CALL FOR A CONSULTANT TO DEVELOP POLICY BRIEFS

CEHURD aims at reducing the effects of unsafe abortion among Adolescent Girls and Young Women (AGYW) using the Harm Reduction Model (HRM) in the district of Buikwe. The HRM is an evidence-based health and human rights framework that prioritizes strategies to reduce harm and prioritizes health in situations where policies and practices prohibit, stigmatize and drive common human activities underground.

It is against this background that CEHURD seeks for a consultant to develop policy briefs on the current legal provision of abortion.

See details attached

Improving Maternal Health and Promoting Safe Motherhood

Improving Maternal Health and Promoting Safe Motherhood with Three-Pronged Approaches: Education, Human Rights and Access to Reproductive Health Services in Uganda

                                        Sefinew Demlie Gezahegn

                                                 (BSW, MA, MS)

                     Open Society Institute’s Civil Society Professionals Program Fellow (2019/20) at CEHURD

The purpose of this paper is to understand the extent of maternal health problems in Uganda. The paper will explain the major causes of maternal death, complications of maternal health, access to reproductive health services, and interventions to improve maternal health and promote safe motherhood.

Maternal health is the overall health of a mother during gestation, pregnancy, childbirth, and for a period afterwards. Maternal death is “the death of a woman while pregnant, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy or its management (from direct or indirect obstetric death), but not from accidental or incidental causes” (Roback Morse, 2014, par. 6).

According to the World Health Organization (WHO) (2019), approximately 830 women die daily from preventable causes associated with pregnancy and childbirth. In 2017, the Maternal Mortality Ratio (MMR) in developing countries like Uganda was found to be 462 per 100,000 live births whereas the MMR for high income countries was 11 per 100,000 livebirths (WHO, 2019), a stark 451 difference.

In the East African region, major barriers such as inaccessible Sexual and Reproductive Health (SRH) care services contribute to maternal deaths. To prevent maternal mortality and morbidity, access to comprehensive abortion care and contraceptive services are largely needed. In this East African region, it is estimated that 2.7 million abortions take place annually; however, a majority of these abortions are unsafe and oftentimes a cause for maternal mortality and morbidity (Cleeve et al., 2016).

In 2016, the Ugandan Demographic Health Survey (UDHS) indicated that Uganda has shown slight progress in reducing maternal mortality which was 368 deaths per 100,000 live births compared to 428 maternal deaths per 100,000 live births in 2011(UDHS, 2011; UNICEF Uganda, 2019). In 2016, approximately 15 pregnant Ugandan women were dying every day because of direct causes such as hemorrhage and hypertensive disorder.

Complications (such as high blood pressure, gestational diabetes, anemia, infections, breech position) during pregnancy and following childbirth remain a common cause of maternal mortality. Almost all of these complications develop during pregnancy (Atuhaire & Kaberuka, 2016). In Uganda, hemorrhage (42%), prolonged labor (22%) and unsafe abortion (11%) are the major causes for maternal mortality (Böhret, 2018).

Notably, the above statistics are attributed to subsequent consequences such as violence, lack of education and sexuality education, unplanned and unwanted pregnancy, early marriage, and vulnerability from infections/HIV/AIDS (United Nations Population Fund, 2011). All of which result to lack of assistance and women failing to receive support from their respective communities. In this regard, three major challenges have been identified that inhibit improving maternal health which encompasses; generally weak health systems, inadequate funding for reproductive health, and lack of respect for women’s and girls’ rights at large.

Supporting Opportunities for Ugandans to Learn (SOUL) Foundation (n.d.) indicated that women in rural Uganda are suffering from several barriers to access lifesaving maternal healthcare, mainly associated with delays. These delays include delay in reaching care (lack of transport and road infrastructure), delay in receiving the appropriate and adequate care (lack of skilled birth attendants at delivery), and delay in decision making to seek care. This clearly indicates causes of maternal death are largely preventable with appropriate interventions such as well-equipped facilities, access to trained midwives at facilities, strong referral systems, among others.

Institutions like the Center for Heath Human rights and Development (CEHURD) have over the years worked hand in hand with partners to curb existing barriers to women’s access to maternal health services, safe motherhood and Sexual Reproductive Health and Rights. In 2019 as part of the commemoration of International Safe Motherhood Day, under the theme “Midwives for Mothers” CEHURD held a “National Dialogue on the State of Maternal Health in Uganda” that took place at the Golf Course Hotel in Kampala. This national dialogue was attended by members of Parliament (specifically those from the Parliamentary Committee on Health), officials from the Ministry of Health, Reproductive and Adolescent Health Divisions, Civil Society Organizations, and various coalitions among other stakeholders.

The welcome remarks by Ms. Nakibuuka Noor Musisi, Director of Programs at CEHURD, had an emphasis on Uganda’s alarming Maternal Mortality Ratio(MMR) currently projected at 336/100,000 live births (approximately 6,000 maternal deaths in a year) caused by hemorrhage, hypertensive disorders of pregnancy, malaria, HIV/AIDS among others (Uganda Demographic and Health Survey 2016). Notably, uneducated girls are more at risk of teenage pregnancy (35%) compared to girls with a high school education (17%). According to UNICEF (2015), it is projected that 45% of girls in Uganda get into early marriage even though the legal age for marriage is to be 18 years old (Sofia Garsbo, 2018). In this regard, 40% of girls get married before their 18th birthday where one out of 10 gets married before the age of 15(Girls not Brides, n.d.). Child marriages in Uganda continue to be high and the second worst in the East African community following South Sudan. Contributing factors for child marriage specifically in northern Uganda include lack of education, cultural and social beliefs, and high rate of poverty (Save the Children Uganda, 2018).

Participants at the National Dialogue identified common challenges they are facing in providing maternal health services in Uganda, which include lack of dignity and respect at facilities, limited human resource, unaffordable costs, and lack of medicine. Furthermore, emphasis was on delays as a fundamental cause for maternal mortality due to lack of blood, lack of transportation, inadequate staff in facilities and delay in decision making. As an intervention, National Dialogue participants came up with solutions such as blood donations (community blood harvesting), institutionalizing Maternal and Perinatal Death Surveillance and Response (MPDSR), increasing quality of care initiatives, high stakeholders’ engagement and referral systems to address maternal mortality in Uganda.

Another essential part of the dialogue was evaluating the implementation of the 2011 Parliamentary Resolution on Maternal Health. The resolution incorporated issues such as maternal death audits; Abuja Declaration of 15% of Gross Domestic Product (GDP) budgeting for health sector; midwifery training curriculum; addressing the shortage of medical professionals; community empowerment to fight against maternal mortality; and parliament annual reports on the status of maternal mortality. In order to realize these essential themes, members of parliament, representatives from the Ministry of Health, Civil Society Organizations, and other coalitions agreed to continue working hand in hand on improving maternal health by providing alternative policy options and working with communities closely.

All in all, the state of maternal health is a pressing global concern specifically in Uganda due to low funding for health care services, insufficient infrastructure (roads, electricity), lack of enough skilled health workers, inadequate supplies in facilities, lack of education and sexuality education, cultural practices and beliefs. As a result of such disparities, maternal mortality remained high.

Safe motherhood can be realized through providing human rights guarantees, such as the right to access to full information and quality services to make informed decisions without barriers (be it legal, political or health related) and free from any violence or intimidation activities. Essentially, the prevention of maternal death and illness is a basic human right, and most importantly, it is a social justice issue. Every woman is entitled to the right to life, safe maternal health care, non-discrimination, and equality. In order to improve maternal health and reduce maternal mortality, the following approaches are recommended.

Approach One: educating women and girls offers the opportunity to delay marriage and the first birth until adolescents are physically, psychologically, and economically well prepared to be healthy mothers. Given these points, health information and contraceptive services should be available for teenagers and adolescents to help them make informed decisions for a delayed marriage and first birth. Empowering women and girls through education further benefits them to claim their rights (including their sexual reproductive health rights); escape from the poverty trap; and essentially to protect themselves from traditional and cultural practices.

Approach Two: access to facilities with adequate supplies, skilled health workers (gynecologists, midwives, nurses, obstetricians, and medical officers) and infrastructural developments (roads) must be available for coordinated standby maternal health services. Solving access issues lessens maternal deaths caused by preventable delays. Furthermore, skilled health professionals should attend all childbirths specifically to avoid hemorrhage (severe bleeding) and infections after birth.

Approach Three: partnerships and stakeholders’ active engagement is an invaluable resource in creating safe motherhood in communities. In order to reduce the maternal mortality ratio to less than 70 per 100,000 live births to achieve the Sustainable Development Goals (SDGs) by 2030, the collaboration of major stakeholders is largely needed. They together may host maternal health and safe motherhood awareness raising programs such as TV shows (dramas), radio talk shows, campaigns on social media and brochure distributions throughout Uganda. They also can push the government to formulate and implement policies to reach out the most vulnerable and indigenous communities in the realization process of safe motherhood and improved maternal health.

In conclusion, integrating of these 3 approaches will go a long way in the realization of safe motherhood in Uganda.

References

Anastasi, E., Borchert, M., Campbell, O., Sondorp, E., Kaducu, F., Hill, O., & Okeng, D. (2015).

Losing women along the path to safe motherhood: Why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC Pregnancy and Childbirth. Retrieved from (Böhret, 2018)

Atuhaire, R., & Kaberuka, W. (2016). Factors contributing to maternal mortality in Uganda. African Journal of Economic Review, 4(2). Retrieved from https://www.ajol.info/index.php/ajer/article/view/136040

Böhret, I. (2018). Maternal Mortality in Uganda. https://doi.org/10.13140/RG.2.2.16930.07361

Cleeve, A., Oguttu, M., Ganatra, B., Atuhairwe, S., Larsson, E. C., Makenzius, M., … Gemzell-Danielsson, K. (2016). Time to act—Comprehensive abortion care in east Africa. The Lancet Global Health, 4(9), e601-e602. doi:10.1016/s2214-109x (16)30136-x Ensuring Every Woman Can Deliver with Dignity. (n.d.).

Retrieved from https://www.souluganda.org/maternalhealth

Girls not Brides. (n.d.). WHAT’S THE CHILD MARRIAGE RATE? HOW BIG OF AN ISSUE IS CHILD MARRIAGE? Retrieved from https://www.girlsnotbrides.org/child-marriage/uganda/

Priorities for Safe Motherhood. (2016). Retrieved from http://www.safemotherhood.org/priorities/index.html

Roback Morse, A. (2014, January 10). Definitions of maternal mortality.

Retrieved from https://www.pop.org/definitions-of-maternal-mortality/

Save the Children Uganda. (2018, November 14). ONE GIRL EVERY MINUTE IS AT RISK OF CHILD MARRIAGE IN UGANDA, WARNS SAVE THE CHILDREN. Retrieved from https://uganda.savethechildren.net/news/one-girl-every-minute-risk-child-marriage-uganda-warns-save-children-1

Sofia Garsbo, I. (2018). Early marriage in Mbale District, Uganda: Examining young women’s perceptions, agency and the influence of The Hunger Project Uganda (Unpublished doctoral dissertation). University of Amsterdam, Amsterdam.

United Nations International Children’s Emergency Fund Uganda. (2019, September 20). More women and children survive today than ever before – UN report. Retrieved from https://www.unicef.org/uganda/press-releases/more-women-and-children-survive-today-ever-un-report

United Nations Population Fund. (2011, March 2). Keys to improving maternal health: education, resources and community partnerships. Retrieved from http://unfpa.org/news/keys-improving-maternal-health-education-resources-and-community-partnerships

World Health Organization. (2019, September 19). Maternal mortality. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

The author of the article can be reached out through sefinewd@gmail.com / sgezahegn@brandeis.edu.

Meaningful Youth participation

THERE IS NO WAY ANYTHING IS GOING TO BE DONE FOR THE YOUNG PEOPLE WITHOUT THEM BECAUSE IT WILL BE AGAINST THEM! (THE IMPORTANCE OF MEANINGFUL YOUTH PARTICIPATION)

I agree with World Contraception day ambassador Nana Abeulsoud when she states that today there are more young people than before and therefore youth voices matter because no one is more convincing to define the future through innovation but the largest population. It is common knowledge that Uganda has the second youngest population in the world with about 78% below 30 years and half of that below 15 years. We should also note the alarming growth rate which is 3% per annum, the unemployment rate of the youth which is 38% and the rate at which teenagers are getting pregnant has increased from 24% to 25%. It is on this premise that I focus on Adolescent girls and young women.  Adolescent girls and young women (AGYW), especially in sub-Saharan Africa, are highly vulnerable to HIV. In 2015, up to an estimated 450,000 new infections occurred among AGYW aged 15-24 years globally, translating into approximately 1,229 new infections per day.[1] In Uganda, where AGYW are estimated at 6,569,000 or 16% of the population, up to 29,640 infections occurred in 2015.[2] In 2014, HIV prevalence among young people aged 15-24 years was estimated at 3.72% for women and 2.32% for men.[3] New HIV infections among AGYW are substantially higher than among males of the same age because HIV is more commonly acquired from male sexual partners who are a few or several years older.[4] Findings from the Uganda AIDS Indicator Survey conducted by Ministry of Health revealed that 3% of adolescent girls 15-19 years live with HIV, and that prevalence doubles (7.1%) by the time they are 24 years.[5] Estimates for 2015 show that the country registered an estimated 83,000 new HIV infections, 22% of them among AGYW, among whom an average of 50 infections occurred on a daily basis.[6]

While carrying out research on integrating Legal Empowerment and Social Accountability (LESA) for Sexual Reproductive health and HIV services for Young People in Kibwa and Kireku slums, I realized that the biggest challenge these adolescent girls and young women face is lack of information. After being assured of confidentiality, some of them who had had children before 18 and had gotten infected wished they had known of contraception, what to do in case of coerced sexual activity and infection, redress mechanisms and what their rights as individuals are. INFORMATION. That’s what they basically wished they had. Most of them are brilliant with a lot of potential but have been derailed from what they could have been simply because they didn’t have this information.

I have interacted with these young people in our legal aid tents in a number of community outreaches and health and youth camps under different projects and the need cuts across. Some of the cases they report and some of the legal advice they seek is in regards to situations that would have been easily been avoided if they had the information they needed. At one of the most recent community outreaches in Mayuge district, I encountered a 21 year old girl who had had six children in six consecutive years simply because she did not know that she could say no to an early marriage as she was not coerced into it but also because she didn’t know of any family planning methods. This information should also be given to the parents of these young people as I have encountered parents that encourage some of this behavior by giving away their own children to be ‘married’ at a young age which is not right even if they have been defiled.

We therefore have to ensure that all the sexual reproductive health rights information is disseminated to the youth specifically in the hard to reach areas like the rural and slum areas but also involve them in decisions related to and for them. Also, young people need models and not critics like John Wooden said. Criticizing them for the past will not help improve the present and future situation. We should also have confidence in them and give them a chance to work with duty bearers as partners. Meaningful Youth Participation (MYP) means that young people work in all stages of decision-making and can participate on equal terms with adults at a number of levels, or alternatively work independently from adults and make decisions solely with the involvement of youth voices. MYP is a right that all young people have according to the Convention on the Rights of the Child. According to this UN Convention, young people have the fundamental right to participate and access information related to decision-making processes that affect their life and well-being. There is clear evidence that MYP benefits society, has positive effects on their development, strengthens organizational capacity and is key to achieving Sexual and Reproductive Health and Rights (SRHR) program outcomes. The youth should be encouraged to take charge of their lives by addressing their situation and then taking action in order to improve their access to resources and transform their consciousness through their beliefs, values, and attitudes. Policy and decision makers should also appreciate the benefits to the country of sufficiently investing in the young people and the risk/consequences to the country of not investing in their empowerment. Advocacy for SRHR enabling policy and social environment for adolescents and young people and empowerment of adolescents and young people to voice their rights and SRHR challenges that affect them should be intensified.

Since Adolescent girls and young women are the mostly affected as earlier illustrated, the Gender Transformative Approach (GTA) which actively strives to examine, question, and change rigid gender norms and imbalances of power as a means of achieving SRHR objectives, as well as gender equality objectives should also be applied. Male involvement and movements such as the ‘she decides’ movement which I am part of should also be encouraged so that we can have a world where every girl and woman can decide what to do with her body, her life and with her future WITHOUT QUESTION. And just Antonio Guterres (former secretary general of the United Nations) said, we need to place a special focus on young women and girls. So many futures are derailed when young women are pushed out of school, subjected to child marriage or have poor access to education and health care. When we empower Africa’s young women and girls, everyone wins.

The legal Empowerment and Social Accountability (LESA) approach will also go a long way in equipping the young people with the information they need and strengthen the capacity of Adolescent Girls and Young Women (AGYW) and their communities to demand for improved quality of SRH services for AGYW, including protection from sexual and gender-based violence (SGBV).

In a nutshell, youth voices matter because it is through that they can become fully empowered to become leaders in their own right. And for those in the struggle in the fight for the rights of the young people, there are times when you will see results in ten seconds and there are times you won’t see any for ten years. Either way, keep planting those seeds of character, eventually they will bloom.

Kyagera Nairuba Angella

Community Empowerment program (CEHURD)


[1] UNAIDS 2016 Estimates. Geneva: UNAIDS; 2016. (http://www.unaids.org/en/resources/documents/2016/HIV_estimates_with_ uncertainty_bounds_1990-2015 )

[2] PEPFAR. Uganda: DREAMS overview. https://www.pepfar.gov/documents/organization/253961.pdf

[3] Uganda AIDS Commission (2015). 2014 Uganda HIV and AIDS Country Progress Report

[4] UNAIDS 2016. HIV prevention among adolescent girls and young women: Putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys. Guidance

[5] Ministry of Health (2011). Uganda AIDS Indicator Survey. http://health.go.ug/docs/UAIS_2011_REPORT.pdf

[6] Office of the President of Uganda (2017). Presidential fast track initiative on ending AIDS as a public health problem in Uganda; a five-point plan

Unresolved Maternal deaths

The Constitutional Court of Uganda on 30th September, 2019 formally heard Constitution Petition No. 16 of 2011. This case was filed in 2011 by the Center for Health Human Rights & Development & others against the Attorney General, challenging the unavailability of basic maternal commodities, the unethical conduct of health workers in public health facilities and failure of government to provide emergency obstetric care services among others.

On 2nd October, 2018, the President of the Republic of Uganda, His Excellency, Yoweri Kaguta Museveni officially commissioned the Mulago Specialised Women’s and Neonatal Hospital which was constructed to offer specialised services to women and children. On 18th September, 2018, Dr. Ruth Acheng, the Minister for Health made a ministerial statement on the operationalization of Mulago Specialised Women’s and Neonatal Hospital wherein she stated that there will be user fees charged for the services offered at the Hospital. The pay policy put in place categorised services offered at the hospital as Standard, VIP and VVIP services.  Furthermore, a waiver committee to determine who qualifies to access free services at the facility was to be put in place. This is an act of retrogression in the progressive realisation of the right to health and access to medical services. This prompted the Center for Health, Human Rights & Development to file Miscellaneous Cause No. 235 of 2019 against the Attorney General challenging inter alia the act of turning a public service into a private hospital at the Mulago Specialised Women’s and Neonatal Hospital.

It is over eight years since Constitutional petition No. 16 of 2011 was filed but there has been no redress from Court. Maternal deaths continue to happen in both public and private health facilities; some of these deaths are reported, others are concealed especially those happening in private health facilities.

In private health facilities, the vice is on rise leading to high maternal deaths; there are several instances of maternal deaths due to negligence and we highlight a few in this article. On 28th September, 2018, a mother admitted at St. Charles Lwanga Hospital in Buikwe District died along with her baby because of the hospital administration’s failure to refer her to another hospital for better management. The medical personnel supposed to attend to her were not on duty and the cashier tasked to provide the medical bill for payment before the discharge and referral of the mother was absent.

On 13th March, 2019, a mother lost her child at Alshafa Modern Hospital in Jinja District because the doctor supposed to attend to her reached the hospital late and the insistent requests by her to be referred to another facility were rejected. On 12th July, 2019, another maternal death occurred following the actions of a doctor at Butiru Chrisco Hospital in Manafwa District who failed to refer an expectant mother for better management because that referral would cause his hospital to lose funds which were being paid by USAID under the Uganda Voucher Plus Activity. On 20th October, 2018, a mother admitted to Kibuli Hospital underwent a cesarean section and spent over four hours in the theater; she was wheeled out of theater and placed in the ward while still unconscious. She was unattended to for more than 6 hours despite the fact that she was bleeding and eventually died.

These continuous maternal deaths raise the big question on who bears responsibility for all these deaths. Under Objective XX of the National Objectives and Directive Principles of State Policy of the Constitution of Uganda provides that the state shall take all practical measures to ensure the provision of basic medical services to the population.

The right to life is guaranteed under Article 22(1) of the Constitution of the Republic of Uganda. Clause 4 of the Uganda Medical and Dental Practitioners Council Code of professional ethics states that a practitioner shall not violate the human rights of a patient, the patient’s family or his or her caregiver. Furthermore, a practitioner is not to carry out any specific actions that constitute a violation of bill of rights enshrined in the Constitution of Uganda and international human rights law. Are health workers really aware about the provisions in the bill of rights or other international human rights laws in respect to health?

In Uganda, the health profession has many bodies that regulate the different medical professions; the Medical and Dental Practitioners Council is a body corporate established by an Act of Parliament – the Medical and Dental Practitioners Act, Cap 272 responsible for licensing, monitoring and regulating the practice of medicine and dentistry in Uganda. The Nurses and Midwives Council established by the Nurses and Midwives Act, Cap 274 mandated to train, register, enroll and discipline nurses and midwives of all categories in Uganda. The Allied Health Professionals Council is established under the Allied Health Professionals Act, Cap 268 mandated to regulate, supervise and control allied health professionals (Clinical officers). When a violation of human rights in respect to health particularly through medical negligence arises, complaints ought to be lodged with the appropriate bodies.

How then do these bodies that regulate the health profession and other stakeholders contribute to the reduction in maternal deaths in Uganda? The Uganda Law Society has partnered with the Uganda Medical Association in a number of activities for example on 30th August, 2019, the Uganda Law Society organized the first ever  Health Awareness Day for lawyers and invited the President of the Uganda Medical Association who came along with a team of doctors to speak to the lawyers that had gathered. This partnership is a strong partnership and an avenue for lawyers, medical professionals and other stakeholders to learn and embrace a human rights-based approach to tackling issues that arise in respect to the right to health.

The Ministry of Health is a key stakeholder in respect to health-related matters since it bridges the gap between the people and the medical profession since it supervises both government and private health facilities within the country.  Many public health facilities in the country have no medicines, basic services, no trained health workers to attend to people seeking health services including women seeking maternity services. In the absence of immediate intervention by medical professionals, the rates of maternal mortality continue to increase and issues surrounding maternal mortality are not addressed or resolved.

In light of the above, there is a wide gap that needs to be filled by different stake holders to fight this vice and reduce maternal mortality in Uganda so as to achieve social justice in health.

Namaganda Jane Kibira and Ajalo Ruth

Center for Health Human Rights and Development. (CEHURD)

Understanding Health and the Law

Health and the law is an emerging area of legal practice beset with a visible lack of national jurisprudence. The relationship between the law and health starts from the definition of the two terms; The World Health Organization (WHO) defines ‘health’ as a ‘state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity’ and the law is defined as ‘the system of rules which a particular country or community recognizes as regulating the actions of its members and which it may enforce by the imposition of penalties’. The marriage of the two gives us Health and the law which refers to those enforceable laws established by government and applied to people for the purpose of building a healthy society.

In Uganda, health and the law did not exist as an independent area of practice until recently. It was largely embedded within the law of tort under medical negligence, constitutional law under quarantines for reasons of public health and safety and in criminal law under imposing sanctions on health workers for committing negligent acts. Health and the law has slowly garnered force in India and South Africa as seen in the 1998 case of Soobramoney v the Minister of Health (KwaZulu Natal), the Constitutional Court said that the government was justified in restricting access to kidney dialysis, because of the high cost of this type of care, and the need for the government to have reasonable plans for spending its health care resources.

In the 2002 case of Minister of Health v Treatment Action Campaign, the Court stated that the government was wrong to restrict access to the antiretroviral medicine, nevirapine, that is effective in reducing the risk of mother-to-child HIV transmission and ordered the government to make the medicine available to pregnant women living with HIV.

The principal legislation informing health and the law in Uganda is found in the Constitution of the Republic of Uganda, 1995 which creates an obligation on the State to ensure that all Ugandans enjoy opportunities and access to health services and ensure provision of medical services to the population. It can also be found in acts of Parliament which include the Public Health Act Cap 281, Insurance Act 6 of 2017, the Medical and Dental Practitioners Act Cap 272, the Nurses and Midwives Act Cap 274, the Allied Health Professionals Act Cap 268, Mental Treatment Act Cap 279, Venereal Diseases Act Cap 284, National Medical Stores Act Cap 207 and National Drug Policy and Authority Act Cap 206.

Health and the law has also seen a slow but sure growth in the courts of law where the Courts have set precedent in several cases such as the cases of Joyce Nakacwa vs. Attorney General Constitutional Petition No. 2 of 2001 which was unfortunately not heard on its merits, there is also Sarah Watsemba Goseltine and Baby David Goseltine vs. Attorney General High Court Civil Suit No. 675 of 2006 which discusses medical negligence. Medical negligence contributes to death, damage, injury of patients.

Although the legal framework provides for redress against medical negligence in form of civil and criminal law, these laws are inadequate because it is hard for a victim to prove medical negligence against a medical professional let alone extract payment of damages from the government.

The case of CEHURD vs AG Constitutional Petition No. 16 of 2011 challenges inter alia the non-provision of basic indispensable maternal health commodities in government health facilities but the Petition was struck out for raising political questions but this decision was overturned by the Supreme Court in Constitutional Appeal No.1 of 2013 and the petition was forwarded back to the Constitutional Court to be heard on its merits. On 30th September, 2019, the Constitutional Court heard arguments for and against this matter which was adjourned for a ruling which will be delivered on notice. There is also a growing connection between medical negligence and the right to health as seen in the cases of CEHURD & 3 ORS vs Nakaseke District Local Administration Civil Suit No. 111 of 2011 and CEHURD & 2 ORS vs Attorney General Civil Suit No. 212 of 2013 which discuss the right to health and medical negligence.

Health and the law has now expanded with the growing subscription to medical insurance and the increase of private actors in the health sector and some of the issues presented before Court now include; rights of persons with mental disabilities, tobacco control, sexual reproductive health, access to medicines, access to health information, quality of health care in private health facilities, businesses in the health sector among others.

There are also issues of professional misconduct/unethical behavior by health professionals, medical negligence, unhealthy and unsafe working environment in health facilities which jeopardize patient safety. The non-appreciation of the distinction between rights violations, ethics and medical negligence have also been prominent.

AJALO RUTH

ajalo@cehurd.org

Centre for Health, Human Rights and Development (CEHURD)