This media call for investigative story ideas seeks to set the regional SRHR agenda for discussion,to improve visibility of Sexual and Reproductive Health challenges in the East African region and to build a class of media people that can report in an informed and objective manner.
The objective of this call is to increase documentation of Sexual and Reproductive Health Rights and how far governments have gone in upholding their obligations to protect, fulfill and respect SRHRs in the East Africa region.
THE SPECIFIC AREAS OF FOCUS INCLUDE;
The state of maternal health in your country;
Legal and policy framework of abortion in your country;
Barriers to accessing SRH services among the youth and, strategies or initiatives to address these barriers;
Attitudes and practices (social norms) of abortion in your country.
Or any other story ideas in the area of SRHR that may have a direct or indirect bearing on the impact of unsafe abortion in any East African Country
“Intellectuals solve problems; geniuses prevent them.”-Albert Einstein. This notion rhymes well with the trend taken by civil society organizations in Uganda. They have won the hats of intellectuals and not geniuses, in solving human rights related problems. This they have done through empowering communities to demand for rights, developed research programs, and litigated in the areas of health among others, While these interventions are necessary to address some key underlying issues of human rights abuses, it could be improved by first tackling the root cause of limited success of human rights.
It is not surprising that many of the human rights violations that call for the need for civil society to intervene, are mainly due to the limited government budgetary resources attributed to key sectors such as health, education and the judiciary. One of the key issues that have been discussed and strategies developed by CEHURD a civil society organisation committed to social justice in health, is the budget allocation to the health sector.
An analysis of the budgetary allocations to the Health Sector shows a 5% increment of the budgetary allocations to health in the FY 2015/2016 compared to FY 2014/2015. In April 2001, the African Union Heads of State, including the Ugandan President, met in Abuja, Nigeria and pledged to increase government funding of the health sector to at least 15% of the national budget. Despite this commitment however, Uganda’s allocation to the health sector for the past 5 years stagnantly remained between 7-9%. This is a clear indication that either there is a lack of political will to realize the enjoyment of the right to health by its citizens or that it has failed on its commitment made in 2001 at Abuja. It is no wonder that the sector is constantly ailed with shortage of medicines supply, low remuneration for medical staff, low staffing in public health centers, poor health facilities all over the country among others.
The continued limited allocation of the national budget to the health sector coupled with resultant human rights violations (that obviously occur due to the limited budget) saw CEHURD and others institute a case to try to remedy the situation. The case filed against Wakiso District Local Government (CEHURD, Emmanuella Anzoyo, suing through next friend Christine Munduru & anor v Wakiso District Local Government & Medical Superintendent, Entebbe General Hospital)highlights of the Entebbe General Hospital, which is located in Wakiso District to stalk and provide free rabies medicine to individuals bitten by stray animals. This case highlights a story of an 8 year old, Emmanuella Anzoyo who was bitten by a stray dog in Kasenyi (one of the suburbs along Entebbe road). Her mother was quick to take her to Entebbe General Hospital for treatment. The poor woman (who has no job and under the care of good Samaritans) was asked to pay Ugx. 250,000 for the dosage of the anti-rabies vaccine for her daughter. It should be noted that once this vaccine is not administered in the first ten days, it is automatic that the patient dies.
How does this relate to limited budgetary allocations? A close look at the sectorial budgetary allocations, reveals that National Medical Stores funding has remained the same as the last financial year. This is so despite the recent 2014 census reports that portrays an increase in the national population to 37 million people. The injustice in this case lies in the fact that the rabies vaccine was not economically accessible to young Emmanuelle, since it was too expensive. Her mother needed money that she did not have, making the medicine inaccessible to her, thereby amounting to a violation of Emmanuelle’s right to health. With the continued budgetary allocations to health, there will be continued limited access to medicine, and hence the subsequent achievement of the right to health in Uganda this financial year, as there will be limited resources to work with.
It is the role of governments to promote fulfill and protect individuals’ right to health. This stretches to the government’s responsibility to ensure that essential medicines such as the rabies vaccine are available and accessible by the people. Once government falls short of its aforementioned obligation, it is the role of civil society to awaken it to this. One way could be making a shadow budget that is aimed at ensuring the respect and fulfilment of all human rights. Additionally Civil Society could empower communities to demand for involvement in health program implementation, planning and monitoring.
This calls for venturing into budget related advocacy at both local and national level, so as to prepare for the FY 2016/2017. This has to be a concerted effort of civil society, and not by just a few members. There is also a need for capacity building within civil society as regards to budget advocacy so as to create a concerted, timely, and effective movement. If not, we will continue to bandage up the wounds, without removing the log that we keep stumbling over.
It is now time for civil society to wear the hat of the genius as Einstein proposes, and find more permanent ways of preventing recurring human rights abuses. If we continue to do things the same way, we will continue to yield the same results. Now is the time to step away from the traditional forms of advocacy and embrace a transformational tool-budget advocacy, by all civil society members.
Centre for Health Human Rights and Development-CEHURD (Intern 2015)
August 14th, 2015
For immediate release
Nakaseke District Local Government Demonstrates Accountability for health rights violations in Nakaseke District Hospital
Kampala – Uganda -Today, Mr. Mugerwa David and his three children have received a cheque worth UGX 9, 400,000 from the Chief Administration Officer of Nakaseke District Local Government. This payment is partial compensation of the UGX 35,000,000 awarded to this family by the High Court of Uganda for violation of human and maternal health rights of Ms. Nanteza Irene who died in labour due to the negligent acts of employees of Nakaseke District Hospital.
In May 2012, The Center for Health, Human Rights and Development (CEHURD), Mugerwa David and his four Children dragged Nakaseke District Hospital to court over failure to provide basic Emergency obstetric Care to Ms. Nanteza Irene (Now deceased) while she was in labour at the Hospital. On the 5th of May, 2012 Nanteza was taken to Nakaseke hospital by her husband, Mugerwa David to deliver her baby. While at the hospital, a nurse detected that the deceased suffered an obstructed labour that required urgent intervention by a doctor. The doctor on duty only arrived at the hospital after over eight hours when it was already too late for any medical intervention to reverse the haemorrhage that had arisen due to a ruptured uterus. Ms. Nanteza Irene died.
On the 30th of April, 2015, Hon. Justice Benjamin Kabiito while delivering his judgment to the case concluded that Nanteza’s human and maternal health rights, right to basic medical care and the rights of her children and husband were violated. Nakaseke District Local government was found vicariously liable for the acts of the doctor and the hospital administrator who failed to ensure the provision of emergency obstetric care urgently required by Ms. Nanteza Irene. The Court then awarded general damages worth UGX 35,000,000 against Nakaseke District Local Government to Mr. Mugerwa and his children for the pain and loss of their loved one.
This case demonstrates to Ugandans that local governments can be held responsible for their inaction, or failure to protect human rights, as well as the infringements on human rights. As agents of central government, Local governments are supposed to take appropriate measures to prevent, punish, investigate, or redress harm caused by their employees that could lead to a violation of human rights as guaranteed by the 1995 constitution of Uganda.
“CEHURD applauds Nakaseke District Local Government for taking urgent steps to meet the orders issued by Court.” Notes Mr. Mulumba Moses, Executive Director of CEHURD. “We also take cognizance of the improvements in Nakaseke District Hospital after the determination of the case, we have received reports that Nakaseke district Hospital has now got a new outpatient department, two theaters, and three isolation wards and is putting in place measures to supervise health workers among others. This is good progress; NO MOTHER SHOULD DIE WHILE GIVING BIRTH.” Mulumba adds.
For more information contact firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com or call 0414 532283
As one of the program goals at Centre for Health Human Rights and Development to; document, influence and advocate for human rights and health law policies, plans and best practices that impact and improve the social justice in health, CEHURD is working closely with media to ensure this. Here the daily monitor shares a story on Plant Varieties. Find here full story
By: Margherita Cinà, Intern from McGill University
A 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 between 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.
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.
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)