There is an urgent need to prioritise access to health care and services for survivors of sexual gender-based violence

Despite government’s initiatives and programmes to facilitate the utilisation of SGBV services in Uganda, there is still evidence of barriers and several gender disparities which persist in access to sexual and reproductive health services for survivors of sexual gender-based violence. 

By Judith Nakalembe

As we mark the 16 days of activism campaign against Gender Based Violence (GBV), we appreciate the Government of Uganda through the Ministry of Gender, Labour and Social Development, and Ministry of Health for the tremendous effort in policy and programme development and implementation with regard to prevention and response to GBV. This is reflected in the enactment of several legislation such as the Domestic Violence Act 2010, The Prohibition of Female Genital Mutilation Act, 2010, Trafficking in Persons Act 2010. This is in addition to policies such as the Uganda Gender Policy 2007, The National Policy on Elimination of Gender Based Violence in Uganda 2016, the Guidelines for Establishment and Management of Gender Based Violence Shelters in Uganda. The recent directive to prohibit health service providers from soliciting funds from survivors of sexual and gender based violence is also of note. These policies, directives, laws and guidelines provide the legal context within which programmes on prevention and response to GBV occur, foster zero tolerance environment, provide comprehensive response and care and support services to survivors as well as eliminate impunity by the abusers. Article 33 of the 1995 constitution of the Republic of Uganda government has an obligation to protect women and girls from any form of violence, which is why these 16 days are important, as they give us an opportunity to assess how we are doing on that front, and in achieving the sustainable development goals (SDGs), particularly SDG 3.

As civil society, we complement government efforts in prevention and response to SGBV. Despite government initiatives and programmes to facilitate the utilisation of SGBV services in Uganda, there is still evidence of barriers and several gender disparities which persist in access to sexual and reproductive health services for survivors of sexual gender-based violence.

Ms Nakalembe is a Programme Officer in the Community Empowerment Programme, CEHURD.

The 2021 Annual Police Crime Report and an assessment by Center for Health, Human Rights and Development (CEHURD) of cases reported before and during the pandemic in various districts,indicate an increase in sexual offences reported. When faced with SGBV, survivors are advised to report to public health facilities urgently as a referral mechanism for medical examination and management and to fill in Police Form 3 appropriately. However, in the course of our interventions we have observed that some health facilities are not survivor centred, and lack appropriate good quality care for survivors of sexual violence. Survivors are also unable to access services 24 hours a day, as most health service providers work half day and are hardly available over the weekends. We have had to contend with unethical health service providers who solicit funds at a fee of Shs50,000 from survivors for medical examination and the form. A majority of survivors cannot afford it and end up only reporting the cases to police without seeking medical attention yet sexual abuse can lead to numerous health adverse health conditions. These include disability due to injury, HIV/Aids, sexually transmitted infections (STIs), unintended pregnancy, unsafe abortions, mental health outcomes, including posttraumatic stress disorder, anxiety and depression, and an increased risk of ideated or attempted suicide, among others.

During the Generation Equality Forum, an international initiative in favour of gender equality, held in Paris on June 30 to July 2, 2021 the government of Uganda committed to eliminating GBV by scaling up comprehensive, accessible, and quality services for survivors. The commitments included;

  1. Supporting the collection of forensic evidence on GBV, violence against children (VAC), especially capital offences reported through the media, GBV special courts and shelters, Sauti 116, Police, Health Facilities, NGOs and LCs to inform court processes.
  2. Effective implementation of GBV/VAC legislation with adequate resourcing and budgets.
  3. Provision of timely medical services including Emergency Contraceptives (EC), Post Exposure Prophylaxis (PEP) and STI treatment etc. to GBV/VAC survivors for increased access to timely, comprehensive and quality medical services to GBV/VAC survivors.
  4. Development of a national guideline for health service providers on identification and Management of victims/survivors of GBV, including roles, responsibilities and referral pathways and socialization to health providers at all levels and related stakeholders on the National guideline
  5. Training health facility staff to handle GBV/VAC cases including collecting of forensic evidence for Improvement in the quality of forensic evidence and service delivery to GBV/VAC survivors.
  6. Establishment of additional 20 shelters across the county to handle issues GBV/VAC survivors.
  7. Provide training and support to all service providers within the Criminal Justice systems dealing with GBV/VAC matters (including police, prosecutors, magistrates, intermediaries, court preparation officers, health care providers and policy makers) to strengthen victim-centric survivor focused services and prevent any forms of secondary victimization.
  8. Programs for counseling and psychosocial support to young girls that got pregnant during COVID 19 lockdown established.
  9. Ensuring that victims and survivors’ rights are fully protected through formal Justice systems and perpetrators are brought to justice by enhancing the capacities of the policing and prosecution institutions to ensure GBV survivors are able to access quality justice services; accessible, responsive and gender inclusive to ensure GBV survivors are able to access efficient and sensitive criminal justice that is quick and inclusive.
  10. Mechanisms put in place for survivors/victims who seek legal redress as well as whistleblowers who provide information in-order to protect them from reprisals and further harm. 
  11. Put in place interventions to respond to specific barriers that victims may face in accessing information and services, addressing the unequal and inequitable spread of victim services.

As we commemorate these 16 days of activism (from November 25th to December 10th), we call upon the Government of Uganda to fulfill these commitments, and end gender-based violence.

A version of this article was published in the Daily Monitor on 1st December 2021.

Judiciary Endorses the Need for a Sexuality Education Policy in Uganda

Kampala – Uganda. Center for Health, Human Rights and Development (CEHURD) with joy welcomes the long-awaited ruling from the High Court of Uganda at Kampala in the case of CEHURD vs. Attorney General & Family Life Network [Miscellaneous Cause No. 309 of 2016], commonly referred to as the Comprehensive Sexuality Education case. The High Court agreed with our submissions and the trial judge, Hon. Justice Lydia Mugambe, directed the Ministry of Education and Sports to develop a comprehensive sexuality education policy within two years, among other orders.

Another point of contention in the case was the use of the term, “comprehensive” sexuality education. To this, Hon. Justice Mugambe stated that, “The inclusion or exclusion of the term ‘comprehensive’ is a simple matter of form that should never derail the substance of this process.”

Through this judgement, Hon. Justice Mugambe upheld the fundamental human rights of all Ugandans to access health information on their sexuality.

Background

On the 18th day of November 2016, The Center for Health, Human Rights and Development (CEHURD) filed a case against the Attorney General, challenging the Ministry of Education and Sports’ ban on Comprehensive Sexuality Education (CSE), and their omission and delay to pass a policy on sexuality education as a violation of the right to access information contrary to Article 41 and the right to education contrary to article 30 and 34(2) of the Constitution of the Republic of Uganda, 1995. 

This case was premised on a resolution issued by the Parliament of the Republic of Uganda on 17th August 2016 directing the Ministry of Education and Sports to ban the teaching and training of CSE in Uganda. On 28th November 2016 the Ministry of Gender, Labour and Social Development issued a press statement emphasizing to the public that the ban of CSE in Uganda was applicable in both school and non-school environments. This in effect halted the dissemination of all sexuality education in Uganda, leaving the population prey to unwanted pregnancies, STDs and STIs due to lack of information.

In May 2018, the Ministry of Education and Sports finalized and passed the National Sexuality Education Framework (NSEF) which has never been implemented and actualised, three years since its development.

Uganda, however, committed herself to formulating policies on comprehensive sexuality education in December 2013 under the Ministerial Commitment on Comprehensive Sexuality on sexual and reproductive health services for adolescents and young people in Eastern and Southern Africa (ESA).

Court ruling

The High Court of Uganda through Lady Justice Lydia Mugambe upheld the rights of adolescents and ordered that;

  1. The Government’s inordinate delay and/or omission of over ten years to develop a comprehensive sexuality education policy in Uganda is a violation of Uganda’s obligations under international law and Articles 30,41 and 34(2) of the Constitution; Sections 4 (1) (c), (g) and (i) of the Children (Amendment) Act 2016; and Section 4(1) & (2) of the Education (pre-primary, primary and post primary) Act.
  • The Government of Uganda through the Ministry of Education and Sports should within two years develop a Comprehensive Sexuality Education Policy
  • The Government of Uganda through the Ministry of Education and Sports should identify and work with a breadth of relevant stakeholders and address all issues competently
  • The Attorney General should compile and submit a report to this Court every six months showing progress and implementation of the orders.

Find full Press Statement here

Job Opportunities

National Forum of People Living with HIV/AIDS Networks Uganda (NAFOPHANU) in consortium with Center for Health Human Rights and Development (CEHURD) and Uganda Harm Reduction Network (UHRN) are implementing a Global fund project titled: Supporting Uganda’s Response to HIV/AIDS and Tuberculosis Reduction Strategy (UGA-C-TASO) in three regions of West Nile, Acholi and Karomoja. The project has the job opportunities below for immediate deployment:

Deadline: 22 October 2021

Government Must Prioritise Safety of Health Workers to Protect Patients During Covid-19 and Beyond

PRESS STATEMENT

Thursday, September 16th, 2021

Government Must Prioritise Safety of Health Workers to Protect Patients During Covid-19 and Beyond

Kampala-Uganda. Center for Health, Human Rights and Development (CEHURD) and partners join the world to mark World Patient Safety Day. At a time when the healthcare system is receiving more patients, the day, which is marked every September 17th (tomorrow), is an opportunity to pause and evaluate their safety. The day has come at a time when CEHURD is running on online campaign, calling for safety in health facilities, under the hashtag, #SafetyInHealthFacilities.

This year’s theme, “safe maternal and newborn care”, is a reminder to deal with the issues mothers face in health facilities, when their safety is not taken care of.

It is estimated that on average, Uganda loses more than 300 mothers per 100,000 live births every year. Furthermore, about 200,000 children under the age of five, due to preventable causes. Considering the significant burden of risks and harm women and newborns are exposed to due to unsafe care, compounded by the disruption of essential health services caused by the COVID-19 pandemic, the campaign on safety is even more important this year.

It is imperative to note that the majority of stillbirths and maternal and new-born deaths are avoidable through the provision of safe and quality care by skilled health professionals working in supportive environments. This can only be achieved through the engagement of all stakeholders and the adoption of comprehensive health systems and community-based approaches.

The safety of patients is closely related to the safety of health workers. This has been magnified by the COVID pandemic. The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives. In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatisation. The World Health Organisation recently highlighted an alarming rise in reports of verbal harassment, discrimination, and physical violence against health workers in the wake of COVID-19. No country, hospital or clinic can keep its mothers and children safe without keeping  its workers safe.

We therefore call on government and health care leaders to address persistent threats to health safety of health workers to ensure safe maternal and newborn care.

On this World Patient Safety Day, we remind the government that it has a legal and moral obligation to ensure the health, safety and wellbeing of health facility workers, health facility users and make child bearing a dignified process.  To promote safety in health facilities, we specifically call on government to;

  1. Develop and implement national programmes for occupational health and safety of health workers. This will include appointment of officers specifically responsible for health and safety in health facilities, and reporting and analysing serious safety related incidents.
  2. Protect health workers and health users from violence in health facilities, and promote the culture of zero tolerance to violence in health facilities. This should also provide for implementation mechanisms through which survivors can easily report cases of abuse to responsible officers.
  3. Improve mental health psychological wellbeing of health workers. This includes maintaining appropriate safe staffing levels within health facilities, providing health related insurance to ensure coverage for work related risk, especially for those working in high-risk areas.
  4. Protect health workers and patients from physical and biological hazards.Ensure availability of  personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. Ensure an adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions.

For more information, contact Grace Kenganzi on kenganzi@cehurd.org and copy info@cehurd.org or call 0778 723449 or 0414 532283

It is imperative that we popularize the various contraception methods for young people

Uganda is committed to scaling up the use of modern contraceptive methods to ensure that every Ugandan woman can be able to make a decision of when to have children. On this day it’s imperative that we popularize the various contraceptive methods that are safe and appropriate for both young people and adolescents’ use.

BY MARIANNA KAYAGA –Programme Officer at CEHURD and the President for the Youth Advisory Committee SRHR Alliance.

         

As a young person who was then fresh from campus, I had friends who were sexually active. I really didn’t know much about the need for contraception or the various types on the market. As time went by, I noticed that a number of girls I had studied with showed up pregnant. I simply wondered to myself “why didn’t she ask her boyfriend to put on a condom or even withdraw?” I thought this since these were the only forms of contraception I knew at the time.                                                                                              

I inadvertently became the judge and jury to all these girls who ended up pregnant while we were still in school and under the care of our parents and guardians. This kind of judgment came about because I didn’t have access to information on contraception and neither did I understand or know the circumstances in which these girls got pregnant. One of these girls gave birth to twins and I recall how during classes, her lactating breasts gave off a strange smell let alone the fact that her garments often had patches around the breasts area.

One of my very close friends also got pregnant at the age of nineteen years and the first thing I remember telling her was to get an abortion because it really didn’t make much sense to me for a young girl to be pregnant without having any financial security. She then went through the nine months of the pregnancy but indicated that whole process was really devastating to the fact that she ended up getting a Caesarean section. The midwives said she was too weak to have a natural child birth.

Due to the overwhelming on-going experiences around me I became curious about learning of the different contraceptives and I must say I was privileged to have access to SRHR information through various media platforms, my friends who have unlimited access to information and various easy to read materials.

According to the Oxford dictionary Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. On September 26th  ‘’World contraception day’’ as we usually prefer to call it, it is our mission as young people to spread the word and raise awareness about different contraceptive methods and safe sex. This is to enable both young men and women to make informed choices on their sexual and reproductive health. As a country we are all going through a crisis and uncertainty from the COVID-19 pandemic, reliable sexual health services that provide a range of options and information are more important now than ever.

Uganda’s total fertility, maternal mortality and teenage pregnancy rates remain among the highest globally. Uganda is committed to scaling up the use of modern contraceptive methods to ensure that every Ugandan woman can be able to make a decision of when to have children. In 2017, Uganda revised its commitment made in 2012 of reducing unmet needs of adolescents from 30.4% in 2016 to 25% in 2021. By improving the number of health facilities or structures in hard-to-reach areas, the government of Uganda strives to expand its reach and provision of services including permanent, reversible and long-acting methods. These commitments will contribute to the nation’s ambitious goal to reduce the unmet need for family planning to 10% and increase the use of modern contraception by 50%.

In Uganda, with national lockdowns and restrictions in movement which meant no transportation by both public and private means, young people could not access their usual services. This has been acute in rural areas which make up 85% of the country’s population and as a result, the numbers of unplanned and teenage pregnancies have immensely risen especially with the closure of schools.

The enormous rise in unplanned pregnancies amongst young people is because there is a huge gap in access to information about the available services, the supply chain of distribution and the overwhelmed health systems diverting resources to the COVID – 19 responses, access to SRHR services for young people including contraception, has been restricted and barriers have increased.

On this day it’s imperative that we popularize the various contraceptive methods that are safe and appropriate for both young people and adolescents’ use. Some of which include combined oral contraceptives, progestin-only pills, Depo-Provera (DMPA) injectable contraceptive, implants and condoms. IUDs are appropriate for young people when they are in a stable and mutually monogamous relationship or marriage. This is to ensure that we reduce the numbers of teenage and unplanned pregnancies both in urban and rural areas.