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Call for Proposals to Develop A New Strategic Plan, 2025 – 2034 for Center for Health Human Rights and Development (CEHURD))

CEHURD is a Non-Governmental (NGO), not-for-profit indigenous research and advocacy organization established 15 years ago to pioneer the justiciability of the right to health by advancing social justice in health and human rights in Uganda and East Africa and has been implementing its five-year strategic plan (2020 –2024) since January 2020.

The duration of the strategic plan (SP) will come to an end in December 2024. A mid-term review (MTR) was undertaken after 2.5 years of implementation to assess progress and a detailed report is available.

CEHURD plans to engage services of a consultant with expertise in formulation and evaluation of strategic plans with an advocacy focus and who has a good understanding of issues of health, human rights sexual and reproductive health and rights (SRHR) to support the process of developing a new strategic plan and enablers for its implementation. Deadline is July 15th 2024.

Access Call Details > Call for Application for Developing CEHURD SP

Access ToRs > CEHURD’s ToRs Strategic Plan Development

Fighting a Monster that Guards My Community’s Gate

A story of a GBV male champion Samuel Muhumuza from Hoima District, Uganda trained under Promise II project (DFPA).

“Of course, I’m a man. How can I be seen cooking or doing any home chores meant for women?” – Sam

Samuel Muhumuza is a Gender-Based Violence male champion from Kigorobya Northern Ward, Hoima District. His passion of being a Gender-Based Violence champion is derived from his personal experience and the trainings he has numerously had with Center for Health, Human Rights and Development (CEHURD). In my interview with Sam, he passionately shares how he finds it prestigious to do the kind of work he does and how he never wishes to go back to his previous life of being a politician.

“I knew I was a man. Certain gender roles weren’t for me however much they were affecting me. How could I be seen cooking? I would rather die of hunger than cook for myself or for my children even in the absence of their mum. But this narrative changed”. Says Sam

When change knocked Sam’s door, he embraced it and he’s now impacting his community. In Sam’s home, gender roles are shared amongst individuals be it male or female, and he does this openly so that his community can be able to pick a leaf from him.

“I have cows at home, with no herds man. My wife and I share this role. I also collect water for my family, and I have never lost my hands since I started doing so”. Says Sam

As a Gender-Based Violence champion, Sam has had to go head-to-head with some of his notorious cultural norms that spark of Gender-Based Violence. Much as he does his best to change his fellow men’s mindsets in his community, at times he’s looked at as a person trying to erode away his culture. Among the Alurs where Sam grew up from, women are not supposed to eat with men, they instead serve them, sit down and await on them as they eat until when they get done. After the man has gone, then a woman can eat after. Furthermore, a woman has no right to say no to sex if a man requests, regardless of her health condition. Cultural norms in Sam’s community are highly respected and this is something Sam has to deal with each and every day. He fights a monster that happens to safe guards his community.

Sam comes from a community where some people still believe that Gender-Based Violence cases happen in homes because of sorcery, woman’s delay to open the door for the man returning home past midnight is a sign of disrespect and all these can spark-off a fight. But as a champion who has gone through trainings, he clarifies to his community the major causes of Gender-Based Violence and breaks the myths and misconceptions around it.

In spite the criticism towards Sam’s work, he never stops what he does because it gives him a lot of joy. One of the things he proudly delights in is being able to reconcile breaking families through mediations. He even goes further to offer himself as a surety to suspected fellow men of Gender-Based Violence, with hope that when they’re out, he will talk to them and they change. This is a bold move, right? And surely, at least the two men he has stood for have not disappointed him.

“Much as fighting Gender-Based Violence is tedious and resolving its conflicts take a while, it is a worthwhile experience and this gives me pride and joy” – Sam says.

Sam therefore calls upon cultural leaders to join the mantle of putting an end to Gender-Based Violence and the government to be intentional on sensitizing communities on the dangers of Gender-Based Violence, since illiteracy and cultural norms happen to be the leading causes of Gender-Based Violence. He also urges other fellow men who have embraced change to be extemporary to others as he has been to his community.


By Faith Nabunya

Communications Officer,

Center for Health, Human Rights and Development (CEHURD)

The fight against Obstetric Fistula in Uganda: Progress made but challenges remain 

According to the United Nations, Obstetric fistula is a hole between the birth canal and bladder or rectum, caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. This abnormal opening leaves women and girls with a constant leakage of urine, stool or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Ninety percent of pregnancies involving fistula end in stillbirth.  

Obstetric fistula continues to affect the lives of thousands of women in Uganda. This debilitating condition leaves affected individuals with chronic incontinence and often social isolation.  

The National Library of Medicine (National center for Biometric information) highlights that in Uganda, the current lifetime prevalence of vaginal fistula symptoms is estimated to be between 16.3-22.5 per 1,000 women of reproductive age. This translates to an estimated 140,000 – 200,000 women and girls living with fistula in the country, with over 1,900 new cases occurring annually. 

The United Nations estimates that at least two million women live with fistula in developing countries, with 50,000 to 100,000 new cases occurring each year and these numbers represent only those seeking treatment. Women and girls in Africa, south of the Sahara, are mostly affected by fistula as well as other illnesses from sexual and reproductive health causes. 

The Ugandan government has taken important steps to address this issue. In 2011, the country enacted the National Obstetric Fistula Strategy (2011/12-2015/16) which aims to guide the implementation of prevention, treatment and re-integration activities for obstetric fistula. This has led to increased awareness, training of specialized fistula surgeons, and the establishment of dedicated fistula repair centers across the country.  

Strategic partners in Uganda have also followed suit and have been seen to implement the government’s strategy. The Kingdom of Buganda forexample is also dedicated to raising awareness about obstetric fistula among mothers in the central region. To achieve this, the kingdom collaborates with key hospitals in Buganda, such as Kitovu Hospital in Masaka District, to establish necessary infrastructure and provide support. The Kabaka Foundation, a prominent organization within the kingdom, actively participates in these efforts by organizing an annual Kabaka Birthday run which focuses on fistula awareness, among others. These events serve as a platform to educate the community and garner support from both local and international sources to fund initiatives aimed at preventing and treating obstetric fistula. 

The Terrewode Women Community Hospital – Soroti District, under the leadership of Executive Director Ms. Alice Emasu, has made a significant difference as well by saving the lives of more than two thousand (2,000) women suffering from fistula over a span of five years. We need to see more of such initiatives to create a significant impact. 

However, despite these efforts, challenges remain. The New Vision publication by Umar Kashaka on 8th May 2024 highlights the worry of the Uganda Ministry of Health on the rising backlog of fistula cases. In this article, the Assistant Commissioner of Clinical Services in the Ministry of Health Dr Alex Wasomoke is quoted to have revealed that approximately 1500 fistula operations are carried out in a year but 1,900 new cases are reported annually, leaving a backlog of over 400 cases unattended to. He also noted that each fistula patient needs $400 (1.5m) to undergo surgery and this is a direct affordability concern and a barrier to access of quality care services. 

An article authored by Ndyaye and published in the Daily Monitor on May 20th, 2024, reveals that Uganda currently only has 25 surgeons specializing in fistula repair, a shocking revelation considering the immense demand for such services. These skilled providers have successfully treated thousands of fistula cases, restoring dignity and hope to women and girls who had lost all. However, the demand for fistula treatment remains largely unmet, leaving countless women unable to access these life-changing services. 

Women living with obstetric fistula encounter a multitude of challenges across various aspects of their lives. Physically, they struggle with urinary and/or fecal incontinence, which can lead to skin issues such as rashes and sores, as well as complications like foot drop. Fertility concerns, post repair surgery often plague these women, with uncertainties about their reproductive capabilities and fears of recurrence during future pregnancies. Psychologically, they face disruptions in social relationships, potential divorce, and the potential heart-wrenching loss of their babies through neonatal death. 

The stigma, discrimination, and resultant isolation from their communities contribute to feelings of depression and low self-esteem. Economically, women with fistula experience a loss of livelihood, becoming heavily reliant on family members for support, and struggle to afford necessary treatment and transportation to healthcare facilities. Socially, they encounter challenges such as impaired marital status and responsibilities, limited participation in community activities, and various forms of discrimination based on health, disability, marital status, education, and socioeconomic standing.  

Despite these hurdles, many women can successfully reintegrate into their communities post-repair, although relationship issues and fertility anxieties often persist. It is important to address the holistic needs of women with fistula, encompassing physical, psychological, social, and economic support, to facilitate their complete recovery and successful reintegration into society. 

Underlying social factors such as poverty, gender inequality, child marriage, and limited access to quality maternal healthcare continue to drive the persistence of obstetric fistula in Uganda.  Addressing these social factors through multi-sectoral interventions is crucial to achieving the goal of ending fistula by 2030. 

On this International Day to End Obstetric Fistula, we therefore call upon the government and all actors to renew its strength towards this cause. Increased investment in prevention, treatment, and rehabilitation services is needed, along with empowering women and girls, challenging harmful social norms, and strengthening the overall healthcare system. Employing a comprehensive rights-based and multisectoral approach, at large, can finally place obstetric fistula to the history books in Uganda and beyond.  

It is very possible to change the status quo and impact society positively. 

 Compiled by Jacqueline Twemanye, Communications Department, Center for Health, Human Rights and Development (CEHURD). 

COVID-19: The place of the right to health in national response for Uganda

Moses Mulumba, Executive Director -CEHURD

As the state and non-state actors take steps in dealing with COVID-19, I would wish to remind them of the need to urgently strike a balance between these prevention approaches and rights with collective responsibilities. While the state must take efficient intervention, which includes undertaking the right to health impact assessment of interventions, individuals should be taking responsibilities of complying with guidance from the Ministry of Health including social distancing, hand washing and taking other measures that have been identified as effective in preventing the further spread of the virus.

From a right to health perspective, it is important for the government of Uganda to ensure that prevention and treatment measures in form of supplies and commodities, such as sanitisers of sufficient quality, are available, accessible, and affordable for the most vulnerable communities including: the older persons, those under incarceration, refugees and the very poor. There is also dire need to devise strategies on how poor households, communities and hard-to-reach places without access to clean water, or those who cannot afford and / or access soap, detergents and sanitisers can utilise the prevention measure on hand washing with soap and water. Equitable access to information on COVID-19, must be availed to those that may not access it through the conventional avenues.

Community participation and solidarity are pillars that have historically been critical in controlling and managing similar outbreaks in Uganda. The effective use of the formal and informal community participation structures in our health system will ensure that communities are active and informed participants in the creation of a responsive health system. In the social isolation mechanism, identification of cases and first management of these cases starts from the family unit and the communities and as such; communities must be viewed as active participants who need to be provided with sufficient, updated and timely information including clearly defined referral systems for the management of COVID-19 cases.

In times like these, the Government’s obligation of protecting the public from third parties violating the rights of communities becomes very important. We envisage that cases of private actors seeking to make earnings out of the desperate situation on COVID-19 will be on the rise. The much-needed commodities like sanitisers, soaps, masks etc will be faked and/or counterfeited and in some cases sold on the black market much more expensively to the communities. In places where there is absence of government isolation centres, private sector facilities may be provided as an option but at a cost that is unaffordable and out of reach for many of those that are subject to quarantines. Research attempts, including clinical trials will be common and some of these may threaten the key ethical and human rights principles of research. The government needs to make full use of the policy space Uganda has in intellectual property as an LDC to enable it utilise new innovations. We therefore call upon the state to pay particular attention to the right to health implication of commercialisation of commodities and other key services in the era of COVID-19. 

We call upon the Government of Uganda to pay extra attention to vulnerabilities in the communities and those faced with the burden of being healthcare providers and carers in the times of COVID-19. While the majority of the reported cases in different regions are men, women are the care-givers which, not only puts them at a higher risk of contracting the virus, but also neglecting their other health and human rights. With social distancing and self-isolation, no alternative options are being proposed and implemented to ensure that girls and women continue to access sexual and reproductive health services. Those in prisons and police custody have particular vulnerabilities and interventions packages should be defined to reduce their risks.

We need to evaluate the extent to which information is reaching those in hard-to-reach areas such as islands, remote and inaccessible areas, pastoral communities, and settlements for refugees and internally displaced persons.

Lastly, as General Comment 14 on the Right to the Highest Attainable Standard of Health provides, violations of the right to health occur when the state, among other things deliberately withholds or misrepresents information vital to health protection or treatment. This can also happen when the state suspends a legislation or when it adopts laws or policies that interfere with the enjoyment of any of the components of the right to health. Given that Uganda’s legislation on public health is over 85 years old, we must make an urgent effort to review the key provisions under the Public Health Act that are central for Uganda to have effective responses for global pandemics like COVID-19. Regulatory approval for new medicines and speedy attention to developing new formulations for the prevention and treatment of COVID-19 are important considerations too.

Let us all take care of ourselves, those around us and stay healthy.

The writer is the Executive Director of Center for Health, Human Rights and Development (CEHURD)

A version of this article was originally published in the Daily Monitor.

Total lock down: What it means for Community Participation in the response to COVID-19

Christopher Baguma | Community participation and COVID-19

Community health was an idea mooted by world leaders in 1978 that created the Declaration of Alma-Ata, which reaffirmed access to health as a fundamental human right and identified primary health care as the key to attaining the goal of health for all. During the 30th anniversary of Alma-Ata in 2008, leaders discussed the role of primary health care in achieving the United Nations’ Millennium Development Goals. This led to rejuvenated calls for use of community health workers (CHWs) as a form of community participation. 

Since the Alma-Ata declaration, successive Ugandan governments have acknowledged the relationship between health and poverty and in the 1990s, with the help of development partners, community health interventions were implemented. In 1999, Uganda’s health policy included community empowerment and mobilisation for health as key elements of the national minimum health care package and subsequently made a commitment to the Abuja Declaration of 2001 This also demonstrated the benefits of community-based interventions and opened the way for a strategy based on Village Health Teams (VHTs). The National Village Health Team (VHT) strategy and guidelines in Uganda were developed in 2000 and by 2003 country-wide roll outs of the VHT strategy had commenced. VHTs are lay people, working in a voluntary capacity, acting as a link between the formal health sector and their communities. They are given basic training on major health issues, including childhood diarrhea, malaria and pneumonia, and play a role in disease surveillance through activities such as data collection and reporting. 

In the wake of COVID-19, the Government of Uganda under the leadership of President Yoweri Museveni issued guidelines initially including the closure of  all schools and places of worship for 30 days and the suspension of travel both in and out of the country with the hope that such measures will slow the spread of the disease. However, as the number of infections increased and the president announced more guidelines ranging from quarantine, restricted internal movements and a curfew. These preventive measures are certainly a good start, but they may not be enough, especially given the systemic and deep-rooted challenges facing Uganda’s public health system.

However, there is no clear mechanism from the Ministry of Health that links communities with existing health care services which is done by the Community Health Workers and Village Health teams using community-based approaches. Accessing health facilities is challenging and expensive for those living in remote and rural areas. Most of the information regarding the COVID-19 pandemic is in English, which means rural communities might not have access to or might find it difficult to understand publicly available information. This raises challenges in accessing timely and relevant information as well as  health services. Prolonged periods of quarantine and movement restrictions are causing emotional unrest and anxiety, gender-based violence including sexual exploitation, interrupted access to sexual and reproductive health services, including access to family planning within the communities.  

To address all these issues, the communities must meaningfully participate in health programmes at the local level. The government should therefore engage community health workers and village health teams to increase coverage and cost-effectiveness of health services delivery in the COVID-19 period. To the CSOs, use the existing community structures like peers, champions and paralegals, among others in rural and urban areas to engage these structures to build strong grassroots coalitions that could reach out to the marginalized communities in the response to COVID-19.

Center for Health, Human Rights and Development (CEHURD) in the fight to reduce the spread of COVID-19 has engaged its community structures; known as Community Health Advocates (CHAs) by designing communication materials highlighting COVID-19 prevention strategies and a toll free line 0800313131 to report any health issue arising within the community that need our intervention. The CHAs work with communities to navigate the healthcare system at the local level by providing information on health, community resources and their rights to health. They work with the communities in identifying and reporting health issues and concerns to the duty bearers. These CHAs have a strong understanding of the healthcare system and resources available within the community as they provide health education to the community related to disease prevention, screenings, and health practices. They do promote community action and garner support to motivate them to seek specific healthy policies by engaging local authorities, healthcare providers and other organisations to develop a more coordinated approach in accessing health services. The coordinated approach is realised due to the existing structure which starts from the community, parish, sub-county and district level with the leadership of the district coordinator and strategic support and coordination from CEHURD secretariat. 

The writer is the Programme Manager -Knowledge Management Program at Center for Health, Human Rights and Development (CEHURD)

A version of this article was originally published in the Daily Monitor.

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