Walking the tight rope: The role of local governments in promoting access to emergency obstetric care in Uganda
By Primah Kwagala
According to Chapter 11 of Uganda’s Constitution, local governments have a mandate to oversee the performance of their employees, provide them services and monitor those services. It is on this basis that the Center for Health, Human Rights and Development (CEHURD) came to work with a family in Nakaseke District to seek justice for the maternal deaths in Nakaseke District Hospital.
In May 2011, Ms. Nanteza Irene accompanied by her husband Mr. Mugerwa David went to Nakaseke District Hospital to deliver their baby. The midwives on duty uncovered that there was an obstruction during Ms. Natenza’s labour. This required emergency obstetric care by a doctor who was nowhere to be found. The doctor finally arrived eight hours later but was too late to save Ms. Nanteza’s life.
CEHURD alongside Mr. Mugerwa David and his children filed a civil suit in the high court in 2012 against Nakaseke District Local Government. The plaintiffs sought general and punitive damages in addition to declarations that the deceased’s right to life, health, freedom from inhuman and degrading treatment, equal treatment and the children’s rights to be cared for by their mother had been violated by the hospital staff. CEHURD argued that the Nakaseke District Local Government was vicariously liable for the acts and omissions of their employees.
The court held that the local government was responsible for the administrative and supervisory oversight of Nakaseke District Hospital. The local government was in charge of sending an administrator to ensure that there were adequate heath care services in place at the hospital. In this case, however, the government failed to ensure that there were sufficient resources, such as doctors, at the hospital. The court held that the doctor was vicariously liable for the death of Ms. Nanteza Irene.
This case saw for the very first time in Uganda, a justice of the High court visit to a district hospital to establish the facts and circumstances. This illustrates the commitment from the judge to understand the issues of health and human rights.
Indeed Justice Benjamin Kabiito’s judgment held that Ms. Nanteza Irene’s human and maternal rights and the rights of her family were violated. Justice Benjamin Kabiito decried the poor status of health in the country and the meager resources devoted to the health sector but found it sufficient to award general damages worth UGX 35,000,000 against Nakaseke District Local Government. He cautioned the health workers that were negligent in handling the deceased and called on the Uganda Medical and Dental Practitioners’ Council to investigate issues of negligent conduct leading to deaths of innocent citizens.
This case was the first of its kind to recognize the right to access emergence obstetric care (EMC) as being justiciable and a fundamental human right in Uganda. The results of this case set precedence for the litigation of maternal health rights in Uganda.
The case further opened public’s eyes on their ability to demand health and human rights while ensuring that the Code of Conduct and Ethics for Public Service of conduct laid out by the government. A key issue to also note was Justice Kabiito’s limited appreciation of human rights issues. Contrary to the public opinion that human rights are a westernized idea being imposed on Ugandans, the issue of emergence obstetric care was homegrown. Much as Justice Kabiito wanted to subvert the discussion to negligence and tortuous conduct of health workers, jurisprudence was drawn into the perspective of how the judiciary understands health and human rights of ordinary citizens of Uganda.