Realizing our own destinies: Engaging the community in achieving the right to health

By: Margherita Cinà, Intern from McGill University

MargheritaA few days ago I visited Kabarole District in Western Uganda and I was talked to a layman involved in projects for strengthening his community. Being a Canadian interested in development and finding myself in a new, and very different country, I asked him what the biggest challenge was with development initiatives in the area. He responded:

“In Uganda, we have a saying: ‘God gives meat to those who do not have teeth’. This means that many people are given things that they cannot use, and that’s a big problem with development initiatives because many organizations do exactly that. Organizations need to know the local community, their needs, culture, and governance structures before they come and try to help us. For there to be long-lasting success, organizations have to work with the community so that members can take ownership over the project and so that efforts are not wasted. Many organizations don’t do that.”

Since the beginning my internship at the Center for Health, Human Rights and Development (CEHURD) on 11 May 2015, I have witnessed the works of an organization that does not make that mistake. I have had the opportunity of being involved in all three of CEHURD’s programs (Research Documentation and Advocacy, Strategic Litigation, and Community Empowerment) and I have been able to witness the importance and the effectiveness of the approach of engaging community members and providing them with the knowledge to demand for their rights. Particularly, through the Community Empowerment Program, CEHURD works with local communities to identify specific health issues and work together to address them by creating knowledge and awareness.

At the beginning of June, I travelled with the CEHURD team to Manafwa District in Eastern Uganda and participated in implementing a project in partnership with the African Rural Development Initiative (ARDI), a Community Based Organization that works closely with CEHURD in that area. Together, the two organizations have been working to advance sexual reproductive health (SRH) in schools in this district. The organizations sensitize students on pertinent issues of SRH, such as access and barriers to modern family planning methods, and help them make informed decisions about their own reproductive health. The project also involved holding stakeholder dialogues with religious and cultural leaders, the police, and community members, all of whom play essential roles in the topic of SRH.

This particular community project is a direct response to a study conducted by CEHURD in 2014 entitled “Criminalization of Abortion and Access to Post-Abortion Care in Uganda: Community experiences and perceptions in Manafwa District”. This study revealed that unsafe abortions are particularly prevalent in Manafwa District. A local health care centre, Bugobero Health Centre IV, reported that they received approximately 25 patients per month who needed post-abortion care (PAC), while a total of 205 abortion cases were registered by public health facilities in the district over a period of 12 months. Given the illegal nature of abortions, it is likely that these numbers do not show the whole extent of the problem, as many cases remain unreported for fear of the legal and social consequences of this criminal act. Uganda has one of the highest rates of maternal mortality in Eastern Africa with a rate of 438:100,000 live births. Of the over 6,000 estimated maternal deaths that occur in the country every year, about 26% (more than one quarter!) are attributed to unsafe abortions.

I engaged students from four schools, including Lwakhakha Primary and Secondary, Bumbo Secondary, and Kisawayi Primary, to critically think about and discuss SRH issues and over 500 students were involved in debating the topic: “Should the use of contraceptives be encouraged in schools?”

This topic was chosen in order to open dialogue between school children about contraceptive use and the high rates of unsafe abortions that occur in their district. Students bSCA_5036etween the ages of 8 and 22 were selected ahead of time to debate both sides of the argument. At the end of the formal section of the debate, the floor was opened up to other students that wanted to contribute arguments either for or against the motion.

Overall, the level of debate was very good and the students were all enthusiastic and quite comfortable talking about issues of sex, contraceptives, pregnancy and sexually transmitted illnesses. There were however many misconceptions of the use of contraceptive that were found across all 4 schools. Among the most frequent mistakes were that contraception use damages reproductive organs, causes permanent infertility, produces deformed babies with big heads or the size of small rats, leads to diseases such as hypertension, and that girls will waste the family’s little financial capital on buying these pills, Injectaplans, or condoms.

Following the debate, a community health worker, a midwife at a Health Centre III, gave the students sexual education by explaining biological basics as well as addressing some of the myths and misconceptions about contraceptive use that arose during the course of the debates. Importantly, she also informed all the students that contraception, such as pills and condoms, are actually free of charge at health centres and therefore can be obtained by anyone. She told the students of the “youth-friendly services” are available in many health centres and that students should begin to start accessing them if they are engaging in sexual activities.

The nurse also brought in the issue of unsafe, self-induced abortions, an issue that had been raised by a few of the students arguing for the use of contraception to be encouraged in schools. Many early pregnancies by young girls who are still in school can lead to the girls seeking unsafe abortions in order to remain in school or avoid stigma by family or community members. In order to avoid these early pregnancies, it was highlighted that the two best options were abstinence and, if that is not possible, condom use.SCA_5025

The students remained engaged throughout the whole session. At the end of the midwife’s talk, students asked very relevant and interesting follow-up questions and, upon an informal evaluation at the end of the session, students clearly indicated that they had learnt new information about contraception use and were aware that some of their initial ideas were in fact wrong.

My visit to Manafwa District taught me many things and helped me reflect on some of my own conceptions of human rights and development initiatives. Firstly, I began to think deeper about what exact “the right to health means,” which is three obligations on the government: the obligations to respect, protect, and fulfill. Empowering community members through these dialogues and debates is the beginning of creating an environment where individuals take ownership of their rights and begin not only to understand them, but to also be able to hold appropriate people or institutions accountable. The government always has the three obligations however, when individuals are not aware of their rights, they are not able to demand those rights. By informing individuals on their sexual reproductive health rights, the government becomes accountable for its duty to respect and protect the communities.

the writer receives a gift from one of the school heads.
the writer receives a gift from one of the school heads.

Secondly, I had the opportunity to experience and to reflect on what it takes to begin to effect real change in a least developed country (LDC) like Uganda. My personal interests have always been in development issues, particularly around health issues, in low- middle-income countries and yet this is the first time that I have had the opportunity to work with an indigenous NGO and, more specifically, to interact with the community members that many international laws and policies I’ve read or studied are supposed to help.

This experience in Manafwa District with the CEHURD team has allowed me to better understand the challenges and barriers that individuals and communities face as well as their specific needs and stories.
When it comes to reducing the number of maternal deaths due to unsafe abortions, the road begins with educating children and youth on the facts of SRH and then including all key stakeholders in the discussion. Sustainable and effective change starts by addressing specific community needs and involving all those in the community in the change process.

By Margherita China
Intern-Centre for Health, Human Rights and Development (CEHURD)

We are Hiring: Research Officer and Administrative Assistant

Job Title : RESEARCH OFFICER

Reports to: PROGRAMME MANAGER

Job Purpose:

To provide overall leadership and management of CEHURD’s research processes and the coordination of CEHURD’s Regional work on Health Equity. This is a dynamic position that requires the officer to provide leadership in designing and implementing research projects and evidence-based advocacy initiatives. Other responsibilities include fundraising, coordination of regional health equity initiatives with a strong contribution to CEHURD’s Strategic Plan.

 

Job Title : ADMINISTRATIVE ASSISTANT

Reports to: OPERATIONS MANAGER

Job Purpose:

To perform a range of administrative tasks for the effective and efficient operations of CEHURD. While the Administrative Assistant reports to the Operations Manager, she may often be required to perform administrative and office support activities for multiple supervisors.

DOWNLOAD THE JOB DESCRIPTION

The closing date for the receipt of applications is 31st July 2015 by 12:00noon; and only shortlisted applicants will be contacted.

  1. Application Submission Guidelines

    If you believe you are the ideal candidate for any of these posts, please submit your Application Letter, Curriculum Vitae, and copies of your academic documents in a sealed envelope, clearly indicating the position applied for on the “top left-hand side of the envelope” to:

    The Executive Director
    Center for Health, Human Rights and Development Plot 833, Old Kiira Road, Ntinda-Kiwatule
    P.O. Box 16617 Wandegeya
    Kampala – Uganda

    OR Email your application & other supporting documents to: info@cehurd.org clearly indicating the position applied for in the subject line of the email.

Launching the standards and guidelines on unsafe abortions to confront the public health crisis in Uganda

The Ministry of health launched the “Standards and Guidelines for the Reduction of Maternal Mortality and Morbidity Due to Unsafe abortion in Uganda on 4th April 2015.” According to the Uganda Demographic and Health Survey (UDHS) 2011, Uganda has a maternal mortality ration of 438 per 100,000 live births, 26 percent of these deaths are attributed to unsafe abortions.

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As an intervention, in 2013 the Ministry of Health in collaboration with Development partners, implementing partners, and stakeholders including; the Center for health human rights and development (CEHURD), IPAS Reproductive health Uganda (RHU), Association of Obstetricians and Gynecologist of Uganda (AOGU), Makerere University department of Psychiatry, Ministry of Justice and Constitutional Affairs, Makerere University School of Laws PACE, Health GAP, Marie Stopes Uganda, and the Coalition to Stop Maternal Mortality Due to Unsafe abortion (CSMMUA) started a consultative process for the development of Standards and Guidelines to address the mortality and morbidity as caused by unsafe abortions in the country.

These guidelines will be implemented in all health facilities nationwide and will also be used by health professionals as well as policy makers to take steps in the area of service delivery, advocacy and capacity building all aimed at reducing maternal mortality and morbidity caused by unsafe abortion in Uganda.

The launch of the Standards and guidelines which has marked the end of the two years multi-stakeholder consultative journey has been officiated by the Director of Health services at the ministry of Health Professor Anthony Mbonye on behalf of the State Minister of Health (in charge of primary health care) Honourable Sarah Opendi. In his statement during the launch, the Professor noted that Uganda like any other country pledged to meet the obligation under the Maputo plan of Action, MDG 5 on reduction of maternal mortality as well as other Global initiatives in order to ensure that lives are not lost as a result of unsafe abortions. “This has therefore remained a key Government concern,” he added.

The chief executive officer of CEHURD, Mr. Mulumba Moses said that the standards and guidelines document is a step towards stopping women from turning to backstreet alleys. Mr. Mulumba added that it is encouraging to hear that the ministry is ready to tackle the problem head on by developing a policy structure that aims to deal with an issue that has been ignored for far too long.

In Uganda, termination of pregnancy is restricted and only permitted to preserve the life, mental and physical health of pregnant mothers. There have been challenges due to limited understanding of the legal environment by health providers, policy makers and patients hence formulating these guidelines which will help in solving this issue.

Dr. Charles Kigundu, president of the Association of Gynecologist and Obstetricians of Uganda noted that as health workers dealing with maternal health issues still find a lot of women coming to them with complications such as infections and punctured uteri. The guidelines will help solve the situation greatly since many health professionals believe that abortion is totally legal yet the guidelines provide a better picture on how, when, and in what circumstances a safe abortion can be performed.

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