The Center for Health Human Rights and Development (CEHURD) this week joined the 2017 Prince Mahidol Award Conference in Bangkok, Thailand.
The conference this year is themed on Addressing the Health of Vulnerable Populations for an Inclusive Society. Our Executive Director, Mr. Mulumba, Moses will be together with others convening a session titled ‘Can the Right to Health be used to overcome Exclusion from the Health Services?‘
Kampala, Uganda: Today the High Court of Uganda sitting at Kampala has bashed Mulago National Referral for their failure to protect mothers who give birth from the Hospital from loss of their babies in inexplicable circumstances. The directive arises out of a case that was filed in July 2013 by the Center for Health Human Rights and Development (CEHURD), Mubangizi Michael and Musimenta Jennifer against the Attorney General of Uganda and the Executive Director of Mulago National Referral Hospital.
The case is the consequence of the failure of the hospital to account for the whereabouts of the baby of Musimenta Jennifer who gave birth to twins at the Hospital but was only given one baby. The Hospital gave Musimenta Jennifer only one live baby and later gave also her the body of a deceased which after DNA tests was found to not be compatible with Mubangizi Michael and Musimenta Jennifer.
CEHURD, a health and human rights advocacy organization joined the parents of the baby Mubangizi Michael and Musimenta Jennifer and filed a case against the Attorney General acting on behalf of Mulago Hospital and the Executive Director of Mulago National Referral Hospital. We argued in the case that the failure of the Mulago National Referral Hospital to provide information on the whereabouts of the second child was a violation of the parents’ right to health, the rights of the family, the rights of children and the right to access information all of which are protected under the Constitution. We asked Court to declare that the rights of the parents had been violated, to order Mulago National Referral Hospital to provide information on the whereabouts of the baby and to pay general damages to the parents for the untold pain and suffering they had suffered.
The Attorney General and the Executive Director of Mulago National Referral Hospital in response argued that the Musimenta Jennifer gave birth to a dead baby and that she together with Mubangizi Micheal took the body from Hospital Mortuary. The Court has been hearing the case since 2013 and today decided that it was ready to deliver its decision in the case.
“We applaud the High Court for standing boldly in the face of injustice and deciding to end human rights violations which have for long been perpetrated against mothers who use Mulago National Referral Hospital. It is a remarkable sacrifice for mothers to go through the process of labour and exercise all due diligence and effort to deliver the baby successfully into this world. It is therefore grossly cruel and inhuman when the mother who has undertaken this sacrifice is fraudulently and unlawfully deprived of the baby by the people who are tasked with assisting her. CEHURD will follow up with the decision of the High Court and ensure that every individual who has in one way or the other been implicated in the theft of babies is held appropriately accountable.” – James Zeere, CEHURD.
The Constitution of Uganda provides that the rights and freedoms shall be respected, upheld and promoted by all organs and agencies of Government and by all persons including the staff at Mulago National Referral Hospital. Today, the Court has demonstrated the sanctity of the right to health in Uganda by holding Uganda’s biggest Hospital accountable for its health rights violations against Musimenta Jennifer and Mubangizi Micheal.
CEHURD wants to recruit a Programme Officer under its program of Research, Advocacy and Documentation (RDA). Click here to download Full Job description here
Job Purpose: The Programme Officer will work under the Research, Documentation and Advocacy (RDA) Program and will be responsible for performing the tasks listed below towards supporting the program.
This is a highly engaging position requiring multitasking capabilities and capacities to research, write and engage with evidence.
Key Responsibilities:
The attainment of the above will be reflected in the Programme Officer’s appraisal, as well as the achievement of outputs, as described in above key responsibilities.
The Center for health Human Rights and Development (CEHURD) is developing a list of Vendors qualified to provide goods and services at acceptable standards. This Pre-qualification Questionnaire was therefore designed to collect sufficient VENDOR information with regard to its capability and interest in providing goods and services. Please find the Pre-qualification Questionnaire HERE.
By Mr. Mulumba Moses
Experts met this week for the Fourth Global Symposium on Health Systems Research in the beautiful Canadian city of Vancouver. This particular symposium theme was built around resilient and responsive health systems for a changing world. Simply put, on the one hand, health systems must be resilient in ways that enable them to absorb shocks and sustain gains and on the other hand, the systems should be responsive by anticipating change, respecting rights, and engaging politics.
I got an invitation as part of the closing panel to particularly share thoughts from a retrospective look at how lessons learnt from key moments in the field of health policy and systems research and practice might shape and inform the field going forward. This offered me a moment of reflection on the global developments in health policy and how these have continued to shape and affect our health systems nationally. In my reflection, the Global Agenda on health policy has shifted from a broader focus on strengthening resilient and responsive health systems to an approach of sustaining health systems in the most economically efficient manner with minimal public sector investments.
The spirit of building such resilient and responsive health systems was very inscribed in the earlier global health agenda as illuminated in key documents such the 1974 Lalonde Report, the 1978 Alma Ata Declaration on Primary Health and the 1986 Ottawa Charter from the first International Conference on Health Promotion. At the core of these proclamations were health systems built on prevention of health problems and promotion of good health.
The Alma Ata Declaration, for instance, emphasised investments in primary health care and highlighted that people have a right and duty to participate individually and collectively in the planning and implementation of their healthcare. The focus then was to move away from just medicalised health systems to more inclusive ones with a community-engagement component.
In my view, if well implemented, this approach would provide an impetus for building resilient and responsive health systems.
There was, however, a shift in the mindset of theory informing health policy-making towards the early 1990s. At this time, Primary Healthcare approaches and health promotion strategies were criticised for being unmanageable, lacking clear measurable, and very costly to sustain. In the alternative, a selective approach that is disease specific, measurable, and more cost effective was proposed.
It is not surprising that global decisions on health have bred the current famous disease specific projects in areas of HIV/AIDS, Tuberculosis, Malaria and lately maternal health. As such, all funding for the health sector has been moved to these projects. The impacts on the overall health systems especially in the low and middle income countries have been severe.
These range from destruction of Primary health care structures of community participation in health decision making, through to emergency of neglected diseases and parallel programming siphoning key human resources from the mainstream health system to the more resourced disease-specific projects. The disaster in the end has been the non-resilient and unresponsive health systems which are manifested by the outbreak and failures in the control of diseases like Ebola in West Africa.
In my view, the change in mindset could be largely attributed to the major role played by the neoliberal approaches introduced in the early 1990s when the World Bank together with the IMF aggressively introduced Structural Adjustment Programs as condition for receiving bailout loans.
This approach advocated for major budget cuts from social sectors, including health. The call for cutting public expenditure severely affected investment in health systems. They were replaced by projects focused more on diseases and less on Primary Health Care Investments.
This approach has led to development frameworks being highly skewed towards a free market economy. With this thinking continuing to influence national policy making through the famous Poverty Reduction Strategy Papers now metamorphosed as National Development Plans, countries including Uganda continue to conceptualize their national health policies and strategies from an economic perspective more than as a public health concern.
In my opinion, this has by and larger resulted into selling health systems to the market place and commoditising the provision of health care. This has been very carefully crafted to slowly but surely weaken the role of the State in building resilient and responsive health systems. It is, therefore, not surprising that in a number of health systems in low income countries including Uganda, the private sector is providing close to fifty percent (50%) of healthcare. No health system largely run by the private sector can be described as resilient and responsive.
Such implications are not just at the national level, but the entire architect of global health governance. The would be global leaders have to highly depend on the private sector not just for their funding but also agenda setting and proposing the global health priorities. The current proposals on universal health coverage are, therefore, not surprisingly dominated by the role of health insurance. This is understood as a business model.
I will propose that in looking forward, we need to situate health systems research in interrogating a paradigm shift in the current health governance structure. At the global level, health governance should question the agenda setting and toning down on the role of the private sector. At the national level, the state needs to reclaim its role in the social contract, including emphasis on its unfettered regulatory function and – at the community level, health governance should bring back communities in priority setting, involvement, informing evidence, and not merely acting as vehicles for facilitating health provision because of limited resources. In this way, we could talk about a resilient and responsive health system.
Moses Mulumba is a lawyer practicing Health Law and Policy at the Center for Health, Human Rights and Development.
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