The right of access to healthcare: An analysis of how legal and institutional frameworks constrain or facilitate access to healthcare for residents in border areas in the East African Community

Abstract

Background: Despite many countries working hard to attain Universal Health Coverage (UHC) and the Health-related Sustainable Development Goals, access to healthcare services has remained a challenge for communities residing along national borders in the East Africa Community (EAC). Unlike the communities in the interior, those along national borders are more likely to face access barriers and exclusion due to low health investments and inter-state rules for non-citizens. This study explored the legal and institutional frameworks that facilitate or constrain access to healthcare services for communities residing along the national borders in EAC. Methods: This study is part of a broader research implemented in East Africa (2018-2020), employing mixed methods. For this paper, we report data from a literature review, key informant interviews and sub national dialogues with officials involved in planning and implementing health and migration services in EAC. The documents reviewed included regional and national treaties, conventions, policies and access rules, regulations and guidelines that affect border crossing and access to healthcare services. These were retrieved from official online and physical libraries and archives. Results: Overall, the existing laws, policies and guidelines at all levels do not explicitly deal with cross border healthcare access especially for border residents, but address citizen rights and entitlements including health within national frameworks. There is no clarity on whether these rights can be enjoyed beyond one’s country. The review found examples of regionalization of health infrastructure and strategies to invest in shared specialized services (centers of excellence) although this was not addressing border resident communities. The regional EAC policies entail opportunities for increased collaboration and integration between EAC States. In practice, disease surveillance and epidemic control are the main formal collaborative undertakings among sub-national officials responsible for health and migration services. Tools like health insurance cards, national identification cards and travel documents were found to influence access to health services across the borders in EAC. Conclusion: In the era of UHC, there is need to take advantage of the EAC integration to revise legal and policy frameworks to leverage existing investments and facilitate cross-border access to healthcare services for communities residing along EAC borders.