The United Nations Joint Program on HIV and AIDS (UNAIDS) earmarked March 1st as the day to mark zero discrimination. The day, which has been celebrated since 2014, is this week being celebrated under the theme “Stand Out!” It recognizes the fact that, there are inequalities catalyzed by laws and policies that are making it difficult for some persons living with HIV and AIDS (PLHIV) to access care and encourages everyone to stand for fair and just societies thereby undermining these key populations’ rights to health and to be free from discrimination.

 
The national projections based on Uganda’s HIV and AIDS Country progress report of 2014, indicate that there is an increasing number of people living with HIV that is; from 1.4million in 2011 to 1.6milllion in 2013, and 1.5million in 2014, with over 1million orphans due to AIDS.

 
Research today indicates that stigma and discrimination is one of the forces that cause escalation of HIV and AIDS. In the Uganda AIDS Survey of 2011 for instance, it was stated that 21.6 % of men and 16.8 % of women felt People Living with HIV (PLHIV) should be ashamed of themselves, while 22 % of men and 18.3 % of women agreed that those with HIV, should be blamed for introducing the disease into the community.

 
The fear of stigma and discrimination affects the uptake of HIV services. Multiple studies in Sub-Saharan Africa provide evidence that many people who have experienced stigma and discrimination as a result of receiving HIV positive results shy away from accessing the services that would have enabled them to manage the virus and its opportunistic infections.

 
It should be noted that laws and policies play a significant part in either promoting stigma or reducing it. In 2014 parliament passed the HIV and AIDS management and Control Act. This Act, even though good and for all intents and purposes to promote care and treatment of PLHIVA, undermines the confidentiality of patients living with HIV and AIDS in certain aspects. In cases where the rights of PLHIVA were promoted, no regulations have to this date been passed to operationalize the positive aspects.

 
Civil society groups have been very keen in advocating for an anti-Stigma policy, however government needs to increase support towards this process to ensure that counseling and civic education on rights of PLHIVA are provided for, in a systemic manner.

 
Further, key to the issue of fighting stigma and discrimination is the aspect of financing of HIV drugs and programs. Parliament has noted that for the past four consecutive years, in spite of the increase in HIV and AIDS infections, there has been no increment in government funds towards purchase of ARVs at the National Medical Stores (NMS). In FY2015/16 the parliamentary committee on health reported that the NMS budget for Antiretroviral therapies (ARVs) remained stagnated at 100 billion for the projected year 2016/17. This is in spite of the fluctuations in dollar currency rates, which led NMS to incur losses of up to 17billion shillings. There is a need for government to increase funding for ARVs this financial year.

 
We thus call on government to;
1. Increase finances for ARVs in FY 2016/17 from the allotted 100bn to at least 150bn
2. Fast track the process of putting in place an Anti-stigma policy
3. Fast track the passing regulations for implementation of positive aspects of the HIV Prevention and Management ACT
4. Prioritize the process of putting in place an AIDS Trust Fund

 
This statement is supported by the Advocacy for Better Health in Uganda.

The capacity of Ugandans to demand for their health rights is still limited due to inadequate awareness resulting from limited availability of the requisite information which translates into poor health indices. Starting January 2016, CEHURD in collaboration with PATH under the Access to Better Health (ABH) project embarked on a series of activities aimed at creating awareness among Ugandans in regards to their right to health. These rights are stated in a document that is known as the Patients’ Charter.

 

The Patients Charter is a result of joint effort by Ministry of Health in partnership with Civil Society Organizations led by the Uganda National Health Consumers Organization (UNHCO). The objective of this charter is to empower health consumers to demand high quality health care, to promote the rights of patients and to improve the quality of life of all Ugandans and finally eradicate poverty nationwide. This charter provides a basis for a legal and regulatory framework in health that contributes to improved capacity for quality health care.

 

CEHURD embarked on a series of radio and television talk shows discussing various articles under this charter. Some of these included the patients’ right to redress, the right to access to information, the right to a healthy and safe environment and the right to consent, among others. These patients’ rights were discussed on a number of stations like Radio One, Radio Simba, Radio Suubi, Akaboozi Radio, NTV, Bukedde TV, and CBS Radio among others; on both English and Luganda programs.

 

During these shows,we realized that majority of  Ugandans were not aware of this document called the Patients Charter that defines the rights and responsibilities of patients in Uganda,they were not aware that health service delivery is more than physical treament and that it also relates to other determinants of the right to health. Furthermore,citizens are not aware that they have a right to lodge a complaint of any health rights violation to the Uganda Human Rights Commission, Uganda Medical and Dental Practitioners Coucil or the courts of law for a redress.

 

On the bright side, we managed to reach a large audience across the country and helped in educating and sensitizing them in their rights as patients. These shows will go on for the next couple of months during which CEHURD will continue in its mission to advance health rights for vulnerable communites and the Ugandan society at large.

 

On the 10th day of October 2010, Ms. Anguko Jennifer, a former district councilor lost her life at Arua Regional Referral Hospital. The late Anguko died during labour after a 16 hour wait at the hospital without medical attention from the hospital. This resulted into the rapture of her uterus and subsequent death of both the mother and her unborn child.
In its efforts to contribute to the reduction of maternal mortality in Uganda, the Center for Health, Human Rights and Development (CEHURD), together with the husband of the deceased, Mr. Inziku Valente filed a petition in the Constitutional Court seeking declarations that; the death of expectant mothers resulting from non-provision of maternal health care packages is violation of the right to life and the failure of doctors, midwives, nurses and government to take the required essential care during ante-natal, delivery and post natal is a violation of right to health, among others. The medical report on the death of Jennifer Anguko indicated that some of the possible causes of her death included inadequate staffing, lack of basic Essential Maternal Health Commodities and poor communication and coordination within the hospital.
Jennifer’s death is just one of the many avoidable deaths occurring in Uganda. Different efforts were taken to ensure the deceased’s passing is accounted for, and the Ministry of Health intervened by demanding that the Uganda Medical and Dental Practitioner’s Council (UMDPC) accounts on the matter, which followed an inquiry into the matter on 7th May 2012 at Arua Regional Referral Hospital.
Following this, on the 29th of January 2016, the Uganda Medical and Dental Practitioner’s Council gave its stand regarding the death of Ms. Anguko Jennifer. The UMDPC found that there was indeed a delay in intervention at the hospital among others and that this led to the death of the patient and therefore issued a stern caution to the hospital director and also asserted that the issues concerning the nurses and midwives had been brought to the attention of the nurses’ council for further action.
This decision reflects all the efforts made by all parties concerned and goes a long way in the fight for justice for victims of health rights violations

On 5th May 2011, Nanteza Irene, now deceased, went into labour at her home. She was taken to hospital by her husband on that same afternoon and upon arrival; she was checked and then admitted to the maternity ward by the nurse on duty. However, the patient, now deceased, started having major complications and the nurse on duty concluded that she needed immediate attention from the doctor on call who was inexplicably unavailable. After eight (8) hours in the hospital without proper medical care for her haemorrhage and ruptured uterus, she passed away.

 

On 30 April 2015, the High Court of Uganda at Kampala rendered a judgment on a suit brought against the Nakaseke District Local Administration for the violation of Nanteza Irene’s maternal health rights. The plaintiffs were awarded general damages for the sum of UGX 35 million with an interest of six percent (6%) per annum from the date of judgement until full payment.

To follow up on these directions and document the impact of civil suit no. 111 of 2012 on maternal health service provision at Nakaseke district hospital that was brought by CEHURD and the deceased’s family, a team of seven from CEHURD embarked on a journey to Nakaseke district on January 14th 2016.
We were able to meet a number of people including the Deputy CAO, In-Charge Human Resources at the District, the Administrator-Nakaseke Hospital, 3 VHTs, 2 community people, a Parish chairman and a district health inspector.

According to the district locals, there has been a very significant improvement in maternal health services at the hospital since CEHURD filed the case to the extent that no maternal death has been reported at Nakaseke hospital. There has also been a renovation of the Hospital infrastructure; a new wing of the hospital was opened up and the hospital now owns a working ambulance.

However, there are a number of challenges still facing the hospital including; the lack of medicines and also the shortage of medical staff and equipment. On a lighter note however, the district administration is quite interested in establishing a working relationship with CEHURD to implement the content of the judgment which they believe goes beyond cash payment.