subject to systems that restrict their autonomy like the kafala (sponsorship) system in Lebanon, which can add to their vulnerability2–5. This study aims to understand the challenges female MDWs face in accessing healthcare. It is based on Penchansky's framework for healthcare access (affordability, availability, accessibility, accommodation, and acceptability)6, with Saurman's addition of “awareness”7. By understanding their experiences, the study also identifies priorities for change from their perspectives.

METHODS:
In this qualitative study, semi-structured in-depth interviews were conducted with MDWs from diverse nationalities, living and working situations in Lebanon to understand their experiences and priorities related to healthcare access. We employed an inductive-deductive coding approach to identify emerging themes using Dedoose.

RESULTS:
Thematic analysis of the interviews revealed a complex interplay of barriers, including financial constraints, lack of comprehensive health insurance, dependency on employers for decisions, legal vulnerabilities due to the kafala system, experiences of discrimination and mistrust within the healthcare system, and limited access to information about available services. Participants prioritized reforms such as increased financial support, abolition of the kafala system, expanded access to subsidized healthcare centers, equitable treatment, and improved employer-provided insurance coverage.

CONCLUSIONS:
The findings highlight the impact of the kafala system, power imbalances, and socioeconomic disadvantages on MDWs' ability to seek timely and appropriate medical care. Affordability, accommodation of needs, and acceptability of services emerged as critical dimensions requiring intervention.