Non- Communicable Disease on the rise in Uganda; Who is to blame

By Ibrahim Nsereko

ncdsOut of 57 Million deaths that occur globally every year, 63% (36 million) are due to Non Communicable Diseases (NCDs). These NCDs are commonly cardiovascular diseases, cancers, diabetes and chronic lung diseases. The Uganda National Household Survey 2009/10 revealed that Non-Communicable Diseases (NCDs) and their risk factors are now an emerging problem in Uganda although the focus has been directed to infectious diseases to a greater extent. The World Health Organization notes in its 2010 global status report on NCDs, that NCDs are rising rapidly and are projected to exceed communicable maternal, perinatal and nutritional diseases as the commonest causes of death by 2030.

Risk factors leading to common NCDs such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are highly prevalent within our societies, communities and families. For example in a recent survey carried out by the Center for Health, Human Rights and Development (CEHURD) with support from United Nations Development Program (UNDP) Uganda country office, on the prevalence of risk factors for non communicable diseases among university students in and around Kampala, it was revealed that up to 67% of the respondents did not know what NCDs were, 12% of students have used drugs, particularly Marijuana, 15% were current tobacco smokers, 9% smoked Shisha. More than 40% of the respondents were staying with parents who smoke, 10% have friends who smoke, 60% have smoked for less and 57% exposed to pro-cigarette advertisements.

Who is to blame?
The World Health Organization (WHO) says that a major reduction in the burden of NCDs will come from population-wide interventions, such as tobacco control measures and cutting on raw salt intake, improved health care, early detection and timely treatment. Early detection of NCDs necessitates availability of NCD screening services in health facilities. But how many health facilities in our districts have these services?

In areas where NCD services are available, these are often hampered by access to essential medicines.
A recent visit to communities of Nyenga and Najja sub-counties of Buikwe district revealed that a huge percentage of the community members find no point in visiting health facilities if not sick let alone screening for NCDs.
“We are not interested in NCD screening if we have no medicines in health facilities within our physical reach” Laments Mary Scovia Namwanje, a resident of Bujuta B , Nyenga subcouty- Buikwe district.

The cost
With the increasing levels of poverty in Uganda, how many Ugandans can afford to buy the expensive brand NCD medicines? The situation at hand requires government to strengthen existing health facilities by providing among others essential NCD medicines and NCD screening services for at least all health center IVs as well as district, regional and national referral hospitals – prioritization of NCDs by government is the way to go.

The role of individuals in the community
The Global Strategy on Diet, Physical Activity and Health, 2004, outlines the factors that increase the risks of non communicable diseases as being; elevated consumption of energy-dense, nutrient-poor foods that are high in fat, sugar and salt; reduced levels of physical activity at home, at school, at work and for recreation and transport; and use of tobacco. Most risk factors leading to NCDs cited are preventable without incurring expenses. This requires individual and community interventions. Growing and eating of fruits and vegetables, avoiding tobacco growing and smoking, engaging in physical activities in schools, homes and work places etc.

It is noticed that majority Ugandans carryout agriculture and grow a variety of nutritious foods including fruits and vegetables but all these are sold off without sparing any for home consumption – what can government do to help? The first steps in the reduction of NCDs require individuals to take care of their health by avoiding life styles leading to NCDs – It’s everyone’s responsibility to fight NCDs.

As concerned citizens of Uganda, we should not apportion blame for the increased cases of NCDs to either government or community. Collective efforts of government, Civil Society Organizations, communities, individuals, private sector in promoting interventions geared towards reducing NCD risk factors is the shorter route to the reduction of increased cases of NCDs in Uganda.

Child theft in health facilities; Mulago national referral hospital on the spot

By Nakibuuka Noor Musisi

mulagoHeath facilities should be the safest places for every expectant mother to deliver. They should be trusted, attractive and able to provide the services.  They should be well equipped and health workers well facilitated to provide the services. A maternity ward should, at that, be prioritized in terms of facilitation, equipment, with available medicines and well-motivated health workers; for they handle lives of mothers and their new born babies.

Since 2011, Uganda has seen a new trend of advocacy aimed at ensuring that mothers enjoy safety in delivery. This has been coupled with massive budgetary campaigns, massive CSO mobilizations, petitions to speaker of parliament, commitments from members of parliament, continuous media engagements but most importantly of all the use of the legal arm where rights are violated.

Constitutional Petition No. 16 of 2011 (CEHUD and Ors .V. Attorney General) for example was an eye awakener for the government and relevant officials to ensure that the budget allocated to the health sector is sufficient. Upon filing of this case, civil society and Parliament engaged in an unprecedented effort to block passage of Uganda’s Financial Year 2012-13 budget unless the catastrophic shortage of health workers was addressed as a matter of priority. Indeed 49.5 billion was allocated to the health sector to recruit 6,172 additional health workers and deploy them to HCIIIs and IVs in financial year 2012-13.

That is not all. We cannot conclude that presence of health workers in health facilities is enough to ensure safe delivery of expectant mothers. A lot more is needed. Unless that “more” is cleared, we are yet to ensure safer delivery of mothers and safety of new born babies in health facilities. Center for health, Human rights and development has never relaxed. The outcomes of petition 16 energized its efforts to advocate for women’s rights.

CEHURD has since embarked on other factors that draw women away from delivering in health facilities. Remember the joy of every expectant mother is having a bouncing baby. The pain mothers’ encounter during delivery is taken away by a smile from that child. Have you ever imagined going through that pain and you never see your child! A pronunciation of its death and having an opportunity to bury its body, though painful, may somehow comfort the mother. This was not the case with Musimenta Jennifer and Mubangizi Michael.

It is alleged that the couple went to the National referral hospital to deliver and were given one child despite giving birth to two. It is further alleged that the second child died but the whereabouts of the body are not known. The couple was given a fresh dead body after three days and the DNA that was carried out revealed the component from the sample of the dead fresh body was incompatible with that of the parents.

The second twin has since grown and is well nurtured for by the parents. She however is a reminder to the parents of the other twin. It is traumatizing to them to see one child and with no information on the whereabouts of their second baby or its body.

CEHURD intervened in the matter to not only advocate for the rights of these parents to care for and nurture their child, and or have a right to bury the deceased but  also to ensure that within the health care setting, these constitutional rights are observed. We also meant to ensure safety of delivery within the health facilities in order to reduce the number of maternal death. As such, CEHURD together with the couple instituted a human rights violation case in the high court of Uganda vide Civil suit No. 212 of 2013. The case seeks for declarations on violations of the rights to health, freedom from cruel inhuman and degrading treatment and rights of the child.

This case is ongoing in court and we are yet to get the decision from court. It is important however to note that this case is one of the many that draw women from delivering in health facilities. Many other cases of child theft have been reported while others go unnoticed. The cause is what is questioned. Could it be a problem with the administration system; is it the failure to sufficiently remunerate health professionals that they negligently act, could it be the security system or the poor system of handling new born babies?

Theft of new born babies has now become a trend in this hospital. We hope that the High court will deliver justice to the couple. We believe that court’s determination of the matter will impact on many other cases of child theft reported.

Fostering community participation in health system governance

By Nantaba Julianna

HassuDuring this quarter, CEHURD has engaged with Health Unit Management Committees (HUMCs) in Kiboga and Kyankwanzi districts. This has been one as part of a three year participatory action research project titled “Health System Governance: Community Participation as a Key Strategy for Realizing the Right to Health.” This engagement entailed capacity building and community dialogues with members of HUMCs of Kikoolimbo Health Center in Kyankwanzi and Nyamiringa Health Center in Kiboga.

Although the project engaged various stake holders in the decentralized health system, there has been a specific focus on Health Unit Management Committees (HUMCs)  a structure establish by Ministry of Health to among others promote community participation the decentralized health system.

Community participation has been argued as one of the strategies that can be utilized in realizing the right to health given the role it can play in  promoting accountability of duty bearers to right’s holders and improving the effectiveness and sustainability of health interventions, programs and services in various ways. Community participation means that the community is no longer a passive recipient of health care, but an active participant in the creation of a health care system that serves their specific needs.

This action research has affirmed the role that HUMCs can play in facilitating health service accountability, since they are supposed to act as the interface between communities and points of care. It also revealed that challenges of these structures including; role confusion in what committee members’ duty and the lack of knowledge among community members on the role and existence of such structures.

Having identified these challenges, CEHURD team met with the members of these management committees, took them through a various process to enable them understand their roles and responsibilities during which they were empowered and organized a community dialogue with the communities which the health center serves. These community dialogues were utilized as an avenue for community members to understand the role of HUMCs and also air their challenges, improve on communication between service providers and patients and after work together on strategies to address the challenges.

This action research has reaffirmed that Civil Society can indeed play a role holding health services accountable and creating a sense of community ownership of health services (London, 2007). It has the potential to strengthen trust and good relationships between patients and health workers. It allows communities to participate in defining models of care and resource allocation in health and for communities to become involved in dealing with the social and economic determinants of health.

We acknowledge the role and contribution of Veronica Masanja (Nyamirina Health Facility in-charge) who took part in the re-search exchange visit during which best practices and models were shared, members of the two HUMCs who dedicated time to this process, District Health Officers of the two districts, our collaborating partners from the Learning Network for Health and Human Rights of the School of Public Health and Family Medicine at the University of Cape Town (UCT) and support from the International Development and Research Center(IDRC), Canada.

Enhancing community advocacy: The Community advocates for health and human rights

By Serunjogi Francis

chasAmong the ways of eliminating health inequalities within communities is through carrying out advocacy to enable promotion of access to better health care services. Advocacy as put, the act of taking a position on an issue, and initiating actions in a deliberate attempt to influence policy choices may involve developing partnerships and creating structures geared towards promoting quality services delivery. On the other hand, community health advocacy involves taking action by the community itself with an aim of improving service delivery in health. This may involve creating programs, developing collaborations and partnerships and or, creating structures that can help to back up the process. Such structures can help to enhance community engagement ongoing projects and to increase community awareness of the issues being addressed.

In a bid to enhance community level advocacy, CEHURD with support AKIBA-UHAKI engaged community leaders and members in selecting a team of 15 Community advocates for health and human rights from three sub-counties in Buikwe district. The training was carried out with guidance from the protocol adapted from the Human rights and Gender mainstreaming for health professional manual which was developed and pretested  in collaboration with Ministry of Health and WHO in 2013.

Much as there are health structures at community level including the Health Unit Management Committees (HUMCs) and Village Health Teams (VHTs), Community advocates for health and human rights act as a monitoring tool and enhance accountability which is a key aspect of advocacy.

This community advocates were tasked to identifying and document health rights violations within their sub-counties; mobilize communities to seek for health services, operate as an Alternative Dispute Resolution (ADR) mechanism within their communities and to serve as a health services monitoring tool. Since CEHURD does advocacy at the national level, evidence gathered by these advocates is an added advantage to the ongoing processes.

The ever growing demand in health needs and the existence of inequities in resource allocation keeps calling for continuous energies in advocating for improved health care delivery right from the community levels. This therefore calls for persistence, dedication, and investment not only in energy but monies too if change is to be realized in the affirmative.  CEHURD therefore expects to further support these advocates in terms of monitoring their work and also continuously develop their capacity for better implementation.

Litigating the right to health in Uganda; My experience

By Rebecca Carr

RebeccaThis Summer I undertook an internship at the Centre for Health, Human Rights and Development, Uganda (CEHURD) as part of the University of Toronto’s International Human Rights Internship Program. Although placed within CEHURD’s strategic litigation team, I was also able to see how the organisations work interacted with its other: community empowerment, HRDA (Human Rights Documentation and Advocacy), and communications teams. The complementary way in which its teams work together is, I think, what makes CEHURD unique, and is what appeared to make its right-to-health- enhancing strategies, highly effective.

On my first day, for instance, I went to the High Court to help report on a case that CEHURD is undertaking on behalf of communities living in Kiryamuli and Bamtakudde. The case concerned the destruction of the communities’ natural environment and water source, contrary to their rights to health and to a healthy environment, among others. The damage – it is alleged – was caused by the defendant’s commercial quarrying activities. The journey to court was not, much to my surprise, spent rehearsing legal arguments, but by a number of CEHURDs lawyers contacting media outlets about the case. Social rights sensitization, particularly through the media is, after all, critical to the rights broad and continued acceptance.  Throughout the course of the internship, it became apparent that this acceptance was necessary not only within local communities, but within Uganda’s legal circles and policy arenas also, and was something that CEHURD was also keenly aware of.

During the summer, for instance, the strategic litigation team organised a Magistrates Forum to bring Magistrates, Academics, CEHURD staff and the media together to discuss human rights questions within the context of the criminal law. How, for example, might socioeconomic human rights protections be respected within Uganda’s somewhat rigid, criminal law provisions? And to what extent are women’s reproductive health rights recognised within the confines of the country’s current Penal code? The day provided a much-needed space for critical dialogue and debate, and illustrated the importance of engaging the judiciary in rights-litigation matters, beyond the courtroom itself.

On the policy front, I saw how CEHURD connects its impressive grassroots research from the many communities it works with, to the policy-level advocacy it undertakes. I was able to attend, for instance, meetings regarding – what is likely to become – the country’s sexual and reproductive health guidelines that CEHURD played a major role in creating.

My time at CEHURD was varied and exciting. Almost every day new issues regarding Ugandan’s rights to health would arise and that I thoroughly enjoyed being able to assist with. What I’ve taken away the most is CEHURDs creative approach to tackling right to health issues, complex issues of a fundamental concern to the Ugandan people.

I thank all the staff at CEHURD, whose passion, commitment and kindness enabled me to have such a wonderful internship and time in Uganda.