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

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.