Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa

Abstract

ObjectivesThis study explored the experiences of accessing care across the border in East Africa.ParticipantsFrom 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.SettingAccess 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.MeasuresExploratory 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.ResultsThe 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.ConclusionCommunities 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.

Key Considerations: Cross-Border Dynamics between Uganda and Rwanda in the Context of the Outbreak of Ebola, 2022

“…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. 7 If this trend has re-emerged following the 2019-2022 border closure, it would suggest a heightened risk of cross-border care seeking from persons at risk from SVD.…”

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

“…Despite health being a fundamental right, access to cross border health especially for communities residing along international borders remains a challenge (1). In the East African Community (EAC), many communities residing along the border are treated as non-citizen and excluded from entitlements such as health services in the neighboring communities across the national border (2). Worldwide, people who reside close to the inter-state borders have great di culty accessing health services.…”

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

“…It is not uncommon to find the same community split across and residing in two countries while being socially and economically interdependent [19]. Border communities often cross the borders for one reason or another, including accessing health services in a neighbouring country [20][21][22].…”