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Reflecting on CEHURD’s Achievements and Stories of Success in Uganda’s Health Care System

CEHURD launched a national campaign to raise awareness of and advocate for safety in health-care facilities, recognizing that safety is a prerequisite for a strong health-care system.

Israel iya jeep

Post-World Patient Safety Day 2022 by Israel Iya Jeep                                    

The world patient safety day is observed annually on 17th September with the objective of increasing public awareness and engagement, enhance global understanding, and work towards global solidarity and action by member states to promote patient safety.[1] Across the world, unsafe medication practices and medication errors are a leading cause of avoidable harm in health care [l1]  and this year’s theme for the World Patient Safety Day embraces this fact. The theme builds on the ongoing efforts by the World Health Organization to ensure medication without harm. The theme provides the necessary motivation to take urgent action towards reducing medication-related harm through strengthening systems and practices of medication use.[2]  The world patient safety day is thus a global campaign calling on stakeholders to prioritize and take early action in key areas associated with significant patient harm that may occur due to unsafe medication practices. Furthermore, the world patient day offers great potential to raise awareness and understanding of health issues and mobilize support for action, from local communities to the international stage to further the fundamental principle of medicine “do no harm”.[3]

CEHURD with support from the Joint Advocacy for Sexual and Reproductive Health and Rights (JAS) Programme in commemoration of world patient safety day, kick-started a national campaign to amplify and advocate for safety in health facilities, recognizing that safety is a prerequisite for a strong health system. CEHURD is contributing – towards ensuring safety issues in health facilities are addressed and to this end, CEHURD has challenged the actions and inactions of hospitals that put patients safety at stake for instance, it challenged Mulago hospital on new born care and management, challenged the actions and omissions of the government of Uganda for failure to provide minimum maternal health services in petition 16 – What the constitutional court decision on access to basic maternal healthcare means, CEHURD with the Uganda Medical Association advocated for Prioritization of safety of health workers to protect patients during covid-19-and-beyond, an increase of salaries for health workers, documented facts on the state of health facilities and amplified the voice to renovate, build and ensure adequate health infrastructure. All these efforts are aimed at ensuring that patients’ safety is guaranteed and no patient suffers injury or dies because of unsafe and poor health care.

CEHURD’s efforts have recorded stories of success and progress in the health sector; he first success was achieved in constitutional appeal 01 of 2013, In this case, CEHURD contended that the non-provision of basic indispensable health maternal commodities in government health facilities and the imprudent and unethical behaviours of health workers towards expectant mothers contravened the constitution.  The supreme court, in rejecting the political-question-doctrine defence raised by the Attorney General, held that the executive cannot escape scrutiny where its actions or inactions violate constitutional provisions and that Article 20 of the constitution does not exclude any institution from respecting, upholding and promoting human rights. 

In addition to the above, the supreme court opened gates for public interest litigation especially in the area of health rights and patient safety when Justice lady Esther Kisaakye held that it’s not a requirement under the constitution for a petitioner who seeks redress to show that they suffered a personal legal grievance. CEHURD has leveraged on this order to bring legal action to advance health rights and cause structural reforms in the health sector as demonstrated in civil case No. 212 of 2013 in the High Court of Uganda between Center for health, human rights and development and others v Executive Director Mulago Hospital and others. In this case, court issued orders in form of structural interdicts in the health sector for instance orders requiring that Mulago hospital as a mandatory obligation takes steps to ensure and or enhance the respect, movement and safety of babies, dead or alive in hospitals and orders relating to the Executive Director of Mulago hospital to submit as a mandatory duty a written report every after 4 months regarding the steps taken to enhance the respect, movement and safety of babies to CEHURD.

Still in the jurisprudential circles, the dismissal and the decision in Uganda v Kato Frederick criminal case 56 of 2020 builds confidence among medical practitioners to continue providing safe-post-abortion care to different people that enter the doors for help which in turn may   reduce the severe effects of unsafe abortion that contribute to high maternal mortality rates[l2] . The case demonstrates that medical practitioners can provide safe post abortion care without fear of getting prosecuted.

CEHURD has conducted policy and legal framework mapping aimed at identifying laws, bills, policies, strategies and guidelines affecting self-care to identify opportunities and gaps that  inform advocacy for institutionalization of self-care in Uganda. [l3] 

CEHURD has also conducted research and facilitated investigations on the state of health facilities in Uganda for example the “No safety guarantees in moribund health system | PANORAMA” documentary which identified issues relating to poor quality health care, health expert shortage, unskilled man power, inadequate documentation of statistics relating to patient safety, inadequate man power, lack of infrastructure, ageing infrastructure among others. All these efforts have culminated into structural reforms in the health sector such as provision of safety gears to health workers, mitigating health expert shortage, building homes for cancer patients at the Mulago cancer institute, renovation of Busolwe Hospital, and influencing budgetary innovations in the health sector.

CEHURD has condemned detention of persons with mental illnesses and patients in health facilities, emphasising that Hospitals are not gazetted detention facilities according to the law of Uganda, and that there are special places where we have to detain people “No health facility is allowed to detain patients for any reason despite the business background. If people owe you, hand them to institutions who have that mandate.” ~ Dr Katumba | Uganda Medical & Dental practitioners’ Council.

We talk about these successes, achievements, progress to inform, influence, and inspire movements, the government, and all stakeholders to join the campaign aimed at causing positive structural changes in our heath sector and ensuring patient safety because a flourishing health sector is key in achieving our national goals. We call everyone to engage in advocacy efforts with key stakeholders including developing national campaigns, organizing policy forums, advocacy and technical events, capacity-building initiatives, lighting up iconic monuments with the goal of pursuing the objectives of the world patient safety day and the year’s theme of raising global awareness on the high burden of medication-related harm due to medication error and unsafe practices. We must not tire to advocate for urgent action to improve medication safety through engaging with health workers and other partners in the health sector in the efforts to prevent medication errors and reduce medical-related harm. We must empower patients and families to be actively involved in the safe use of medication, and scaling up implementation of the global patients’ safety challenge which is medication without harm.

In conclusion therefore, we all have a role to play in ensuring patient safety and the call for all persons to fully embrace and actively take part in activities aimed at promoting awareness and mobilize support for safety in health facilities at large.

The writer is an intern at the Center for Health, Human rights and Development.


[1] World patient safety day 2022 accessible at https://www.who.int/news-room/events/details/2022/09/17/default-calendar/world-patient-safety-day-2022

[2] Supra

[3] World patient safety day accessible ta https://nationaltoday.com/world-patient-safety-day


 [l1]This is repeated in the same sentence so lets keep the one at the beginning of the sentence

 [l2]I don’t know if this is a fact because we don’t have evidence that the numbers have reduced

 [l3]This is not very accurate so just leave it out.

Civil Society Appeals for an Extension on Standards for Intellectual Property Rights on Medicines

Uganda –Kampala —Civil society Organizations working on health and access to medicines have today appealed to His Excellence Ambassador Christopher Onyanga Aparr the Permanent Representative to the Permanent Mission of Uganda to the United Nations in Geneva to lead Least developed County (LDC) members of the World Trade Organization (WTO), to act collectively to submit a duly motivated request to the Council on Trade Related Aspects of Intellectual Property (TRIPS) for an indefinite extension of the soon-to-lapse pharmaceutical transition period at the upcoming TRIPS Council meeting on 24th February, 2015.

According to a 2002 WTO TRIPS Council decision, member countries of the WTO considered to be least developed are exempted from enforcing patents and data protections on Pharmaceutical products for until 1st January 2016.

Intellectual properties such as patents raise the costs of medicines because patent holders can eliminate competition which would otherwise lead to cheaper prices. Global studies, including the MSF, Untangling the Web of Antiretroviral Prices routinely show that generic medicines are almost always priced lower than even the discounted prices drug companies sometimes offer to lower-income countries like Uganda.

In a letter dated 16th February, 2014 civil society groups recalled Article 66.1 of the TRIPS Agreement which provides to the effect that the Council for TRIPS “shall, upon duly motivated request by a least-developed country Member, accord extensions”.

In this appeal, the groups are of the view that the extension of the transition period be for as long as an LDC Member State remains a LDC, without conditions, and that it should further motivate waivers of Articles 70.8 and 70.9 to the General Council, also for as long as an LDC Member State remains an LDC. The detailed letter can be accessed here>>

The non film coated tenofovir+lamivudine is a two drug combination used with a third medicine, typically efavirenz or nivirapine.

“Cease Use of Bitter medicines” – CSOs ask of government

PRESS STATEMENT

People living with HIV Call for Urgent Action by Health Ministry to
Cease Use of “Unusable” Medicine
Risk of Chaos in HIV Treatment Undermines the Right to Health

For Immediate Release: September 2 2014
Contact for more information: Kenneth Mwehonge, HEPS Uganda and
Uganda Coalition for Access to Essential Medicines:: 0701182809
Margaret Happy, International Community of Women Living with HIV East
Africa: 0772695133
Read More “Cease Use of Bitter medicines” – CSOs ask of government

More than 500 abortions in Gulu last year, says report

By Cissy Makumbi 

Gulu hospital management has called for government intervention following the release of a report showing an increase in cases of abortion in the district.

The report released on Wednesday shows that up to 568 babies were aborted in the year 2011/2012.

The authorities, who compiled the report, say there is need to save the unborn babies from the practice, common among girls who have unprotected sex for money.

In 2010/2011, about 500 unborn babies were terminated, according to the same report, although it still remains unclear whether the culprits were brought to book, since the practice is a crime under the law.

The director of the hospital, Dr Anthony Onyach, however, attributed the increase in the vice to failure by many mothers to use family planning methods, thus conceiving against their will.

“Most abortions occur among girls who report to the hospital when they are very sick after administering herbs and other drugs on themselves, while others seek help from shrines,” Mr Onyach said.

The same report indicates a drastic decline in the number of mothers seeking family planning services at the health facility. It shows that although in 2010/2011 there were at least 1,239 mothers who visited the hospital’s family planning unit, in 2011/2012, the number reduced to only 770.

Health experts attribute the increasing number of women with cervical cancer to unsafe abortions. Under the law, abortion is illegal and punishable, a situation that sees many women do it undercover with support from ill-equipped health personnel and traditional healers.

The Ministry of Health is considering the recommendations of a report it commissioned into the safety and legality of abortion. The report proposes legalising abortion in specific cases such as rape.

However, the debate on legalising abortion has not been met with open arms, with the proposal opposed by many Ugandans, most arguments based on religious, cultural and moral grounds

Source: http://www.monitor.co.ug/News/National/More+than+500+abortions+in+Gulu+last+year++says+report/-/688334/1506654/-/vx98ym/-/index.html

Indian patent rules infuriate Big Pharma

A CLASH over India’s drug market was inevitable. Foreign drugmakers, facing paltry growth in the West, are eyeing India hungrily. Rising incomes and rates of chronic disease may push sales from $12 billion in 2010 to $74 billion in 2020, according to PwC, a consultancy. But tapping this growth means having patents that protect intellectual property. India is home to a thriving generics industry, whose copycat drugs make up about 90% of the market. India’s drug-patent laws are just seven years old. Its government is keen to encourage generics and keep prices down.

Now India’s patent rules are being put to the test. Novartis, a Swiss giant, is challenging India for denying a patent for Glivec, its blockbuster cancer drug. The fight is due to reach India’s Supreme Court on September 11th. Bayer, a German drugmaker, has a different problem: in March India’s patent controller ordered it to license a drug to a local manufacturer. Its appeal had its first hearing on September 3rd. The cases will help decide how quickly India’s 1.2 billion people get new drugs, and at what price.

India’s drug industry has a unique history. For more than 30 years, the country did not recognise pharmaceutical patents. Domestic firms became masters at copying medicine and making it cheaply. After joining the World Trade Organisation (WTO) in 1995, India had to change its patent policy. But its new system, in place since 2005, includes special protections for both patients and generic manufacturers.

For example, the law bars patents of minor changes to existing drugs, a practice known as “evergreening”. Drug reformulations are often used to extend patents elsewhere; they get no protection in India. The country also has broad criteria for “compulsory licensing”. A WTO agreement allows countries, in some instances, to force a firm to license a patented drug to a generic company. India’s rules give officials broad powers to do this.

Now both provisions are under attack. In 2006 India denied Novartis a patent for Glivec, calling it an unpatentable modification of an existing substance, imatinib. Novartis insists this is nonsense. Only by making it in salt form, imatinib mesylate, did Novartis have a proper drug: the body absorbed the medicine 30% more easily.

Paul Herrling, the chair of Novartis’s Institute for Tropical Diseases, says the case is a test of what is patentable in India. “We are being accused of evergreening,” he says. “Having that concept applied to Glivec, which was one of the major breakthroughs in cancer therapies, is completely ridiculous.” Michelle Childs of Médecins Sans Frontières, a non-profit, retorts that drug firms such as Novartis should not win patents for minor improvements. This would keep generics off the market, driving up prices.

Bayer’s case is equally heated. In 2008 it won an Indian patent for Nexavar, a kidney-cancer drug. But in March India’s patent controller issued the country’s first compulsory licence. He wrote that Bayer had not made Nexavar “reasonably affordable” (Bayer offered it for a whopping $5,000 a month), that the company failed to provide enough of the drug and, in a protectionist nod, reckoned that importing Nexavar further hurt Bayer’s case. The controller ordered an Indian company, Natco, to sell Nexavar for one-thirtieth of Bayer’s price. Bayer will receive a 6% royalty. Meanwhile Bayer is fending off another competitor, Cipla, which has sold generic Nexavar in India for years.

As these cases drag on, India’s government is considering other ways to get cheaper medicine. It plans to offer free generics in public hospitals, which would drive up sales of very cheap copies. It may also set price controls for patented drugs. However, generic companies are not immune to regulatory pressure. Ministers plan to expand price controls for a broader swathe of generics.

Cost versus innovation

 

 

“We realise the industry will take a hit,” explains D.G. Shah of the Indian Pharmaceutical Alliance, which represents big generic companies. “We’re trying to find a solution so that the government’s concerns on access and affordability are addressed without threatening the long-term growth of the pharmaceutical industry.” Nice work, if they can get it.

Source: http://www.economist.com/node/21562226