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.