Results Access was considered to be easy for personal health-care card (PHC) holders. However, interviewees identified few factors that facilitated access related to the Ecuadorian population (PHC holder, language, social net- works) and the health system (free care, opening hours). In contrast, a number of hindering factors related to both the Ecuadorian population (insufficient knowledge of the sys- tem, problems with the documentation in obtaining the PHC, working conditions) and to the system itself (infor- mation availability, resources, organisation, attitude of staff) were also identified.