Access to healthcare remains a big challenge in Africa. The situation is particularly appalling for border resident communities as they are often not given priority by policy makers. The existence of different state territorial sovereignty, administrative frameworks with different currencies, support services, legal/regulatory systems, and languages make healthcare access for border resident populations even more complex. Unlike in the central areas; in some sparsely populated border areas, the nearest facility may be in another country. Another significant barrier lies in the economic deprivation to which the border areas are usually exposed. In this era of Universal Health Coverage, how are communities residing along national borders going to be served without any financial burden as well as ensuring their overall wellbeing? This is an overarching question we intend to contribute to. This will be done through a study conducted at five paired-cross border sites in East Africa. Specifically; four interrelated objectives are proposed; Objective 1: This will explore the existing legal-institutional contextual constraints and enablers to access to cross border healthcare services for border resident communities, by way of two main methods; 1) review of administrative and legal documents and 2) Key Informant Interviews with border officials and managers of political administrative units near the border. Objective 2: This objective will explore the health systems constraints and implications for serving border communities. Key informant interviews will be the main methods for this objective. District or county health managers and providers will provide the bulk of this category of respondents. CBOs working to improve health services will also be included in the survey as key informants. Objective 3: This objective will determine how border resident communities navigate legal-institutional and health systems constraints and enablers to health service access. Two main methods will be used a) Survey of those that successfully manage to access services across the border and b) Focus Group Discussions (FGD). For the survey, Appreciative Inquiry (AI) approach will be taken to probe the access pathways for those that have successfully navigated access to three selected services on the other side of the border. We will undertake FGDs to help to mitigate the limitation of surveying only those that successfully navigated the access barriers. The FGD participants will include potential services for cross-border services ie 1) mothers attending child immunization services, and 2) community leaders - including community health workers. Objective 4: This objective aim to identify feasible actions to advance the access and coverage agenda to services for the communities residing along state borders. This will be done through; 1) convening stakeholders to deliberate on the findings from objectives 1, 2 and 3 in order to influence policy and practice and 2) sharing the study findings with the highest regional policy platforms. At these meetings we shall engage sub national, national, and regional policy practitioners to make salient the need to plan for border resident communities. Relatedly, the findings will also be disseminated at local, regional and international conferences in addition to publishing in peer review journals. The survey is anticipated to increase understanding of healthcare access issues and the health systems implications for serving border resident communities. In turn border resident communities will benefit from improved cross border healthcare provision and greater EAC cooperation in health care delivery.