Investing in women’s Health is not a mere humanitarian call, it is a human right and development issue

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation.

By Fatia Kiyange

Every year, on the 28th of May, the world marks International Day of Action for Women’s Health. The day symbolises the importance of giving attention to the health of women and girls. It reminds nations that women’s rights are human rights. Reflecting on the World Health Organization’s definition of health, women’s and girl’s health means that women and girls are in a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Women play an indispensable role in the health of their families and consequently their communities. Because of this, investing in their health is an investment in population health with positive implications for the country’s overall development.

Women’s health, especially in lower-income countries is influenced by many factors. These range from social, cultural and economic to gender, biological factors and place where they live. These come with a myriad of barriers which make it difficult for women and girls to access health care services at the time and in a place where they need them. This constitutes an injustice and a violation of the right to good health and well-being for women and girls, consequently affecting their physical, psychological, mental and spiritual state.

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners. Uganda’s maternal mortality ratio is still high at 336 per 100,000 live deliveries, and this translates into 18 deaths per day. This is way above the target of reducing maternal mortality to less than 70/100,000 births under Sustainable Development Goals. Important to note is that 28% of maternal deaths are among young women aged between 15 to 24 years. Early and unwanted teenage pregnancies are still high with a prevalence of 25%, one of the highest in East and Central Africa and with a national target of reducing it to 15% in the National Development Plan III 2020/21-2024-25. Our child marriage rate also remains very high at 43%. Despite the high total fertility rate of 5.4 contributing to the high population growth rate of 3%, the country has a high unmet need for contraception and other family planning services of 23.8% with a national target of reducing this to 10%. The HIV prevalence among women (7.6%) is higher than the national rate of 6.2%. Sexual and gender-based violence has remained high with spousal violence reaching 56% and sexual violence at 26%. A total of 12,715 cases of defilement (among children 0 -17 years) were reported in 2022 according to the Police crime report for the same year with 653 of these happening among children aged 0 – 8 years.

There are also health conditions women and girls suffer because of their biological make up. These range from reproductive cancers like breast cancer, cervical cancer, to menopause, pregnancy and menstrual cycle challenges. Urinary track infections and sexually transmitted diseases present more in women with undesirable effects.

It is now common knowledge that the Covid-19 pandemic and some of the response measures exacerbated indicators for sexual reproductive health, especially among young people and heightened the need for specific health services, such as mental health. However, emphasis for post-Covid recovery have been placed more on stimulating economic recovery programs. Attention towards access to quality health care for the most vulnerable members of our society could be given more attention to realise full recovery from the multifaceted impact of Covid-19.

All nations are working to realize the 17 SDGs by 2030 and committed to prioritise progress for those who are furthest behind by pledging to “Leave No One Behind”. Uganda among the first countries to develop a national development plan in line with SDGs for which Universal Health Coverage (UHC) under SDG 3 on good health and well-being is central. UHC means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliation) without the risk of financial hardship when paying for them. Given their economic challenges, women and girls especially those in the remotest areas are more likely to experience catastrophic expenditures on health which push them further down into poverty. A common and practical example is the reality of women and girls having to bear the cost of sanitary pads or their equivalent every month for the larger part of their lifetime.

As a country, we must reflect deeply on the underlying causes of these persistent reproductive health challenges of women and girls and set out to address them in the most honest and transparent way. Only then will we be able to realise Uganda’s Vision 2040 which identifies human capital development as fundamental for development. Human capital development contributes to the National Development Plan (NDP) III’s goal of increased household incomes and quality of life through increased productivity, inclusiveness, and well-being of the population. The Goal of the Human Capital Development Programme (HCDP) is to improve the productivity of labour for increased competitiveness and better quality of life for all. The challenges women and girls face in accessing health care services have to be addressed in order to realise this goal. We also have to reverse the population growth rate and structure which is largely constituted by a dependant young population.

Uganda has several policy and legal frameworks, which if well implemented can lead to improvement of indicators for the reproductive health of women and girls and consequently the health of families and communities. Examples of these are: Uganda Family Planning – FP2030 Commitments; the National Family Planning Costed Implementation Plan II; the National Sexuality Education Framework; 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School settings in Uganda; 2018 Uganda National Parenting Guideline and the second National strategy to end child marriage and teenage pregnancy 2022/2023 – 2026/2027, among others. For full implementation of these frameworks to be realised, financial resources must be allocated.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation. The projected reduction in budget allocation to the health sub-programme in 2023/232 will work against the realisation of the country’s goal of the Human Capital Development Programme (HCDP) of improving the productivity of labour for increased competitiveness and better quality of life for all.

The Writer is the Executive Director at the Center for Health Human Rights and Development (CEHURD).

Terms of Reference for the Uganda National Conference on Health, Human Rights And Development (UCHD) 2023’s Coordinator

Center for Health, Human Rights and Development (CEHURD) is seeking for the services of a competent and experienced large events organiser to coordinated the upcoming Uganda National Conference on Health, Human Rights and Development for a duration of Five (5) months (June – October 2023).

Deadline for submission of applications is Friday 26th May 2023.

Download attachment below for details;

Business or Human Rights? The case of CEHURD and two others against JARO Hospital

CEHURD, has on several occasions challenged Ugandan electricity service providers and regulators for cutting off power supply in health facilities which often jeopardizes the enjoyment of the right to health. Whereas, hospitals are obliged to clear their electricity bills, the measures against such noncompliance should not be meted on babies in incubators, patients on life support and all other health services that operate on electricity.

By Seth Nimwesiga

This concept of business or human rights has attracted attention over the recent years alongside capitalism. It recognizes that businesses should be accountable for their actions. That they have a responsibility to respect human rights and to ensure that any risks against human rights arising out of their operations are prevented, addressed or mitigated.

Over the years, CEHURD has documented cases where business owners under the ambit of private health facilities detain patients for failure to pay medical bills. First, Patrick Obiga who in 2016 was involved in an accident and was rushed to International Hospital Kampala for emergency treatment. His family was able to pay twenty million shillings (20 million) of the thirty-eight million shillings charge, leaving a total of eighteen unpaid, and he was detained as a result. Following CEHURD’s interventions, Patrick was let go by the facility.

We assumed at the time that the media attention had sent a message to the facilities, but to our surprise, in 2022 another facility continued the practice that led CEHURD to engage the courts of law.

The High Court of Uganda delivered a landmark judgement against the detention of patients in private health facilities for non-payment of bills. This followed a case filed by Center for Health Human Rights and Development (CEHURD) and two others against Jaro Hospital and its proprietor, for detaining a 14-year-old boy whose parents could not cover, in time, a bill amounting to over 4 million Uganda Shillings after treatment. The decision is significant for several reasons.

First, it reemphasizes the need to protect the right to health as enshrined in international human rights law as well as in the domestic legal framework in Uganda.

Secondly, the ruling upholds the rule of law, it mandates that private healthcare facilities provide crucial essential healthcare services in a way that is both morally and legally compliant. Private hospitals have a duty to provide quality healthcare to patients, but they also have the responsibility to ensure that their business practices keep in line with the provisions of the law. The High Court of Uganda’s ruling flags the detention of patients as neither fair nor reasonable.

Thirdly, the case exposes the rampant concerns around power imbalances existing between companies doing business and individuals enjoying human rights. Patients who seek healthcare services are often vulnerable. Their enjoyment of human rights is often jeopardized by the demands of the health service providers. The case is a timely reminder that private health facilities ought to operate in a manner consistent with the rule of law and the protection of human rights.

In response to the judicial pronouncement, proprietors of private health facilities do, or threaten to demand collateral or indeed a cash deposit from patients before they receive any services. This raises questions of the intersectionality of business, human rights and the role of the state. The judge advises the facilities, in this case to explore alternatives of debt recovery to claim bills due rather than detain patients.

The detention of patients in private hospitals for non-payment of bills, as such, is a violation of human rights. Such false imprisonment in a non-designated detention facility is an actionable wrong which deprives individuals of their right to liberty and violates their dignity as well.

The judgement also demonstrates the role of different state actors, the judiciary in this case, which is a positive development in the area of business and human rights. The judiciary has sent out a strong message to businesses that they must respect human rights and that they will be held accountable for any violations.

However, more needs to be done to ensure that businesses respect human rights. For instance, several cases have sprung up regarding power blackouts in health facilities for governments non-payment of electricity bills. CEHURD, has on several occasions challenged Ugandan electricity service providers and regulators for cutting off power supply in health facilities which often jeopardizes the enjoyment of the right to health. Whereas, hospitals are obliged to clear their electricity bills, the measures against such noncompliance should not be meted on babies in incubators, patients on life support and all other health services that operate on electricity. Another example is a case where CEHURD challenged the failure of the health minister to regulate the cost of treating COVID-19. All this goes to show that beyond profit maximization, health workers swear an oath to save lives which should be prioritized in accordance with the law.

The state has a role to play in setting standards and regulations that promote human rights and hold businesses accountable for their actions. Businesses also need to take proactive steps to respect human rights and to prevent any negative impacts that their operations may have on human rights.

The case and judgment by the High Court of Uganda could not have come at a better time than now when conversations on the health insurance scheme for Ugandans have stalled in parliament. The Judiciary has struck. Both the legislature and executive arms should follow suit in setting the balance clear. The populace needs available, accessible, acceptable and quality healthcare. The capitalists want their money. Where are the answers?

The writer is a Strategic Litigation lawyer at Center for Health, Human Rights and Development (CEHURD).

Call for Expression of Interest to Conduct a Midterm Evaluation for the Joint Advocacy for Sexual and Reproductive Health and Rights (JAS) Programme in Uganda

The Center for Health, Human Rights and Development (CEHURD) with nineteen (19) partners are implementing a four-year programme titled: The Joint Advocacy for Sexual and Reproductive Health and Rights in Uganda (JAS) Programme in Uganda. The JAS programme is due for midterm evaluation to assess the progress so far made in the implementation. CEHURD therefore, seeks to engage a consultant / firm to support in the external evaluation of the programme that will inform decision making for the remaining period of implementation.

Deadline for application is Friday May 26th 2023.

The Unsung Heroes: Celebrating the Resilience and Dedication of Nurses in Uganda

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

By Christopher Ogwang

International Nurses Day is celebrated annually on May 12th to commemorate the birth anniversary of Florence Nightingale, the founder of modern nursing. This day is an opportunity to acknowledge the contributions of nurses to society, raise awareness about the challenges they face and find possible solutions to them.

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

Uganda, like many other low-income countries, is struggling with a severe shortage of healthcare equipment and supplies. According to a report by the World Health Organization (WHO), Uganda has only 1.2 hospital beds per 1,000 people and a severe shortage of medical equipment, including diagnostic tools, surgical instruments, and anesthesia equipment. This shortage of equipment has a direct impact on the quality of care that nurses can provide, as they often have to work with outdated or insufficient tools.

The shortage of equipment is particularly evident in lower-level healthcare facilities, such as health centers, which are often located in rural areas. These facilities often lack basic equipment like stethoscopes, blood pressure cuffs, and thermometers, making it challenging to diagnose and treat patients. 

On this Nurse International Day, let us take a moment to recognize the challenges that nurses in low-income countries like Uganda face every day. We must work together to address the shortage of equipment and supplies and ensure that nurses have the tools they need to provide quality care to their patients. By investing in healthcare infrastructure and supporting initiatives that provide equipment and supplies, we can help nurses in Uganda provide the care their patients deserve.

The writer is a Senior programme officer at CEHURD in the Campaigns, Partnerships and Networks Programme.

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