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By Kitandwe Rhodine

With young people constituting the greater part of Uganda’s population, any health system that does not respond to their health needs misses an opportunity to transform its community. National Development Plan III recognizes the important role that young people play in fostering economic transformation of this country. However, to be able achieve this, young people’s Sexual and Reproductive Health must have been addressed. A healthy and productive population is a critical driving for the realization of demographic dividend.  This, 12th of August, the international community is celebrating the potential of youth as partners in today’s global society.  This day is celebrated under the theme, Green Skill for youths: towards a sustainable world.  While green jobs are critical in achieving the demographic dividend, young people’s health is a key driving force in enhancing their productivity. The youth day therefore provides an opportunity for the country to reflect on the sexual and reproductive health of young people as a driver for economic growth.

Further, for a country like mine to be able to rethink its sustainability, especially with the fast-growing population of young people, improving its legal and policy framework on SRHR for them is key. In doing so, the government needs to put into consideration their unique sexual needs as well as invest public resources in the realization of the right to health. This will assure them a functional public health delivery system which is critical not just for the young people but the poor and marginalized communities in our society. A study by the world Bank demonstrated that young people are among the poorest strata in our community and as such the biggest beneficiaries of a functional public health system.

It is also important to note that one of greatest inhibiting factors to access to health and sexuality information for young people continues is misinformation and contestations of certain populations within the society. Even when sexuality education is provided in schools (which attract  about 39% of girls and 38% boys), much of what should be given  is not curriculum based. Ideally, there is a lot of information that young people have is from peers and internet yet with the developments in the world, majority of the populace that cannot access this have failed to understand the dimensions of young people. Perhaps, if the government had done much more than it provides and ensured that such information can be accessed in facilities beyond schools, sensitized communities, we would be in a much better place. The cost of inaction in as far as young people’s Sexual and reproductive health is concerned is extremely high.

Teenage pregnancy is currently responsible for nearly one fifth (18 percent) of pregnancies in Uganda and nearly half (46%) of unwanted pregnancies. It is worth noting that teenage pregnancies contribute 20% of infant deaths and 28% of maternal deaths. Access to sexual and reproductive health information and services is extremely crucial for young people.

Many young people see their potential hindered by social norms, cultural attitudes, institutional and structural barriers and violations of their fundamental rights by virtue of their age. Even when they require sexual and reproductive health services, young people often face discrimination and stigma because of societal norms in countries around the world. As a result, that judgement feeds back into health services where young people fear that their confidentiality is not secure or that they will be discriminated against. Discriminatory laws or policies prevent young people from accessing sexual and reproductive services without parental consent, or even allow healthcare workers to deny services based of their own religious beliefs.

As we commemorate the International Youth Day, we need to reflect on the need to transform the public health service delivery so as to be able to service the health needs of young people. We need to embolden young people, create for them platforms to engage in decision making and contribute to national discussions and development. This way, we will assure them of a sustainable world.  The Ministry of Health IN Uganda for example is working in collaboration with the Center for Health Human Rights and Development (CEHURD) will host the Uganda National Conference on Health, Human Rights and Development with a specific focus on the country’s advancement on realising the right to health within the context of the Sustainable Development Goals (SDGs). They have themed it as “The right to Health: A vital component in achieving SDGs” and will hold it between 26th to 29th September. Part of the reason for this conference is to have concrete discussions on building a strong and profound health system that serves all especially the young people. Indeed, with such platforms, the country can assure young people of a health system that serves their needs.

The writer is a lawyer, passionate about Health Rights for young people and working at Center for Human Rights and Development (CEHURD).

A version of this article was first published in Daily Monitor Newspaper on 12th August 2023.

By Noor Nakibuuka

On 10th and 11th July 2023, Africans converged in Nairobi, Kenya to commemorate 20 years of the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (The Maputo Protocol). The protocol was adopted on the 11th of July 2003 in Maputo. It is one specific piece of legislation that advances women’s rights in Africa.

The celebrations come in at a time when most African countries are facing retrogression in advancing women’s rights. Uganda, for example, has had several incidences where access to sexual and reproductive health and rights for girls and women, which is a key pillar in this protocol, is on a descending trajectory. At the same time, other countries like South Sudan have taken bold steps to adopt the protocol given its importance in advancing women’s rights in Africa. South Sudan makes the 44th country out of 55 African countries to adopt the protocol.

As we commemorated the 20 years of Maputo, the Center for Health, Human Rights and Development (CEHURD) had an opportunity to engage in one of the side events that were organized by IPAS Africa Alliance in collaboration with other partners like Akina Mama wa Afrika to specifically focus on Article 14 of this protocol. The article  discusses access to safe abortion as a key human rights issue. From the discussions, it was emphasized that indeed many African countries should look into this instrument to advance women’s rights to access safe abortion, since many still have archaic legislations that restrict the same at domestic level.

While speaking at this side event, Commissioner Njie Sallah of the African Commission on Human and People’s Rights specifically highlighted the importance of this article that, “the article is one that we would all wish to retain, highly guard and utilize it to advance women’s rights. Many African countries do not have such a progressive legislation when it comes to this issue and it’s important that as human rights activists, leaders, pan Africans, government officials, deeply think about the importance of this article”. The Maputo Protocol is one of its kind.

The commemoration also comes at a time when many countries have boldly advanced conversations around access to safe and legal abortion. In Uganda, the Constitution allows Parliament to enact a law regulating termination of pregnancy. However, since its promulgation in 1995, parliament has not taken such a step. This prompted CEHURD to institute a legal case in the Constitutional Court for an interpretation of this particular constitutional provision. The existing Penal Code Act, was enacted over 70 years ago and does not address public health discussions that have since been advanced by the colonialists including Britain to put aside such legislations. The court is yet to issue a ruling in this matter.

Uganda is celebrated for having boldly ratified the Maputo Protocol. While the state entered a reservation on article 14(2)(c) of the same, pertaining to reproductive health and safe abortion, commendable steps have been taken to advance the rights of women. Uganda enacted various pieces of legislation that place women at the forefront of decision making. Beyond the Constitution that stipulates equality, non-discrimination, the maternal role that women play in society, and the leadership of women, among others, the Domestic Violence Act, 2010, Equal Opportunities Commission Act 2007, the Penal Code Act cap 120, the Public Finance Management Act, 2015, et cetera, have provisions that advance gender equality and women’s rights.

At the 20th anniversary of Maputo, it is worthy to note that this protocol is special. Of all the regional and international human rights instruments that Uganda and other African countries have ratified, the Maputo Protocol is one of a kind and a lot of attention is paid to it. Implementation of the Maputo Protocol has been the core agenda under the Solidarity for African Women’s Rights (SOAWR) to which CEHURD is a member together with 62 other Civil Society Organisations working across 32 African countries to protect and advance women’s rights. SOAWR has ensured that each of the African member countries works towards the implementation of the protocol and reports back to the committee even when governments have fallen short of this reporting.

CEHURD celebrates SOAWR, for having taken this bold step. We will continue to work to ensure that women’s rights are recognized, protected, respected and fulfilled.

The writer is a Lawyer and Deputy Executive Director – Programmes at Center for Health, Human Rights and Development (CEHURD). 

Empowering Health Service Providers in Uganda: CEHURD’s Impact on Sexual and Reproductive Healthcare Transformation

CEHURD’s strategic litigation approach has been instrumental in strengthening health systems. By utilizing health workers as witnesses in strategic cases, CEHURD has shed light on systemic issues and advocated for policy reforms. Through these efforts, we have successfully influenced positive changes in the healthcare infrastructure, resource allocation, and access to essential medicines and supplies.

By Ms. Ajalo Ruth 

CEHURD is a non-governmental, not-for-profit indigenous research and advocacy organisation established to pioneer advocacy for the justiciability of the right to health in Uganda and East Africa, and with a regional and global impact. CEHURD works towards ensuring that the vulnerable communities in Uganda access health systems and that social justice and human rights in health systems are realized. One of the goals of the organization is to create an enabling legal environment and justice system that promotes, respects, and guarantees the right to health.

The provision of quality sexual and reproductive healthcare services in Uganda has long been a challenge, especially in under-served communities.  CEHURD has over the years taken a deliberate effort in transforming healthcare through legal and policy awareness on sexual and reproductive health and rights thus empowering health service providers with the right information to deliver quality health care. This has been realized through a multi-faceted approach that includes trainings, legal support, and strategic litigation.

CEHURD recognizes the critical role health service providers play in ensuring women and girls do not die due to preventable causes. It has nurtured and sustained relations with medical health service providers associations to create exchange learning platforms where health care service providers are equipped with up-to-date knowledge and skills to deliver effective healthcare services and advocate for better health care systems.

Health service providers have been trained on the Harm Reduction and Life Indication Models. The Harm Reduction Model refers to a range of public health policies and practices designed to lessen the negative social and/or physical consequences associated with various behaviors both legal and illegal, while the Life Indication Model addresses a lacuna that often arises when the state permits abortive procedures under certain exceptions, such as to save the life of the mother. These trainings ensure that health workers are equipped with the necessary information and tools to provide appropriate and compassionate care, reducing harm and improving health outcomes for patients and to keep within the confines of the legal framework in Uganda.

The trainings of health service providers have also paved the way for the development of various knowledge products with information guiding them on how to effectively offer SRHR information and services. There has also been ongoing litigation of cases which are advocating for a progressive legal and policy environment around SRHR to support health workers to operate and offer SRHR services legally.

Given the known controversies around abortion related health care services, CEHURD established the Legal Support Network (LSN). This is a network of lawyers that plays the crucial role of providing free legal services to health service providers who are caught up in the criminal justice system. In addition to representing health workers in legal proceedings relating to Sexual and Reproductive Health and Rights (SRHR) services, the LSN also aims at building a body of legal practitioners knowledgeable on the law and practice on SRHR in Uganda. Further, the LSN has been a big player in the various health service provider trainings as well as ensuring that the said professionals operate within the law.

More so, CEHURD’s strategic litigation approach has been instrumental in strengthening health systems. By utilizing health workers as witnesses in strategic cases, CEHURD has shed light on systemic issues and advocated for policy reforms. Through these efforts, we have successfully influenced positive changes in the healthcare infrastructure, resource allocation, and access to essential medicines and supplies.

CEHURD’s engagement with health workers has yielded remarkable success stories. Health workers involved in CEHURD’s initiatives have demonstrated improved knowledge of laws and policies surrounding SRHR. Their commitment and dedication have been recognized, with accolades such as “Midwife of the Year, 2022” awarded to deserving individuals with whom we have worked. These success stories serve as inspirations, showcasing the positive impact of CEHURD’s empowerment programs on health workers’ professional growth and patient care.

While our work with various health service providers  has achieved notable progress, challenges persist; limited resources, the restrictive legal environment on SRHR, cultural barriers, and social stigmas pose ongoing obstacles to effective healthcare delivery. Additionally, health workers still face risks and legal challenges in providing care related to contested issues such as safe abortion care. CEHURD continues to address these challenges through collaborative efforts and advocacy for policy reforms.

Nonetheless, we continue to invest resources in capacity building for health workers, ensuring they receive ongoing trainings to stay afloat given the slippery Ugandan environment within which they operate vis a vis the evolving healthcare context like digital service provision. It calls for strengthened partnerships with stakeholders to advocate for progressive policies, particularly in sensitive areas like abortion. Additionally, CEHURD emphasizes the importance of expanding legal support networks to protect health workers’ rights and foster a supportive environment within the criminal justice system.

The writer is a Lawyer and a Programme Officer in the Strategic Litigation Programme at CEHURD.