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My Experience Litigating Sexual and Reproductive Health and Rights Related Cases

“Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Such are the places where every man, woman and child seeks equal justice, equal opportunity, and equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere.”

Eleanor Roosevelt

By Ruth Ajalo | Lawyer

Before joining the Center for Health, Human Rights and Development (CEHURD), I had basic information
about the right to health. This basic information was gained while pursuing the health and the law course
unit in my fourth year at Makerere University Law School. Learning the right to health was exciting and it
set a spark within me that I desired to carry forward in my career. This did not materialise immediately after Law School but when I eventually joined CEHURD, I was excited and looked forward to learning more about the right to health and this unique area of legal practice.


At CEHURD, I have learnt, unlearnt and I continue to learn each day about the right to health and the
intersectionality of health and human rights. I can confirm that there is a lot of knowledge and exposure that the right to health brings to light. CEHURD, among other things, provides legal support to victims and survivors of sexual violence and health rights violations. It also litigates strategic cases aimed at addressing systemic gaps and bottlenecks within the provision of health services in the country. 


CEHURD prepares, nurtures, and gives you a platform to shine and build your career. As a legal
practitioner, last year, I had the unique opportunity of litigating a landmark Sexual and Reproductive Health Rights case before a bench of five justices of the Constitutional Court. This is a dream come true for any young lawyer.


My experience in handling and litigating SRHR cases has been an emotional rollercoaster; it has been easy, hard, tasking, draining both physically and emotionally at times but above all, fulfilling. It is exciting to secure a win for a client and a win for the transformation in the provision of health services in the country.
Litigating SRHR cases is unique because this is not something you do without learning, unlearning,
understanding and preparing. Your mind is trained to creatively pick out the rights issues in the case and
articulate them sufficiently in a manner that reflects preparation and in-depth knowledge of the issues at
hand. Furthermore, the external lawyers we work with on some of our cases have to be oriented on the
unique aspects of the right to health and why it matters before they delve into the gist of the cases. This
calls for thorough research, preparation which continuously builds one’s mastery in the area of Health and Sexual and Reproductive health.


When a person calls the CEHURD toll-free line or walks into the office seeking help, that person is either
seeking information or is seeking for support. They are usually hurting or have suffered some form of loss
and need redress and or some form of support. Regardless of the circumstances and the facts of the case,
as lawyers we are expected to be non-judgmental, good listeners and provide the most appropriate
professional support. During the client-advocate meeting, when the client breaks down and starts to cry, the counsel must wear another hat of a counsellor and have to exercise empathy towards them. This requires that the lawyer for a moment, abandons the legal path and the knowledge acquired in Law School to concentrate on helping a client recompose through provision of Psychological first aid. This requires that for a moment, you abandon the legal package and knowledge you walked into the meeting with, and take on a new mantle of a counsellor.

We walk the journey with our clients, we counsel them, we exercise empathy, we hand-hold, we manage expectations and above all, we keep an open mind as we handle these cases. It is important to note this process also takes on an emotional toll on the lawyer and calls for selfcare. The emotional toll is largely because lawyers by training are not counsellors but in country with limited professional counsellors, any lawyer will by default provide; counselling to their clients especially when engaged in SRHR.


This type of work is not void of challenges such as the heart-breaking experiences of the clients, and being misunderstood by the public because of the nature of the work done, among others. Sexual and
Reproductive Health is a largely contested arena. Listening to clients’ experiences can get emotionally
draining because their experiences are in most cases very painful and nobody deserves to go through such grueling experiences. Furthermore, the clients are not conversant with the litigation progress and despite an effort to explain to them and manage expectations, they get burnt out and experience litigation fatigue.


Litigating human rights will certainly be difficult for any client especially if they are facing stigma,
discrimination, abuse, and isolation among others because of the delay in the disposal of their cases. 
To respond to these challenges, CEHURD has invested in the provision of psychosocial support to the
legal team that handles these cases, general staff wellness and welfare to enhance the continuity of
litigation. We also share and learn amongst ourselves in the Strategic Litigation Programme with the view
of bettering ourselves. We also hold annual clients’ meetings where clients are invited for interactions and
update meetings about their cases, clients share amongst themselves and learn from each other and we
also receive feedback which we find useful for improving our service delivery.


As mentioned, we are sometimes misunderstood by the public but choose top stick to our calling trudge on nonetheless, undeterred and ever so ready to defend and stand for our clients’ rights and for system
change. 
Justice for our clients comes in many forms; arrest of an accused person, sentencing (imprisonment) of an
accused person, an apology from the health worker, an explanation offered for what went wrong, an
admission of wrongdoing from the health facility or health worker among others. It is these small wins and seeing systemic changes in the provision of Health that is the power below my wings and that keeps me waking up every day to provide legal support.


Despite all the hurdles and challenges encountered, the work is fulfilling. Fulfilment is in the fact that you
helped a person and they didn’t pay you for that service; that you utilised your legal knowledge to address a human rights violation and get justice for your client. Fulfilment is the phone call from a grateful client highlighting his or her gratitude “mwebale nyo, tusimye byona bye mwakola” –” thank you very much, we appreciate everything you do for us”. Some clients call us to update us on the progress of their daughters who suffered violence to indicate that our interventions built the girl’s confidence, she returned to school and she passed her Primary Leaving Examinations (PLE). 


To all human rights defenders, your work is not in vain; a step-by-step effort, a multi-sectoral approach, and perseverance will go a long way in realising a just society; a society in which people are free from sexual violence, free from health rights violations and all other violations around us. Let us persevere and keep the flame burning because society and the world at large still need us. 


Helping one person might not change the world, but it could change the world for one person” – Anonymous.

The writer is a Programme Officer in the Strategic Litigation Programme at the Center for Health, Human Rights and Development (CEHURD).

End Gender Inequalities and End Aids by 2030

We have to agree that the epidemic will not be over until the cycle of new HIV infections is stopped and all people who need it are on lifelong treatment. Treatment alone is unlikely to end AIDS, prevention is also essential. Too many adolescents and young women are still falling between the cracks of the global response.
It is important to note that gender inequality such as gender-based violence leaves young women and girls more vulnerable to HIV. It also restricts the rights of women and adolescent girls, including their ability to refuse unwanted sex or negotiate safer sex, and access HIV and sexual and reproductive health services.

By Mary Nyaketcho

For over 40 years, the 1st of December has offered an opportunity to rally support for people living with and affected by HIV and also to honour those who have died from Aids-related illnesses across the world. Uganda and the world at large are still lagging behind in reaching the commitment to end Aids by 2030 not because of a lack of knowledge or materials to beat Aids, but because of various barriers that obstruct HIV prevention and treatment. Discrimination, gender inequality, poverty, and criminalisation are barriers that prevent people living with HIV/Aids from accessing healthcare. Therefore, World Aids Day raises awareness of the impact of HIV on people’s lives to advocate against stigma and discrimination against those living with HIV and also to highlight how far we have come.

The theme “ending inequalities among adolescent girls, young women and boys” is a call to action. It is a call to action for all of us to confront the inequities that drive AIDS and hinder access to essential HIV services, especially for adolescent girls and young women and boys. The high HIV prevalence among adolescent girls and young women and boys suggests that factors beyond behaviour may be contributing to the heightened vulnerability of this group. Without bold action against inequalities, the world is likely not to reach the target of ending AIDS by 2030. 

Regardless of the enormous advances made to eradicate AIDS globally, adolescent girls, young women and boys are disproportionately at risk of acquiring HIV, a fact that must change. Urgent action to reduce the risk of adolescent girls and young women to HIV is vital to end the epidemic. This won’t be achieved without addressing the entrenched gender inequalities that exist where these girls and young women live.

Globally, young people are among the populations most at risk of and affected by HIV and AIDS and Uganda’s population constitutes a significant percentage of young people. Young girls and boys rarely receive sexuality education and only rely on the wrong perceptions given by their fellow youth. This situation might continue unabated unless causes of vulnerability to infection among them are clearly identified and addressed within respective contexts.

Many adolescent girls and young women aged 15 to 24 years in Uganda are more susceptible to HIV infection than their male counterparts. Adolescent girls and young women are biologically more vulnerable to AIDS and twice as likely as men to become infected, according to the UNAIDS Global AIDS Update 2022. They are at a greater risk because they are physically and physiologically more vulnerable to the sexual transmission of HIV than men their own age. 

It is important to note that gender inequality such as gender-based violence leaves young women and girls more vulnerable to HIV. It also restricts the rights of women and adolescent girls, including their ability to refuse unwanted sex or negotiate safer sex, and access HIV and sexual and reproductive health services. Take for example the situation of early marriage. Gender inequality is at the heart of what drives these marriages. In poverty-stricken communities, most girls are married before the age of 18. Early marriage has profound consequences for the health and well-being of adolescent girls and young women. They are at a greater risk of sexual and gender-based violence and sexual violence is closely linked with an increased chance of acquiring HIV. The men they are married to are also often older and have already been sexually active, which also increases the risk. In addition, it is quite difficult for adolescent girls and young women to negotiate safe sex and condom use. 

Many cultural practices also impede efforts to tackle Aids-related issues. A girl is taught from an early age to be submissive and obey men. The girls have not been taught how to say no, how to say what they want and what they do not want. As a result, adolescent girls and women cannot say no to sex, and not request safe sex if a man does not want to use protection.

For that reason, tackling inequalities is a long-standing global need, whose urgency has only increased. However, ending inequalities requires a lot of transformative change. Economic, political, social, cultural and legal inequalities obstructing progress must be addressed. 

We should endeavour to look into laws and policies that address these inequalities and observe the need to protect the rights of everyone especially adolescent boys and girls and young women. By removing punitive laws, policies, practices, stigma and discrimination that block effective prevention and treatment of AIDS, inequalities will be struck out and with more advocacy on this, HIV/Aids shall subsequently end.

At the societal level, we should address the social and cultural norms and practices that perpetuate inequality. It is clear that addressing inequalities and inequity will require the motivation and engagement of the people who are most affected. Therefore, efforts should be made to empower and strengthen people. 

Staying in school reduces the likelihood that adolescents will be infected with HIV/Aids. Education helps individuals protect themselves against HIV infection. But education itself alone does not help, also, there is a need to integrate sexuality education into the curriculum to equip young people with knowledge about HIV/Aids and their rights.

It is time for the government to act with bold and accountable leadership and move from commitment to action. It must promote inclusive social and economic growth. The government ought to also realise that ending HIV/Aids requires ending all inequalities and driving multisectoral action across a range of sustainable development goals (SDGs) and targets and that promoting equal opportunity are fundamental issues for development and sustainable growth. 

We have to agree that the epidemic will not be over until the cycle of new HIV infections is stopped and all people who need it are on lifelong treatment. Treatment alone is unlikely to end AIDS, prevention is also essential. Too many adolescents and young women are still falling between the cracks of the global response.

Therefore, this year, let us be mindful of the inequalities that exacerbate the dangers for everyone, no matter our status, we are all affected by HIV/Aids in one way or another. So, let’s do all we can in order to help tackle the inequalities and end AIDS.

The writer is an intern in the Community Empowerment Programme at CEHURD

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.

JUDGEMENT: Supreme Court orders the Constitutional Court to hear Maternal Health Cases

The judgment struck down a 2012 ruling by the Constitutional Court that it had no mandate to hear a case regarding the alleged violation of health rights and the rights of women.

The case had been filed by families of two pregnant women who died in childbirth and the Center for Health Human Rights and Development (CEHURD) against the Attorney General in 2011 (Constitutional Petition No. 16 of 2011), arguing that non-provision of maternal health services in Uganda violated the Constitution.

The Attorney General argued on preliminary objection that issues relating to health rights were “political questions”—matter that the Judiciary had no authority to address. Constitutional Court agreed with the State’s objection and dismissed the case.

The Supreme Court’s ruling struck down the Constitutional Court’s judgment, and means the original case can now be heard on its merits.

“With great respect to the Constitutional Court, I think they misunderstood what was required of the court. I do not think the court was required to determine, formulate or implement the health policies of government. In my view, the court is required to determine whether the government has provided or taken all practical measures to ensure the basic medical services to the population. In this case it is maternal services in issue” Bart M Katureebe, Chief Justice

 

 

Access to information, Why it should matter for Communities.

Today information about the global community is continuously becoming more available yet the space to access information supposedly closer to us and about issues that affect us more directly becomes narrower and narrower. But just to what extent is one entitled to know about activities that go on in their backyard that significantly impact their livelihood when they have no proprietary rights in said activities. Human lives and health are significantly affected by the nature of their environment and the activities that are carried out in their environments and the government has through the National Environment Management Authority (NEMA) set up measures to ensure that the environment is not affected by any activities including by requiring impact assessments before such activities are carried out.

Read More Access to information, Why it should matter for Communities.