CEHURD today shines the light on Tuberculosis (TB) as we commemorate the World Tuberculosis day under the theme “The clock is ticking”. This is a call to action towards commitments made by government to end TB especially in the face of the ongoing COVID 19 pandemic which puts these efforts at a risk. The World TB day is commemorated to raise public awareness about the devastating health, social and economic consequences of TB and to call on government to step up efforts to end the global TB epidemic. According to the World Health Organization (WHO), TB remains one of the deadliest infectious killer diseases and each day nearly 4,000 people lose their lives to TB and close to 28,000 people fall ill with this preventable and curable disease. A total of 1,400,000 people in the world died of TB in 2019 alone.

These glaring statistic do not get any better at home as Uganda is one of the 30 WHO designated countries with a high burden of TB and HIV. In 2019 the estimated incidence was 200 per 100,000 people with a mortality rate of 35 people per 100,000.  It is indeed worrying that the cases of TB have even gone up given the little attention to the disease. According to WHO reports, in 2019 Uganda had 65,897 cases of TB notified which is an increase from 57,756 cases notified in 2018.  There have also been reports of high drug resistance which poses a real challenge to the efforts towards controlling the infection. 87% drug resistance was reported in 2019 alone and this calls for more efforts towards research and investment for new medicines. There is however a lurking risk of patents on new medicines which may make these medicines expensive and thereby becoming a barrier to access for many TB patients.

It should be noted that most TB patients in Africa suffer catastrophic treatment costs making access to quality TB treatment impossible despite the disease being curable. In Uganda it is reported that 53% of TB patients suffer catastrophic costs of treatment as indicated in the WHO factsheets on the TB situation in Uganda. Although government has made some efforts toward the control and management of TB through commitments made under the National Tuberculosis and Leprosy Control Program 2016-2020 which aligns with the WHO End TB strategy, more is needed to ensure equitable access to quality treatment for TB patients.

It is disheartening to see that Uganda’s TB financing indicates very little of Government’s political will to end TB as committed under the Control Program and WHO End TB strategy. In 2019 the national budget for TB control and management was USD 37,000, 0000 of which government only contributed 5% while 56% of the financing was by international partners and 39% of the budget was unfunded. The second health sector development plan 2015/2016-2019/2020 is designed to support  government’s commitment to achieving Sustainable Development Goals which among others seeks to “Achieve universal health coverage including financial risk protection, access to quality essential health care services and access to safe , effective quality and affordable essential medicine and vaccination for all by 2030”.

This is to therefore call upon government on this world TB day to fulfil its commitment towards the END TB strategy by;

1. Increasing domestic funding towards TB management and control to ensure equitable access to TB quality treatment
2. Investing in research and development for new and effective medicines to find lasting solutions to drug resistance
3. To utilize the flexibilities in the Trade Related Aspects of Intellectual Property Rights to ensure that Intellectual Property Rights do not pose barriers to accessing the new and more effective medicines

By Annah Kukundakwe -an advocate for Sexual and Reproductive Health and Rights Advocate and Program officer at the Center for Health, Human Rights and Development.

President Yoweri Kaguta Museveni recently noted in his Speech during the NRM Liberation day on 26th January 2021 said people should leave their religious beliefs at home and not carry them to office. I am not sure what motivated him to take this stance, but in my case, i am motivated by the fact that the morality whip that is mainly wielded by religious leaders and members of their congregation, has proven to be untenable. Those that have been the protectors of the moral fabric of society have also many times found themselves has falling victim to this moral policing.

A policy is a course or principle of action adopted by government or the executive to guide decisions and achieve rational outcome. And Policy-making is the act or process of setting and directing the course of action to be pursued by a government, business or organization. The policy making
process entails various phases including stakeholder consultations aimed at building consensus around the policy proposals and developing solutions which will work and gain acceptance in practice.
Among the stakeholders engaged in the policy development process are religious groups who continue to be given a bigger and better platform for consultative processes. Their views on any given policy is given priority and in some cases, the views have been seen to derail or stay discussions about development of policies and laws pertaining to critical issues including social, health and even human rights. A case in point is the National Sexuality Education framework, whose implementation and operationalization has been delayed since its launch in 2018, the SRHR policy guidelines and service standards, including those for addressing maternal mortality due to unsafe abortion (2015) that were recalled and disowned by the government and the continuous failure of the Marriage and Divorce Bill to move beyond the floor of Uganda’s parliament.

Over the years the fate of Ugandans especially women and young people has been left to be decided by religious groups even in cases where decisions that could impact health and life are concerned. However,
the recent happenings in the church, including where they have been rocked by scandals calls for a review of whether religious leaders’ views really ought to count in matters of health and people’s wellbeing
The 1995 constitution recognizes Uganda as a Secular state. Besides the fact that Uganda is described as a state, the desired approach of managing public affairs, should prompt us to question this unfettered authority that religious leaders and other moral groups enjoy in public policy processes.

In my view, the reason why religious groups have enjoyed unchecked reign over the different aspects of people’s lives is because these groups and the institutions have been protected by the dogma of infallibility. There is a belief that they cannot do wrong including on moral grounds. There are also other issues that have consolidated their hold and importance of their opinions on all aspects of life. These include aspects such as owning majority of private schools and health care facilities in the country in comparison to any other group in the country. Noteworthy is also the history of this country where there has been a strong interconnection between the church and state. It is this moral authority that they wield and use as a bargaining chip and in some cases even emotional blackmail in discussions where there are technical people and data that indicates a contrary approach should be adopted.

The impact of these stayed policies, laws and interventions are not an end in themselves as they have far reaching effects on the lives of Uganda’s citizens. For instance, owing to moral objections on young people’s exercise of their agency regarding their sexual reproductive health and rights via an enabling policy, legal and service environment, young people continue to grapple with challenges regarding their sexual and reproductive health because they are unable to receive information on the same.

This has had far reaching impact on their lives like school dropout and loss of lives. Women also continue to die due to preventable causes like unsafe abortion. There is no doubt that Sexual Reproductive Health and Rights (SRHR) continue to be among the most controversial and contentious topics in Uganda’s legal, policy, and social environments. This is in part due
to religious debates. SRHR issues like family planning, sexuality education, adolescent health, teenage pregnancies, unsafe abortion, maternal mortality and morbidity, gender-based violence, sexual abuse and child marriages, continue to constitute a serious public health and human rights threats to women and young people.
I implore the newly elected MPs and persons in the various key ministries to endeavor to steer clear of moral shackles when developing public policies or when passing laws to regulate public and social issues. There is no doubt that people are entitled to their moral and religious beliefs, however, given the subjective nature of these, it is unfair for these parameters to be applied across a wide spectrum of issues that affect
persons from different social, geographical, economic and even religious backgrounds. This means that from the offset, there is an unleveled playfield and an attempt to level this playing field via law and policy
based on among others on subjective moral standards is erroneous. Let us look to data and science to cure the ills that plague our country, that way our development goals will remain relevant and attainable.

A version of this article was published in the Daily Monitor Newspaper on 10th March 2021 pg 15.

The Center for Health, Human Rights and Development (CEHURD) under the PAI – COPASAH partnership invites submissions for case studies on practices and emerging issues of social accountability during the COVID-19 pandemic within the Eastern and Southern Africa region from practitioners on accountability and social action in Health. The case studies should document, showcase and highlight best practices, successes, challenges, lessons learned and innovations towards the practice of social accountability in the health sector during COVID-19.

Application instructions;

Eligible individuals or organisations can submit a write-up of Ten (10) pages maximum. This writeup should include: an introduction about yourself or organisation, areas of focus, constituencies you work with, the problem or issue and a methodology/approach/mechanism you have used as a social accountability practitioner during COVID-19 and lessons leant.

These case studies should be submitted to info@cehurd.org and copy muhumuza@cehurd.org. The application deadline is 15th March, 2021 at 23:59 EAT. A panel of reviewers will evaluate the cases studies and select the best four case studies to be awarded a grant of Two Thousand Five Hundred United States Dollars (USD 2500).

See download for details;

By Precious Tricia Abwooli -CEHURD

Today, 1^st March 2021, we celebrate the zero-discrimination day. This year’s theme is directed towards zero discrimination against women and girls and the need to promote global equality and empowerment.  According to the 2012 World Bank’s World Development Indicators, “women form the majority of the world’s poorest people and the number of women living in rural poverty has increased by 50% since 1975. Women work two-thirds of the world’s working hours and produce half of the world’s food, yet they earn only 10% of the world’s income and own less than 1% of the world’s property”.[1]

Several efforts have been made to fight discrimination against women and girls overtime. These include several international, regional and national laws, conventions and policies. For instance, article 2 of the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) tasks state parties “to take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices which constitute discrimination against women.” Indeed, several state parties have done so, for example Uganda that in 2015 enacted a law eradicating the practice of female genital mutilation.

Nevertheless, discriminatory laws against women and girls persevere globally. They are coupled with traditions that portray them as second-class citizens and are evident across different sectors like health, education, marital rights, employment rights, property rights and more. A case in point is Uganda’s Divorce Act.

While sometimes a picture is painted depicting achievement of gender equality currently, it is likely due to technological developments that give increased visibility to women’s successes and ignores the discriminatory issues. Discrimination not only devastates lives of the women and girls and divides communities, but also undermines development efforts and the building of strong democracies. It locks women and girls into poverty, limits their right of choice and their ability to access education, earn a living and participate in political and public life.  Therefore, it is critical to increase women and girls’ participation in decision making. It is also important to focus on eradication of cultures and traditions that are discriminatory against women and girls. In Uganda’s case, Parliament needs to prioritize laws that promote non-discrimination against women and girls, particularly through revision of laws that do the opposite.

[1] http://documents1.worldbank.org/curated/en/820851467992505410/pdf/102114-REVISED-PUBLIC-WBG-Gender-Strategy.