A safe health worker makes for a safer patient

by Daniella Khanani

In 2018, a six-year-old girl’s limb was amputated as a result of a medical error. The medical personnel injected the wrong drug in the child’s arm, causing complications. The amputation had to happen in order to avoid further complications that would have led to the girl’s death.

When patients seek health care, they are exposed to potential risks, errors and harm as the little girl’s experience illustrates. For more than a decade, the status of patient safety globally was discussed without clear steps forward. This went on until May 2019, when the World Health Assembly agreed to mark off every 17th September as World Patient Safety Day. The major objective of marking the day is to create awareness about patient safety and urge, especially for the member states to show their commitment in making health care safer.

Patient safety, according to the World Health Organisation, refers to a healthcare discipline that emerged with the evolving complexity in healthcare systems and the resulting harm in facilities. . This basically aims at reducing and preventing the risks, errors and harm that occurs to patients during the provision of health care.

This year, the focus of World Patient Safety Day is on health workers. This is timely because the slogan states, “safe health workers, safe patients”. The COVID-19 pandemic has brought this truth to life since people are wary of visiting medical facilities if they even suspect that some of its personnel have tested positive. Yet there is no running away from medical workers if people are to enjoy the right to health.

One of the elements of the right to health is the quality of care. This envisions the provision of scientifically and medically appropriate health services, including availability of skilled medical personnel, scientifically approved medical equipment and unexpired drugs, to mention but a few.

Statistically, over 2.6 Million deaths occur annually due to unsafe care of patients in hospitals yet over 80 per cent of the harm created in different health facilities can be avoided. The most common reasons for the occurrence of harm to patients include: Medical errors caused by wrong prescriptions of medicines by unskilled or negligent medical personnel; lack of standard procedures for storage of medications that look alike; poor communication between the different health providers; lack of involvement of patients in their own care; and unsafe surgical and transfusion procedures, among others.

In Uganda, the recurring causes of an unsafe environment for patients include the existence of numerous unskilled personnel in the health facilities and low patient involvement in their own safety. The Uganda Alliance of Patients Organisation (UAPO) is one of the entities that deals with the protection of patients’ rights in the country. The Alliance organised a workshop in 2019 and one of the attendees had this to say:

“I had a health condition and though I was in much pain, I did not want to be treated by a general doctor, I wanted a female specialist, the doctor on duty told me that if I wanted to get better, I should allow being treated by any doctor, I insisted that I wanted a specialist, they asked me whether I wanted to get better or see a specialist, they got bored with me and said I had “lugezigezi”, to mean being difficult.

This indicates the likelihood that Uganda health workers at the facilities don’t give the required time and attention to heed to the patients requests. .

With the celebration of World Patient Safety Day, it’s important for the various health workers and the persons in charge of health facilities in the UN Member States, to ensure that credence is given to health workers as this trickles down to the patients.  Supported health workers will be in a better position to support their patients.  Additionally, this would prevent patients from resorting to self-medication as well as unapproved herbal medicines that have dire effects.

Supporting health workers

The Ugandan government needs to ensure that more skilled doctors are deployed in the health facilities because the patient- doctor ratio in Uganda is 1: 25725 whereas the patient Nurse ratio is 1:11000. The inadequately staffed health facilities is one of the reasons for the increased danger to patient safety/This leads to the overworking of medical officers at these stations, making them prone to being rude and contemptuous towards patients, especially when the patients have no money to pay for their services.

There have been numerous complaints by patients of medical officer’s negligent and uncouth behaviour towards them. This is majorly as a result of discontentment and the fact that the government underpays them, in addition to the staffing issues highlighted earlier. The government therefore has to cater for the health workers’ welfare, especially with regard to their pay, which will improve their attitudes. This is an obligation that can only be carried out by the government.

The health sector in general requires more funding than it currently receives. The Constitutional Court in its recent judgment in CEHURD & Others V Attorney General Constitutional Petition No. 16/ 2011, given in August 2020, noted that there was need for the government to increase funds allocated to the health sector. This is in order to reduce the corruption of the various health workers at these institutions and to ensure that all patients are able to access basic healthcare services at each health centre in the country, free of charge.

Once this judgement is implemented, then the status of patient’s safety countrywide, especially the pregnant mothers, will greatly improve. In turn, this will reduce the number of mothers that die due to inaccessibility of quality care.

Patients should be able to afford health services

The commercialisation of health services by the service providers needs to be checked. A few weeks ago, the Ministry of Health announced that Mulago hospital will be charging $65 (approximately Shs240,000) for voluntary COVID-19 tests. With the looming economic breakdown that has been caused by the pandemic and the laying off of most labourers from their workplaces, this fee is unreasonably high and makes the health facility inaccessible to persons who earn less than a dollar a day. This puts the life of persons who would genuinely like to know their status but cannot afford the test, at risk.. Such commercialisation of health services, especially in developing countries like Uganda therefore needs to end in order to ensure that health services are accessible to all.

In conclusion, despite the fact that Uganda as a country is making great strides to ensure the protection of patient’s safety countrywide, much more still needs to be done. Safeguarding the rights of health workers, which include putting in place safety measures to protect them and ensuring that patients are able to access health services and facilities at the lowest cost possible. Once these loopholes are tackled, then patient’s safety in the country will be guaranteed.     

What The Constitutional Court Decision On Access To Basic Maternal Healthcare Means

By | Moses Mulumba – Executive Director Center for Health Human Rights and Development.

On August 19, 2020, the Constitutional Court of Uganda passed a landmark judgment in which it pronounced that the Government of Uganda’s omission to adequately provide basic maternal health care services and emergency obstetric care in public health facilities violates the right to health, the right to life and the rights of women as guaranteed under the country’s Constitution.

Uganda’s maternal mortality rate is unacceptably high, at 343 per 100,000 live births. This means that Uganda loses 15 women each day from pregnancy and child birth related causes. 

In its judgment, the Court directed the Government of Uganda to prioritize and provide sufficient funds in the national budget for maternal health care. The Court also ordered, through the Health Minister, that all the health care workers who provide maternal health care services in Uganda be fully trained and all health centres be properly equipped within the next 2 financial years (2020/2021 and 2021/2022). 

This judgement followed a nine-year-long process in which the Center for Health, Human Rights and Development (CEHURD) together with Prof. Ben Twinomugisha of Makerere University School of Law and two other petitioners that had lost loved ones in childbirth, in a manner that they described as violating the rights of women in Uganda

When the original petition first came up for hearing in 2012, the Attorney General of Uganda, representing the Government, raised a preliminary objection to the petition on the ground that the case raised a political question, and therefore under the purview of the political organs of government and not the judiciary.   The judges upheld this objection and hence threw out the case in June 2012. Dissatisfied with this decision, the petitioners filed a successful appeal to the Ugandan Supreme Court, which is the highest judicial body, under Constitutional Appeal No. 1 of 2013 In this appeal, the petitioners argued that the Constitutional Court made a legal mistake when they applied the political question doctrine. The Supreme Court was persuaded by this argument and directed the Constitutional Court to proceed to hear and determine the petition on its merits. 

The August 19, 2020 decision from the Constitutional Court is critical for a number of reasons. First, it places the right to health and access to basic maternal health commodities within the realm of rights that are now justiciable under Uganda’s Constitution. Chapter four of Uganda’s Constitution is silent on the right to health, but makes relatively strong provisions on the rights of women under article 33. The furthest the right to health could be inferred in Uganda’s Constitution is under the National Objectives and Directive Principles of State Policy, which are always argued as unenforceable. The Court agreed with the petitioners that Objectives XIV and XX, read together with Article 8A of Uganda’s Constitution, oblige the Government to provide health and basic medical services to the people of Uganda. 

Secondly, the case clarifies what the concept of minimum core obligations means from the perspective of the right to health and access to basic maternal health care services in Uganda. The Court cited the provisions of the International Covenant on Economic, Social and Cultural Rights and the African Charter on Peoples and Human Rights and indicated that the Government of Uganda should ensure that it provides adequate equipment and supplies for preventive, diagnostic, and curative services, including training of medical staff and development of treatment guidelines and protocols for the management of maternal complications. The Court emphasized that the Government cannot under any circumstance justify noncompliance with the core obligations which derive from the economic, social, and cultural rights of the individual and group. 

Thirdly, the Court also addressed the question of how progressive realization for maternal health care should be measured in the context of Uganda. While the Court was mindful that progressive realization takes into account a State’s available resources, it noted that the unimplemented policies and strategies in Uganda’s case, as demonstrated by the petitioners, could not be said to be expeditious and effective steps towards the realization of the right to health. The Court held that it was not sufficient for the State to merely argue that there are challenges impeding implementation of policies. The State had to demonstrate the measures or steps taken to realize the provision of maternal health care services to women in Uganda. The mere expression of sentiments in reports made to attract donor funding could not measure up to the required test of reasonable steps. The Court found that the statistical data advanced by the Government did not demonstrate reasonable measures taken when the leading causes of maternal deaths in Uganda – including haemorrhage, high blood pressure, unsafe abortion, and infection — remained the same. 

In conclusion, despite the long and cumbersome process of litigating this case, the judges finally gave the rights to accessing basic maternal health care services and obstetric care in public health facilities in Uganda a place in the Constitution. 

The Court’s order that the Government compile and submit to Parliament, with a copy to the Court, an audit report on the status of maternal health in Uganda at the end of each of the next two financial years (2020/2021 and 2021/2022) is one of the most progressive steps that the Ugandan judiciary has demonstrated in the history of social, economic, and cultural rights in Uganda. 

This Court ruling demonstrates that public litigation continues to be a viable option for protection of social, economic, and cultural rights, as well as ensuring access to justice, despite being a lengthy process. 

A version of this article was published in the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics Blog and the Daily Monitor Newspaper.

Judicial Endorsement Of Maternal Health Rights In Uganda

PRESS STATEMENT

FOR IMMEDIATE RELEASE:

WEDNESDAY 19TH AUGUST 2020

JUDICIAL ENDORSEMENT OF MATERNAL HEALTH RIGHTS IN UGANDA

Kampala – Uganda. Today, Center for Health, Human Rights and Development (CEHURD), Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente with joy welcome the long awaited judgement from the Constitutional Court of Uganda in the case of CEHURD, Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente vs. Attorney General [Constitutional Petition No. 16 of 2011]. The Constitutional Court agreed with our submissions and all judges accepted all the grounds of the petition. Through this judgement, the right to maternal health care (and the right to health broadly) has been granted a place in Uganda’s Constitution. The judgment recognizes basic maternal health care services and emergency obstetric care.

This suit, filed in 2011, sought to challenge Government’s omission to adequately provide basic maternal health services and commodities in public health facilities as contravening the right to health, rights of women, right to life and freedom from cruel, inhuman and degrading treatment. The suit is premised on the wrongful deaths of the late Anguko Jennifer who died on 10th December 2010 in Arua Referral Hospital and the late Sylvia Nalubowa who died on 19th August 2010 in Mityana District Hospital. Both women died during child birth when they needed caesarean sections but failed to access the commodities and human resource required to obtain the same.

Today a panel of 5 (five) judges from the Constitutional Court of Uganda including Mr. Justice Alfonse Owiny Dollo DCJ, Mr. Justice Kenneth Kakuru JCC, Mr. Justice F.M.S Egonda Ntende JCC, Mr. Justice Barishaki Cheborion JCC and Mr. Justice Christopher Madrama JCC have upheld the maternal health rights of women and went ahead to declare and order that;

  1. The Government’s omission to adequately provide basic maternal health care services and emergency obstetric care in public health facilities violates the right to health, the rights of women, the right to life and freedom from cruel, inhuman and degrading treatment.
  2. The Government should in the next financial year prioritize and provide sufficient funds in the national budget for maternal health care.
  3. The Ministry of health are directed to ensure that all staff who provide maternal health care services in Uganda are fully trained and all health centers are equipped within the next 2 financial years (2020/2021 and 2021/2022)
  4. The Ministry of Health is directed to compile and submit to Parliament, with a copy to Court a full audit report on the status of Maternal health in Uganda at the end of each of the next 2 financial years (2020/2021 and 2021/2022)
  5.  Rhoda Kukiriza and Inziku Valente are awarded 155,000,000/= each as general and exemplary damages for the psychological torture, loss suffered and violation of rights

In his lead judgement Mr. Justice Barishaki Cheborion JCC found that “I have no doubt that the government has made attempts to address the omissions by putting in place policies, programs as reflected in the respondents submissions however for the right to maternal health to be realised, subsequent implementation of all the above mentioned policies and programs, their extension and evaluation has to be done which to a large extent has not been the case. Adverse effects on maternal health impact negatively on society’s wellbeing”  

He also found that “The deaths of Ms Anguko Jennifer at Arua Regional Referral Hospital and Ms Sylvia Nalubowa at Mityana District Hospital were a result of non-availability of basic maternal health services and negligence of Health Workers. The actions caused utmost pain, degrading and cruel treatment of the deceased for the period they spent in the said hospitals fighting for their lives with no hope of survival until they died. This also caused untold suffering and loss to their families”

He also found that “Women suffer a lot due to shortages or short comings in the delivery of maternal health care services caused by stock-outs of maternal health care packages, drugs, professional negligence. Limited budgetary provisions to the health sector all of which deprive them of opportunity to safely deliver babies. Preventable deaths of pregnant women at Government hospitals deprive Women of the right to enjoy and realize their sexual reproductive rights

We appreciate the judiciary for protecting, promoting and fulfilling the rights of women especially concerning their maternal function, indeed the power of the judicial pen has come to light in this case. Thank You

For more information contact: info@cehurd.org and copy in wasswa@cehurd.org or call 0788-882809.

Instructions For The 7th Annual National Inter-University Constitutional Law Moot Court Competitions 2020

The Center for Health, Human Rights and Development (CEHURD) convenes the Annual National Inter-University Constitutional Law Moot Court Competitions. Since 2014, the moot court competition has seen more than ten (10) law schools in Uganda participate. The moot court competition is geared towards inculcating a better understanding of the Justiciability of the Right to Health and other human rights guaranteed by the Constitution of the Republic of Uganda, 1995 and recognized in several international instruments.
It also aims at aiding law students to improve their public speaking skills and give them an experience of the litigation process in Uganda. The CEHURD moot has built a cohort of young lawyers who appreciate the right to health and its Justiciability within the confines of Uganda’s legal system.