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 meth-
ods. 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 of citizenship.
The review found examples of investments in shared health infrastructure to benefit all EAC member countries – a
signal of closer cooperation for specialized health care, this had not been accompanied by access rule for citizens
outside the host country. The focus on specialized care is unlikely to contribute to the every-day health care needs of
border resident communities in remote areas of EAC. Nevertheless, the establishment of the EAC entail opportunities
for increased collaboration and integration beyond the trade and customs union to included health care and other
social services. The study established active cooperation aimed at disease surveillance and epidemic control among.sub-national officials responsible for health and migration services across borders. Health insurance cards, national
identification cards and official travel documents were found to constrain 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.