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Better health care for mobile populations in East Africa

January 25, 2018

Living in one country and working in another is common for many people in the region served by the East African Community, an intergovernmental organization of six partner states – Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. People in this region also cross borders to obtain health services.

Jimmy Sirari, an adherence support counselor at the Malaba Model Health Center, conducts an outreach activity.Health systems near the borders are not designed for the needs of mobile populations and often lack formal cross-border facility-to-facility linkages, procedures for cross-border referrals and patient-tracking abilities. Consequently, these facilities have overstretched human resources and frequent supply shortages, and health outcomes for patients are likely to be compromised due to missed appointments, inadequate treatment adherence or uneven care coordination.

To respond to these complex challenges, FHI 360’s Cross-Border Health Integrated Partnership Project (CB-HIPP) — funded by the U.S. Agency for International Development (USAID) Kenya/East Africa Mission — conducted a baseline survey. And, through a collaborative intra- and inter-country consultative process, the project designed the East Africa Cross-Border Health System, which is defined by six components:

  • A functional coordination and collaboration system
  • A functional cross-border referral system
  • A cross-border health information system 
  • Local capacity development in migration health 
  • Learning and knowledge sharing
  • Policy and regulatory support

The East Africa Cross-Border Health System operates through a model of cross-border health units (CBHUs) located at each cross-border site. The model — the first use of this approach in this region — works to establish and strengthen structured, coordinated service delivery and referrals to provide integrated health services for mobile populations.

In January 2017, the CB-HIPP team piloted the CBHUs within select border health facilities in seven priority sites in the region. The focus of each unit is to facilitate a formal process for access across the HIV care cascade, increasing HIV testing and linking clients to treatment and care.

Anne Nyongesa, Sub-County AIDS and STI Coordinator in Samia Sub-County, Kenya, reported that the CBHU model has significantly improved patient tracing. In January 2017, the Samia/Sio Port Sub-County Hospital had identified 67 default patients and 27 patients as lost to follow-up. By May, teams from the Kenya and Uganda health units had jointly traced 50 of the default patients and found all 27 of the patients lost to follow-up.

“Ugandan health workers come over and Kenyan health workers go over for meetings of the health units,” Nyongesa said. “We confidently give transfer letters and are informed that they received the client. When people test HIV-positive, health workers can refer those clients confidently.”

In June 2017, East African Community stakeholders recognized CB-HIPP’s model as a sustainable mechanism for cross-border health service delivery and identified the East African Health Research Commission as the most viable regional institution to implement learning and scale-up, through CBHUs, in the region. The East African Community and its partner states will use the model in other cross-border sites in the region, with technical assistance from CB-HIPP. FHI 360 will focus on accelerating the use of the findings and practices for policies and programs to improve the model’s service delivery and scale-up.

The project also began a cross-border monitoring and evaluation system to manage, analyze, use and disseminate program data. The monitoring and evaluation system tracks standard indicators to learn how effective the health units are in assisting target populations with obtaining health services and follows custom indicators that monitor program implementation and effectiveness of the overall cross-border health service delivery model.

Photo caption: Jimmy Sirari, an adherence support counselor at the Malaba Model Health Center, conducts an outreach activity. The CB-HIPP project piloted health units within existing health facilities to provide services for mobile populations in East Africa.

Photo credit: Leanne Kamau/FHI 360