Abstract:
Objectives This study explored the experiences of
accessing care across the border in East Africa.
Participants From February to June 2018, a cross sectional study using qualitative and quantitative methods
was conducted among 279 household adults residing
along selected national border sites of Uganda, Kenya and
Rwanda and had accessed care from the opposite side of
the border 5 years prior to this study.
Setting Access to HIV treatment, maternal delivery and
childhood immunisation services was explored. We applied
the health access framework and an appreciative inquiry
approach to identify factors that enabled access to the
services.
Measures Exploratory factor analysis and linear
regression were used for quantitative data, while deductive
content analysis was done for the qualitative data on
respondent’s experiences navigating health access
barriers.
Results The majority of respondents (83.9%; 234/279)
had accessed care from public health facilities. Nearly
one-third (77/279) had sought care across the border
more than a year ago and 22.9% (64/279) less than a
month ago. From the linear regression, the main predictor
for ease of access for healthcare were ‘‘ease of border
crossing’ (regression coefficient (RegCoef) 0.381);
‘services being free’ (RegCoef 0.478); ‘services and
medicines availability’ (RegCoef 0.274) and ‘acceptable
quality of services’ (RegCoef 0.364). The key facilitators
for successful navigation of access barriers were related
to the presence of informal routes, speaking a similar
language and the ability to pay for the services.
Conclusion Communities resident near national borders
were able to cross borders to seek healthcare. There
is need for a policy environment to enable East Africa
invest better and realise synergies for these communities.
This will advance Universal Health Coverage goals for
communities along the border who represent the far
fang areas of the health system with multiple barriers to
healthcare access.
