Budget allocation and community participation in Uganda’s health sector

Health sector is one of the core yardsticks upon which progress and advancement are realized in a particular country and the state, at which a country’s health sector is ranked, usually indicates the overall growth and development in the country.

Uganda is one of the third world countries that set the 15% target in the Abuja Declaration which our own president Yoweri Kaguta Museveni participated to in April 2001.The question stands is the 15% really allocated to the health sector just like the government promised to? The answer to this is very clear which is NO and because of that a lot of challenges in the health sector for the marginalized groups like women and children are still stumpy and that is why we have 17 women who die every day in Uganda due to maternal mortality, 20 women are caught up in maternal complications every day and we have over 570 youths who are infected with HIV everyday in Uganda.

Uganda’s budgetary allocation towards the health sector has been unpredictable for the past four financial years and whereas health activists have, for long, been advocating for a continuous increase of 15% in the health sector budget, it has been fruitless.

In the financial year 2013/14, the health sector received sh940b, up from sh852b in 2012/13. This meant that the sector received about 7.2% of the national budget of sh13.1 trillion, which is still below the 15% target. Last year, the health sector got about 7.6%, while in 2011/12, it got slightly over 8%.In 2010/11, the allocation to health was sh660b and it leaped to sh985.58b in the subsequent year of 2011/12. However, the drop by sh133.58b in the following year 2012/13 to sh852b left many civil society health activists disgruntled.

Just in this year of 2015, CEHURD carried out a dialogue meeting in Buikwe district with an aim of achieving a meaningful documentation on how the community participates in the budget system at the district.

Different stakeholders participated in this dialogue and some of them like the religious leaders and LC 1s where totally uninformed about the whole process. As to the usual community persons, they did not even want to know about the process because to them, even if their ideas were shared, they were never reflected but rather the ideas of the minority group that participates in the budget committee were the ones forwarded at the national level.

This gap comes with a huge challenge and because of lack of participation by the community at the district level, people who are mostly faced with health difficulties will never get redress but rather inconsistent as priority in other areas will be key and health will remain less presented at the national level hence the continuous fall in the allocation of the 15% on health in the country.

The preceding discussion on community participation in the budget process at the community level has shown that it is not a simple process in which the community can easily engage themselves in but one needs to be optimistic about the future of community participation in the process and as a way forward, there is need for novel avenues for community participation which among others may include interactive budget hearings like community dialogues, encourage community participation in budget conferences at the district and also pressure their local leaders like councilors who represent them at the district committee level to priories health while allocating resources in budget.

By Thuraya Mpanga Zawedde

Speak out on sexuality issues, save lives – CEHURD takes lead

In modern-day times, the issue of sexuality is an aspect of reproductive rights, which is internationally recognized as critical to the advancement and promotion of adolescent human rights. However, under the African culture, open discussions on certain issues on sexuality are regarded as taboo. Cultural norms forbid the teaching about sexual relations and each person is supposed to find out all there is to know by experience.

Ironically, there are some cultural practices having sexual connotations that young adolescent girls are encouraged to become involved in and in which they are tutored from childhood. Such issues relate to the puberty stage of the adolescent girl and are commonly linked with rituals, festivity and celebrations. Closely linked with these cultural practices that have an effect on the sexuality of the adolescent girl are various myths that ensure conformity.

On the other hand, many a time these messages have been sugarcoated in the name protecting cultural and other societal norms, ending up in distortion let alone misinformation.

The Center for Health Human Rights and Development has made tremendous strides in the dissemination of sexual reproductive health rights information to the youth and adolescents in the districts of Manafwa, Kiboga and Kyankwanzi.

This is done through sensitizing and building capacity of selected youth and adolescent representatives, who in turn go down to the communities and spread the word to their peers.

I will borrow the words of a renowned law professor who once said, “We are all products of sex, so we can’t be ashamed to talk about it”. I’m almost certain that we are all agreeable to this fact.

Denial to speak about sex and sexuality is a rather disastrous trend, as it deprives people, particularly youth and adolescents, women and girls, of their right to health information. This has greatly contributed to an increase in complications relating to sexual reproductive health especially in the far-to-reach rural communities.

By Vivian Nakaliika

Utilizing social media to realize maternal health rights – the #selfie4her campaign

Social media has tremendously grown to sensitize people on their rights. A number of communities have engaged on different social media platforms including but not limited to Twitter, Facebook, Whatsapp, and Instagram, and in one way or another there have been massive campaigns geared towards realization of rights.

With text, photos and info graphics, users of the different social media platforms have developed techniques to target not only the rights holders but also the duty bearers. This they do either by tagging the duty bearers themselves onto the different posts or ensuring that the initiated campaigns are popularized with clear explanations on how to get involved.

Once a campaign takes shape, there is community attraction and support for the same and this on many occasions leads to the much desired change. A number of publicly known successful campaigns have started in social media; take for example the case of a maid that mistreated a child in Uganda, whose video clip went viral on social media. What started as a simple post in social media turned out to be the centre of debate across the country for some good time. To-date, a mere mention of the “maid from hell” – like she was tagged – anyone can give you the whole chronology of the case.

Center for Health Human Rights and Development has for a long time focused efforts towards the realization, protection and preservation of human rights, key among which are maternal health related rights. In a bid to realize these, and given its experience in advocacy, CEHURD initiated a new media campaign, the #selfie4her campaign, to amplify citizen voices in the fight to end preventable maternal mortality. This campaign was launched in March 2015 during an east African media fellowship organized by CEHURD, that brought together journalists from the East African region to discuss sexual reproductive health rights issues.

This social media campaign set out to advocate for maternal health rights with reflection that it would in the end lead to an influence of the national budget to at least have 15% of it diverted to the health sector given that it greatly contributes to maternal deaths in the country.

The campaign has since gone viral with different people posting selfies for a woman’s cause. It is one of the simplest campaigns you could think of and it is very easy to follow;

  1. Take a picture of yourself and post it on any social media platform
  2. Or, take a picture of yourself and a mother
  3. Or post a picture of a health facility that could be bad or ideal

With either of the above, one posts a picture with a message aimed at improving lives of women.

CEHURD has not stopped at posting and inviting people to post but its methodology is quite distinctive. We have gone ahead to speak about the same on different TV and radio stations. This has created more attention to and recognition of the same. We have also linked the campaign to other key heath related issues like the planned exportation of health workers to Trinidad and Tobago and health budget advocacy. We hope that you can also join the campaign, and remember the #selfie4her is your hash tag.

By Nakibuuka Noor Musisi and Vivian Nakaliika

The role of civil society organisations in promoting community participation

Among the tenets of the Human Rights based Approach to participation is empowerment. Empowerment involves equipping communities with skills to voice their concerns in seeking better services for their well being. Health Unit management committees as established by the ministry of Health are structures utilized to promote community participation in health at the community level.

In an initiative to promote the decentralizing of the health system, the government of Uganda through Ministry of Health called for an establishment of HUMCs at each government health facility as a way of empowering community members to participate in influencing health system for better service delivery.

This is also due to the fact that Community participation has been identified among the key elements which must be utilized in advancing for the right to health. These committees were established with a responsibility of oversight role at the facility through inspection and supervision of work at the facilities all aimed at improving the quality of health care in these facilities.

As part of an action research process, the Center for Health Human Rights and Development (CEHURD) carried out a case study on two HUMCs in Kikoolimbo health center III in Kyankwanzi district and Nyamiringa health center II Kiboga district. The purpose of this case study was to provide an understanding of the experiences of HUMCs in performing their roles and what role Civil Society can play to support them perform their roles and responsibilities as well as advancing health rights and addressing health inequities using the human rights based approach.

Astonishingly, our findings revealed that these two health unit management committees had limited knowledge of the HUMCs guidelines established by the Ministry of Health which clearly elaborates the roles and responsibilities of these health structures.  This therefore steered the training of these committee members in order to equip them with knowledge on what is expected of them hence improved performance. After the trainings, community dialogues were also held to inform community members about the existence of these committees as well as their roles and responsibilities. We thought this would foster HUMCs performance since majority of the community members within the district were also not aware of existence of the HUMCs but also there guidelines,

This intervention by CEHURD has seen the growth of these HUMCs and transition in leadership. It is worth reporting that after the training, one of the HUMCS team realized that it had over leaved its usefulness and opted to hand over power to a newly trained team that they thought was still energetic to carry on the work. On the 25th March 2015 we witnessed the handing over of office by the old members of the HUMC of Kikoolimbo health center III to the newly selected members. As a means of appreciation, old members were awarded with certificates of service appreciating them for their dedicated efforts in promoting improved health service delivery at the facility. This gives us a lesson that when communities are empowered, they can take it upon them to differentiate between performing and non-performing committees or structures hence seeking for change.

Why health literacy is important in improving maternal health

There is a common belief that pregnancy and child birth is a test of endurance and maternal deaths are just a sad occurrence that in one way or another could not have been avoided; and any woman who evades the traditional birthing practices and delivers by caesarian, is weak and cannot endure pain and suffering that women were born to endure by virtue of them being women. This mentality has resulted into very dangerous practices in which women delay seeking assistance during labor and by the time they realize they are obstructed, it’s too late and they cannot access emergency obstetric care in the nearby health facilities thus end up losing their lives. This coupled with other delays such as distance from the home to the nearby health facility, the health facility’s capacity to manage obstetric complications and the failure to utilize health facilities because mothers do not understand the relevance of the treatments or do not ever seek such services because of ignorance of their existence; all contribute to the high maternal mortality rate in Uganda.

Although maternal mortality in Uganda has declined from 527 deaths per 100,000 live births in 1995, to 438 deaths per 100,000 live births in 2011, this still falls way below the MDG target of 131 deaths per 100,000 live births by 2015. This translates into an annual decline rate of 5.1% and an average of 18 women dying every day. It remains evident that many mothers are still dying as a result of pregnancy related complications and as shown in the Reproductive maternal, Newborn and child health Sharpened plan for Uganda; November 2013 which highlighted the highest maternal mortality to be in Eastern, Western, North and the Karamoja regions and lowest in Central the central region.

Although there has been strong commitment from the Ministry of health and government at large to address preventable causes of maternal morbidity and mortality, there is still generally low turn up for health services in rural areas as expectant mothers prefer receiving care from traditional birth attendants other than health facilities and often mix conventional medicine with local herbs.

Many women choose not to go to health facilities because they do not understand why they are being subjected to tests or why certain medication is important in saving their lives and that of the baby. This is so because most women in rural areas are illiterate and therefore rely on ancient family practices, rumors, myths and misconceptions associated to pregnancy and child birth. Even where women endeavor to visit health facilities for antenatal care, health providers ignore communicating certain information that is important in advising them accordingly on the dangers of prolonged labor and what signs to look out for in order to identify complications that may in one way or another cause obstruction in delivery of the baby which may endanger the mother’s life.

We as Ugandans must keep our mothers, wives, sisters and daughters alive by doing what we can to reduce preventable maternal deaths from happening. Many of us think about saving the child’s life and not the mother’s, but there is a link between child mortality and maternal mortality and it’s indelible. Research and practice have shown that infants whose mothers die within the first 6 weeks of their lives are most likely to die before reaching the age of 2 than infants whose mothers survive child birth. This shows that a child’s survival is dependent on the survival of the mother.

We can therefore only improve access to and delivery of maternal health services in rural areas through Health literacy amongst health providers, women and girls of reproductive age, men, cultural and religious heads etc. There is need for appropriate interventions to address the existing barriers between rural mothers and the formal health care system, this should include health literacy for both men and women in rural communities and health providers on a human rights based approach to service delivery such that we reduce mother’s seeking care in more traditional or homeopathic environments.

In this century, with drugs and commodities to save lives, no woman should have to die due to lack of reproductive health choices or worse still, have to give her life to give life. We can all make it happen for all the women in our lives.

By Florence Nabweteme.