The role health reform plays in advancing Universal Health Coverage (UHC) has yet to be addressed adequately across the integrated delivery of services in East Africa. Many countries in the region have begun implementing some health financing reforms, such as national health insurance expansion, community-based health insurance (CBHI), performance-based financing (PBF), and strategic purchasing; however, there is limited evidence available on how these reforms affect coordinated, equitable, or continuous care. The objective of this systematic review was to assess and synthesize evidence regarding the impact of health-financing reforms on integrated service delivery in East Africa. We used the PRISMA 2020 protocol to systematically review the literature on health-financing reforms related to integrated service delivery outcomes in Kenya, Uganda, Tanzania, Rwanda, Ethiopia, Burundi, and South Sudan by searching PubMed, Embase, Scopus, Web of Science, EconLit, and relevant grey literature sources. Randomized controlled trials (RCTs), quasi-experimental studies, observational studies, and qualitative studies were eligible for inclusion in the review if they assessed the relationship between health-financing reform and the outcome of integrated service delivery. Outcome measures were defined as service utilization/coverage, financial protection, primary healthcare (PHC) integration, referral coordination, quality indicators, and equity. Narrative thematic synthesis was used to synthesize results and meta-analysis with random-effects models was performed when deemed appropriate. The results showed that 76 studies fulfilled the inclusion criteria of the review and 24 of these studies were integrated into the quantitative analysis. Overall, insurance expansion and reforms within risk pooling were consistently associated with an increase in service utilization (a pooled odds ratio of 1.38 at a 95% confidence interval of 1.21 to 1.57) and a decrease in catastrophic health expenditures (a pooled relative risk of 0.64 at a 95% confidence interval of 0.52 to 0.79). Overall, the implementing of a strategic purchasing approach to primary healthcare, as well as the use of performance-based financing, were both related to the improvements made in regard to strengthening primary healthcare provision, coordination of referrals and selected quality indicators. Lower levels of complete enrollment, weak purchasing autonomy and fragmentation from parallel streams of funding consistently limited the potential for countries to achieve integration. Among the three countries included in this review, Rwanda exhibited the highest levels of integration, while Kenya and Uganda had a higher risk of fragmentation. In conclusion, the health financing reforms implemented in East Africa have generated access to healthcare and protection from financial hardship as well as contributing toward improved integrated service provision when combined with comprehensive risk pooling, strategic purchasing and governance reforms. However, financing alone is not sufficient for achieving sustainable integration; therefore in order to support or develop successful integration of health systems, countries require to consolidate their risk pools, harmonize donor funding support, and strengthen their primary healthcare systems. Therefore, policymakers should emphasize health system alignment in order to successfully translate financing reforms into effective, equitable and integrated health systems to achieve UHC.

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D. M. Mami, M.T Emmanuel, M. Patrick, M. O. Sylvester Martin and R. Sesay “Health Financing Reforms and Integrated Service Delivery in East Africa: A Systematic Review”, International Journal of Technology and Engineering Studies, vol. 11, pp. 6-17, 2025.