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Background Global progress toward the Sustainable Development Goals (SDGs) is severely off track. Iran hosts the world’s largest migrant and refugee population, but sanctions, inflation, and workforce migration have strained its capacity. Since the attitudes of service providers influence whether inclusive policies are translated into practice, this study explores frontline staff perspectives on access to public health services for non-citizens in one of Tehran’s largest public health networks. Methods We conducted a cross-sectional survey among staff in three public health centers that serve migrant and refugee populations. The questionnaire assessed five Likert scale outcomes: support for separate centers, shared user fees, prioritization of citizens under conditions of scarcity, equal service provision, and preference for working with citizens. Demographic variables included age, sex, years of experience, and role (clinical vs. non-clinical). Items were analyzed descriptively; subgroup comparisons were conducted using two-sided Mann–Whitney U tests. Results Of approximately 150 eligible healthcare workers, 87 provided complete responses. Agreement with prioritizing citizens was highest at 93.1% (median 5). Support for equal service provision was lowest, with 56.3% of participants expressing disagreement (median 2). A preference for working with citizens was endorsed by 61.9% of the respondents (median 4) and differed by age, experience, and role, with younger, less-experienced, and clinical staff reporting stronger preferences (all p 0.01). Conclusion Healthcare workers’ perspectives can serve as a rapid, low-burden proxy indicator for equitable service delivery. In this exploratory study, workers favored citizen prioritization and fee-based models under conditions of scarcity, with the lowest support expressed for equal access for non-citizens; these preferences were strongest among younger and clinical staff. Adapted service delivery models, targeted training, and clear operational guidance are needed to support equitable access in resource-constrained settings.
Karimian et al. (Wed,) studied this question.