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Developing a New Instinct during my Internship Placement at CEHURD

By Chlöe Shahinian

Within ten minutes of my arrival at the Center for Health, Human Rights and Development (CEHURD), I was partaking in the traditional Monday morning reflections and update meeting for all staff. I tried to keep up with the various staff updates and absorb all of the acronyms being used and the names of the projects being referenced. Later in the day, when the Strategic Litigation (SL) team met separately for a program meeting, I got to learn more about the ongoing work of the team with which I would be interning for the next two months,I knew that the Summer was guaranteed to be filled with new and exciting opportunities.

I found out on my second day that a supervising lawyer would be taking me to the Magistrate’s Court in Entebbe the following day. Having never been to court in Uganda, or Canada for that matter, I was grateful to have such an interesting learning experience so early in my internship. CEHURD, as part of its legal aid clinic services, was attending court to watch brief on a criminal case where a woman had been raped by a healthcare worker while seeking emergency medical care at a hospital. CEHURD’s mandate to attend court in the case was derived from instructions given to them by the survivor. Upon arrival at court, my supervising lawyer guided me to the Registry Office where we handed over various photocopies of the prepared Notice to Watch Brief. These were then each stamped and quickly slipped back into our case file. Next, we exited the grounds of the Court to visit the Office of the Resident State Attorney, where our documents needed to be stamped once again. I sat precisely where my supervising lawyer pointed to and watched in rapt interest as discussions in Luganda (a local language spoken in central Buganda, Kampala) took place around me.

Upon the arrival of the State Attorney, our documents received their final necessary stamp, and we were off to the courthouse again, this time walking and talking with the State Attorney as we made our way. Once we arrived in the courtroom, my supervising lawyer and I slotted into two available spots in the front row of the public seating, and we waited as the accused in the day’s cases were guided into the room by prison warders. When our case name was called, we rushed to leave the courtroom and enter the Magistrate’s chambers, where sexual offense cases are typically heard for reasons relating to the privacy of survivors, and where we finally submitted our paperwork. What seemed like two minutes later, before I could even process what had happened, my supervising lawyer gestured for me to exit, and I realized that we were done at court for the day. “What happened?” I asked my supervising lawyer, “are we done?” I was told that we had adjourned, on the request of the State Prosecutor, to another day as the necessary Committal paperwork had not yet been completed for referral to the High Court which is clothed with the jurisdiction to try offenses of that magnitude. In the moment, it felt like we had spent half a day of work driving to and attending court, only to be returning to the office empty-handed. However, this experience early in my internship has become an example of a quality I have come to see defines CEHURD as an organization: resilience.

In full transparency, I can’t take credit for the word resilience. I first thought about it as a potential guiding theme for this blog post during CEHURD’s whole-organization Project Review Meeting, which took place in the second week of my internship. At the conclusion of the meeting, CEHURD’s Executive Director, Fatia Kiyange, speaking about the implementation of one of the organization’s largest projects, highlighted the resilience of the project’s implementers in the face of various challenges. It occurred to me that resilience was a fruitful lens through which to consider much of the organization’s work, especially in my position as an intern with the Strategic litigation team (SL). The importance of resilience in human rights work became especially apparent to me in the first weeks of my internship when I was tasked with working on an organizational report that would analyze cases in which CEHURD had received a negative judgment and lessons learned from the litigation strategies adopted in those cases. Working on the report allowed me to familiarize myself with CEHURD’s past litigation and helped me to better understand how the SL team has modified its litigation strategy, specifically in cases on appeal, when faced with a negative judgment at a lower court. The report, I realized, was in effect an analysis of CEHURD’s resilience.

As time went by,  I had the privilege to go into the field and see how the SL team manages its ongoing litigation. I learned that working as a member of the team is a lesson in resilience. For instance, at the High Court in Mukono, a case in which CEHURD is a co-applicant was adjourned  because two Respondents had not yet submitted their written submissions despite having previously been ordered by the Court to do so. This case relates to a clean and healthy environment which was filed by CEHURD and Others, National Environment Management Authority (NEMA) and Mukono District Local Government, Civil Application No.1 of 2023. As an intern being newly introduced to this system, it was easy for my first reaction to be frustration. However, in observing my colleagues, I came to see how their experiences navigating Uganda’s justice system have made them incredibly resilient. Each appearance at Court, even if it is only to be informed of an adjournment, is an opportunity to speak with relevant State actors to learn more information, to organize possible mobilization efforts with co-applicants, or even to demonstrate CEHURD’s commitment to the case. Importantly, one of the SL team’s lawyers emphasized to me the impact of showing persistence in always showing up. She highlighted that when State actors, such as the Chief Magistrate, see CEHURD appearing time after time in the interest of their clients, it signals that CEHURD is dedicated to following the case through no matter the difficulty of navigating the obstacles posed. The significance of this follow-through for CEHURD’s vulnerable clients cannot be overstated.

Human rights work is incredibly hard, and as a newcomer in the space, it was easy to lean into instinctual feelings of frustration, impatience, or even resignation when it felt as if we were not progressing quickly enough towards the justice the client rightly deserves. This is an impulse which I fought since the beginning of my internship with CEHURD. However, watching the SL team, and seeing their perseverance in the face of adverse outcomes as well as their unrelenting efforts in defending the rights of their clients, helped me to develop a new instinct: trying to always ask “what can I do next?” as a first reaction, instead of lingering on factors beyond my control. Having completed my internship with CEHURD, I feel that I have strengthened this new instinct in such a way that will assist me in human rights work moving forward.

The writer was a CEHURD intern from McGill University Canada.

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.

A World Of Equal Chances

By John Vianny Ayebare

In his book, Animal Farm, written many years ago, George Orwell tells us about Moses the tame raven who had made it a mission to convince other animals that there was a better world somewhere in what he called Sugar candy Mountain. Moses said that in that world, it was always holidays, and sugar and cake grew on hedges. Anybody visualizing such a world would imagine a world where everyone’s rights are respected, a world where life flourishes and good health reigns supreme.

Every 11th of July, the world remembers the World Population Day which was established by the United Nations in honor of the 11th of July 1987 when the world population hit the five billion mark. What has happened in terms of population growth since then has been extraordinary. Within just 36 years, the number of people gracing this little planet has increased by more than half to an estimated eight billion.

On one hand, this increase in population should signify increased opportunities and a well-developed support system where we all feel treasured and respected, on the other hand, it gives us an opportunity to reflect on the population issues such as family planning, gender equality, violence against others especially the vulnerable, discrimination, access to sexual reproductive services, among others.

The United Nations Population Fund (UNFPA) notes that women contribute 49.7 percent of the total world population, yet it is also evident that despite their special role in this very aspect, they still face uncertainty about their own lives while giving birth. It was revealed early this year that every two minutes, a woman dies during pregnancy or childbirth. Imagine the shame you must accept to the effect that by the time you finish reading this article, at least 3 women will have died. In Uganda, the situation is no different. About 5,500 women die every year while trying to play their natural role of bringing life on earth. This translates to one woman dying every one and a half hours.

The Constitution of Uganda is to the effect that it is the responsibility of the government to direct the health policy in the country. This position is also reiterated in a number of international instruments. For Example, Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women goes further to oblige states to ensure that women access appropriate services in connection with pregnancy, confinement and the postnatal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. Uganda ratified this covenant without any reservations.

While the government has taken great strides to improve the conditions of women and girls through affirmative actions in representation, and education, there is a lot more to be done if we are to achieve the sustainable development goal of ensuring healthy lives and promoting well-being for all, which aims at reducing maternal mortality ratio to less than 70 per 100,000 live births. The following should therefore be done to salvage the situation.

  • Strengthen the Village Health Teams to increase their capacities in monitoring the health needs of pregnant women in their jurisdictions.
  • Men should be encouraged to welcome family planning methods especially those which are male centered, and to support women in accessing family planning services.
  • Establish progressive budgetary commitments at both national and local levels to meet maternal needs and avert the likely dangers of refusal to attend to pregnant women because of their financial incapability. The Abuja Declaration made 22 years ago where African states committed to spending at least 15% of their budgets to the health sector should be respected.
  • Strengthen Public Private Partnerships to ensure ease of access for both antenatal and postnatal care.
  • Provide strict policy guidelines on stocking contraceptives and sexual reproductive services in all health centers to avoid stock outs.

Women should be empowered to make informed choices through unfettered access to sexual reproductive health services while removing barriers such as cultural beliefs, discrimination, violence, and lack of information as far as sexual reproductive services are concerned. This way, we will start looking at a world of 8 billion people as that in Sugar candy Mountain where dignity, happiness and respect for all matter.

The writer is an Intern at the Center for Health, Human Rights and Development – CEHURD.