Report
Across East Africa, governments and their partners are transitioning the delivery of refugee health services from parallel humanitarian systems toward national health systems. This shift reflects commitments under the Comprehensive Refugee Response Framework (CRRF) and the Global Compact on Refugees (GCR), and is driven by protracted displacement, mounting pressure on humanitarian budgets and ambitions for the socioeconomic inclusion of refugees.
The IRC delivers refugee health services across all three countries and works with governments, U.N. agencies and donors on the transitions underway. This paper draws on that frontline experience to compare how the transition is unfolding in Kenya, Uganda and South Sudan—three countries responding to a common, intensifying financing shock from very different starting points. Integration is broadly endorsed and offers real long-term gains in equity, sustainability and social cohesion, but policy commitment alone does not determine outcomes. Success depends less on the ambition of "integration" than on practical enablers: predictable, multi-year financing; viable workforce absorption; resilient supply chains; functional coordination and referral systems; political will; and explicit strategies to protect specialized services through the handover.
The three cases illustrate the range. Uganda shows what a deliberate, structured model can achieve when backed by coherent planning—even as sharp funding cuts now test its sustainability. Kenya has moved decisively on policy reform and selective operational shifts, but faces unresolved gaps in county capacity, financing flows and service continuity. South Sudan illustrates the limits of integration where state capacity and public financing are severely constrained, and where an accelerated transition has, in some cases, led to service deterioration and renewed reliance on short-term humanitarian support.
The common thread is financing: when humanitarian funding contracts faster than governments can absorb costs, service gaps open quickly, hitting workforce, supplies and specialized care first. Integration is best understood not as a cost-saving exit but as a restructuring investment—adequately financed and deliberately sequenced, it can stabilize systems; rushed or underfunded, it erodes service quality and community trust.
The recommendations that follow set out how donors, governments and partners can safeguard predictable financing, workforce continuity and specialized care before responsibility shifts, so that integration strengthens national systems.
