Note: The author was the coordinators of the Abuja Summit representing the UN Draft Access to Health Wellness Implementation of the Abuja Commitment in Africa and IGAD countries: Lessons learned Costantinos Berhutesfa Costantinos, PhD Professor of Public Policy, School of Graduate Studies, AAU & Trustee, Africa Humanitarian Action, costy@costantinos.net , www.africahumanitarian.org First IGAD International Conference: Innovative approaches for equitable access to reproductive health, HIV services among pastoralists, and trans-boundary populations Presentation at the United Nations Conference Centre Hall, Addis Ababa, Dec 3-6, 2014 Abstract Pastoralists and trans-boundary populations are under the grip of an unprecedented crisis, heightened by the inability of states to engage readily in the search for answers to the continent’s human insecurity challenges. Across the continent, these populations live in nations that remain in the throes of famine, poverty & violence and continue to suffer the devastating impact of HIV/ AIDS and STIs and now Ebola . While Africa is at the forefront of the global development agenda today with a remarkable success in rolling back HIV/AIDS, since the Abuja Declaration on HIV/AIDS and ORID, the challenges for such populace remains daunting. The methodology used to conduct this research is qualitative data collected from primary and secondary sources. Existing and emerging health challenges emanate from state fragility and the crises of civic and political leadership in Africa, the crises of managing health care, cross border movements and the challenges of managing communicable diseases. A state is fragile when the basic functions of the State are no longer performed, they breed widespread internal conflict, revolutionary and ethnic wars, adverse regime change, genocide, politicides, and de facto or de jure loss of state legitimacy. The finding point to the need for clear trajectories with strategic entry points to address capacity development to stem the tide of pandemics; addressing the criminal negligence of health care systems in trans-boundary human movements in Africa. Key words: diseases of povert y, human mobility, health systems, state fragility, state capacity,