How The Legal Framework Can Catalyse The Fight Against Lung Cancer In Uganda

Smoking is the leading risk factor for lung cancer. There is still a long way to go for us to start harvesting the fruits of the Tobacco Control Act, 2015. Massive sensitization still needs to be done.

Compiled by Syndia Chemutai

Since its inception in 2012, World Lung Cancer Day has been observed every August 1 with the aim of shining a light on this deadly disease and giving hope to those who are battling it. According to the latest WHO data published in 2018 Lung Cancer Deaths in Uganda reached 439 or 0.17% of total deaths and Uganda ranks at number 150 in the world. 

Smoking is the leading risk factor for lung cancer. Research from the American Cancer Society has it that about 80% of lung cancer deaths result from smoking and according to Tobacco Induced Diseases (TIB), 62.2 % of daily smokers used manufactured cigarettes. There is a high prevalence of tobacco use in Uganda with almost 1 in every 10 Ugandans using tobacco products daily. Statistics from the Uganda Cancer Institute also indicate that 25 % of lung cancer patients were tobacco users.

Globally, tobacco kills nearly 6million people worldwide including 600,000 non smokers exposed to second hand smoke. Uganda ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2007. The Convention was negotiated as a Global Intervention to protect present and future generations from the devastating health, environmental and socio-economic effects of tobacco. One of the steps in fighting Lung cancer besides investing in research and improving on health infrastructure to treat Lung cancer is regulating the causes and tobacco use is one of them. It is linked to 71% of lung cancer cases. 

Uganda passed the Tobacco control Act 2015 and the Tobacco Control Regulations 2019 aimed at controlling the demand for the consumption of tobacco and its products and in the long run, promote the health of persons and reduce tobacco related illnesses and deaths. The law bans smoking in all indoor places and workplaces, on all means of public transport, and in specified outdoor public places, it also bans all tobacco advertising, promotion, and sponsorship, including product displays at points of sale. It prohibits the sale of tobacco products in specified places (health institutions, schools, prisons, and other places), among others.

I commend the government upon taking the initiative as there is an impact created by the Tobacco control Act for instance non-advertisement and promotion of tobacco has been achieved. There are however instances where the provisions have not been upheld, shisha, smokeless, and flavoured tobacco are still being consumed and people can still be seen smoking on the streets and nothing is done about it. Albeit the promulgation of the laws, their enforcement and sensitization of the masses about them should be accelerated. There is no benefit of having good laws only on paper with little or no impact at all on ground. 

There is still a long way to go for us to start harvesting the fruits of the Tobacco Control Act, 2015. Massive sensitization about it should be done, and enforcement of the same should be felt because much of the population is not aware of its existence, some still ignorantly break the laws and since they are not held accountable, they get away with it but the harm is already done. Incentives should also be given to tobacco farmers so they can channel their energies elsewhere, you cannot block their source of livelihood without giving them an option, they should also be clearly educated about the harm that they are causing the world by embarking on tobacco farming. These among other measures can go a long way in the fight against lung cancer.

The writer is an Intern in the Strategic litigation programme at the Center for Health, Human Rights and Development (CEHURD).

Hepatitis Can’t Wait for COVID-19 to go

While the world seems to be drowning in the routine of infections, Covid-19 being the latest devourer, 500 million people are estimated to be infected with Hepatitis B or C worldwide according to the World Health Organization.

Compiled By Jacqueline twemanye

While the world seems to be drowning in the routine of infections, Covid-19 being the latest devourer, 500 million people are estimated to be infected with Hepatitis B or C worldwide according to the World Health Organization. These viruses kill 1.5 million people a year; 1 in every 3 people has been exposed to either or both B and C, while others suffer from alcoholic hepatitis. Unfortunately, most infected people are asymptomatic, that is, they have no or barely any symptoms of infection.

World Hepatitis Day is observed each year on 28th July to draw attention to the viral hepatitis, an inflammation of the liver that causes severe liver disease and hepatocellular cancer.

This year’s (2021) World Hepatitis Day theme “Hepatitis Can’t Wait”, conveys the urgency of efforts needed to eliminate hepatitis as a public health threat.

In Uganda, Hepatitis B infection is highly endemic according to findings from a national serosurvey. With a person dying every 30 seconds from a hepatitis related illness, even in the current COVID-19 crisis – we cannot wait to act.

The Government of Uganda is however applauded for its efforts towards the fight against Hepatitis B. Over 23 million adults and adolescents have been screened for the disease across the country, while 17.6 million adults and adolescents have been successfully vaccinated against Hepatitis B since the mass vaccination campaign was rolled out in 2015 as reported by Ministry of Health, although the target still remains unmet. Vaccination for Hepatitis B is still ongoing in public health facilities across the country for persons above nineteen years of age.

This killer disease is commonly caused by viral infection, abuse of alcohol, drugs, toxins, autoimmune hepatitis (where anti-bodies form against your liver tissue), exposure to infected bodily fluids. You may lower the risk of getting hepatitis by avoiding risky behaviours, such as sharing needles, having unprotected sex and drinking large amounts of alcohol.

Treatment options vary depending on which type of hepatitis you have. Some forms of hepatitis can be prevented through vaccination and lifestyle precautions.

Most people have no symptoms. However, those who develop symptoms may have fatigue, nausea, fever, dark urine, abdominal pain, loss of appetite and yellowing of the skin and eyes (jaundice). In cases of Alcoholic hepatitis, an increase in stomach size due to fluid accumulation.

In escalated conditions one may experience liver failure, cancer or scarring.

A call goes out to global, regional, national leaders, policy makers, communities and other stakeholders to explore opportunities for accelerating the hepatitis response to achieve elimination by 2030.

The writer is a Communications Officer at the Center for Health, Human Rights and Development (CEHURD).

The Power of Community voices in Governance and Social Accountability -DINU

Whereas the implementation of the Action was stalled by unexpected events like the outbreak of the COVID-19 pandemic and the election period, the activities implemented so far have registered quick wins. The activities have presented opportunities for community members to hold duty bearers accountable, and for the leaders to provide clarity and make commitments towards issues raised hence positively impacting the beneficiaries and creating avenues for private sector engagement.

The Center for Health, Human Rights and Development (CEHURD) with Partners in Community Transformation (PICOT) are implementing a two-and-a-half year Action in the districts of Koboko and Maracha, under the Development Initiative for Northern Uganda (DINU) with support from the European Union through the Office of the Prime Minister.

The Action is titled “Integrating Legal Empowerment and Social Accountability for improved local government performance and governance (LESA Action)”, focused on promoting accountable and responsive service delivery in the two districts, using an innovative blend of Legal Empowerment and Social Accountability (LESA) strategies.

Since its inception in January 2020, CEHURD and PICOT have carried out various activities in the districts which include an inception, baseline study, assessment and trainings for Community Health Advocates, radio talk shows, community dialogues, community radio outreaches in the six sub-counties of North Division, Lobule, and Kuluba in Koboko District, and Oluffe, Tara and Oleba sub-counties in Maracha District, in the West Nile region.

Representation of people with disabilities during a community dialogue in Oluffe sub-county, Maracha District.

Whereas the implementation of the Action was stalled by unexpected events like the outbreak of the COVID-19 pandemic and the election period, the activities implemented so far have registered quick wins. The activities have presented opportunities for community members to hold duty bearers accountable, and for the leaders to provide clarity and make commitments towards issues raised hence positively impacting the beneficiaries and creating avenues for private sector engagement as illustrated herein.

The curious case of a Community Development Officer (CDO) with no office

The presence of a functional physical office for any leader in the community goes a long way in bridging the gap between communities, stakeholders, service providers and leaders. This in turn improves transparency and consequently accountability hence improved service delivery.

During one of the community dialogues in Oluffe Sub-County in Maracha District, community representatives raised a complaint about the absence of an office for the then CDO who was stationed on a veranda at the sub-county headquarters. This meant that community members did not have a central place to access information on government programmes and services, feedback or make inquiries which greatly affected delivery of services in the sub-county. In response, the CDO revealed that working on the veranda was not a suitable position for her to effectively serve the people of Oluffe Sub-county.  Fortunately, the LCIII Chairperson committed to offer the CDO office space at the sub-county, which was a great turn of events in terms of accountability and service delivery.

In a follow up activity, we found the CDO in an office annex to the sub county hall which was previously used as a store. She reported great improvement of access to information by communities on government programmes and services such as Emyooga and Senior Citizens Grant (SCG), among others.

The former CDO after she was promoted to the Sub county headquarters

The CDO’s office is pivotal in the lower local government planning and budgeting process as they are the main custodians of basic information sheets. These sheets are a record of all sub county priorities for consideration of the district budget.

Denial of Access to maternal health services

On 19th March 2021, our partner PICOT held a community dialogue in Oleba Sub-county in Maracha District where a community member raised an issue of a maternal health rights violation.

Midmorning on 17th March 2021, an expectant mother from Ede Odravu village, Oleba Sub-County was referred (minutes to delivery) by a midwife at Oleba Health Centre III to Maracha Hospital which is approximately 15km away. Unfortunately, the expectant mother was unable to go far, she gave birth by the road side with the help of community members, who then carried her back to the very health centre.

As a result of the community dialogue, a disciplinary meeting was held with the health facility management and the midwife was put to task to explain her actions. An inquiry was also instituted by the Sub-county Chief who forwarded a report to the Chief Administrative Officer (CAO) for disciplinary action.

“I request the midwife to be transferred if possible because I went through too much trauma and she instead accused me of shaming her, which I apologized for. The story is not different for other mothers, many have lost their children at her hand” – Doreen Dorcus Chandiru

We held a meeting with the CAO as a follow up action to establish what action had been taken by the office of the CAO. The CAO informed us that the matter had been brought to his attention and he instructed the District Health Officer to fully investigate the matter and take necessary disciplinary action.

Legal support and access to Justice

In a meeting held on 17th April2021 at his home in Anyakani village in Oluffe Sub-County, Mr Michael Onyutha narrated the ordeal that befell his household. His 13 year old daughter was defiled by the would-be custodian and headmaster of the school she was in.

In Nyakani village at Mr. Onyutha’s home -father to the defilement survivor

These Sexual and Reproductive Health and Rights violations in schools remain a hindrance to access to quality education for the girl child. They are also gross violations of human rights and an impediment to the Human Capital Development index.

Through our recent community radio outreach held in Oluffe Sub-county, Mr Onyutha raised this issue. CEHURD and PICOT are following up this case to seek justice, using the legal aid arm. We managed to watch brief (attend court) in the case on 21st April 2021 and 2nd June 2021 at the Magistrates Court of Koboko at Koboko and the matter was adjourned to 21st July 2021.

By virtue of these interventions, the LESA Action which focuses on promoting good governance and accountability for improved service delivery in the districts has started to register results that are life changing. Through these dialogues, community representatives and local sub-county authorities are able to share the challenges they face regarding service delivery, accountability and good governance. 

“We had no place to make consultations or register our complaints and that greatly affected downward accountability and good governance in our area. We thank CEHURD and PICOT for the platform” – Agele Amis an Elder in Lobule Sub county -Koboko District

Call to action

It is evident that communities have issues and face challenges in their day to day activities with a need to be heard and attended to. Opening up avenues for dialogues between leaders and the communities they lead should be normalised and held regularly. These sessions should be practical and open to all so as to realise improved service delivery and social accountability.

We therefore encourage more downward accountability interactions even in urban centers.

Compiled by CEHURD-DINU/LESA implementing officers Jacqueline Twemanye, Ruth Ajalo and Christopher Ogwang.

COVID-19 and Beyond: A Spotlight on Uganda’s Adolescents Reproductive Health

The lock down has also led to disruptions in education exposing young people to the risk of Gender Based Violence as well as getting unwanted pregnancies. The increment in internet costs has made it worse as this has further affected access to information.

BY ANNEGRACE NAMUGAANYI | In Commemoration of the World Population Day

The United Nations statistics revealed that up to 16 per cent of the world’s population which is equivalent to 1.2 billion people, are adolescents aged 10-19 years. According to a UNICEF report on Adolescent health and well-being, “an estimated 1.2 million adolescents die every year and mostly from preventable causes.”  The World Health Organization reports reveal that many often die prematurely due to several factors such as; homicide, suicide, violence, motor accidents, pregnancy and childbirth related complication, among others.

Statistics from the United Nations Population Fund (UNFPA) indicate that Uganda has one of the youngest populations in the world with the country’s population annual growth estimated at 3.0% (among the highest in the world). At 9 million, adolescent constitute a quarter on the nation’s population, many of which have limited access to quality education as well as health and social services.

In Uganda, access to adolescent sexual and reproductive health information and services, which among others enhance the ability to remain free from unwanted pregnancies, unsafe abortions, Sexually Transmitted Diseases (STIs) and all forms of sexual violence and coercion is still lacking and this has been worsened with the lock down aimed at curbing the spread of the corona virus. This gives adolescents in Uganda limited choices when it comes to issues relating to quality promotion of healthy sexual behaviors, access to family planning services and information, access to general information on sexual and reproductive health issues, abortion and post-care, condom uses and management of STIs. Whereas the government of Uganda has adopted a number of policies and strategies to address part of the problems faced by young people in the country which among others, include the National Adolescent Policy for Uganda, 2004, School Health Policy for Uganda as well as the Standards and Guidelines for reducing Maternal Mortality from Unsafe Abortions in Uganda (April, 2005), finalization and implementation of these policies is still wanting.

The COVID-19 pandemic has exacerbated an already complex situation. The second wave of the COVID-19 pandemic in Uganda has come with various challenges including difficulty in accessing essential Sexual and Reproductive Health services such as modern contraceptives including condoms due to the of the lock down. The lock down has also led to disruptions in education exposing young people to the risk of Gender Based Violence as well as getting unwanted pregnancies. The increment in internet costs has made it worse as this has further affected access to information.

As a young person, I call upon government to support the well being of my fellow young people by addressing the challenges that have led to higher rates of unmet needs for Sexual and Reproductive Health Services and information. This can be achieved by Government committing to finalizing all the pending policies such as the National School Health Policy, that will enable young people access services and information as well as ensuring that those in existence are implemented.

The writer is an intern at the Center for Health, Human Rights and Development.

CEHURD’s Statement; In Victory for Health Rights, Uganda’s High Court Orders Government to Regulate COVID-19 Treatment Costs

Thursday, July 8th, 2021

KAMPALA. The High Court today heard the case of Mulumba Moses & Center for Health Human Rights and
Development (CEHURD) vs Attorney General, The Medical and Dental Practitioners Council, & The Minister of Health. The case, which was filed on June 24th, 2021 challenges the government, and the medical
council for failure to act in response to exorbitant, unjustified, and extortionate fees hospitals are charging for the
management and treatment of COVID-19.

In today’s hearing, the High Court ordered:
1. The Government, Minister of Health and Medical and Dental Practitioners Council to make
regulations on fees chargeable by hospitals managing and treating COVID -19 patients
2. The Medical and Dental Practitioners Council to make recommendations to the Minister of Health on
reasonable fees chargeable by hospitals for treatment and management of persons suffering from

See details of the Court Order >>>

“Today the court has ruled in favour of the fundamental health rights of patients. It has ordered government and
professional councils to regulate fees for COVID-19 treatment services so that patients are charged fairly. This is
a big win for all Ugandans,” Moses Mulumba, CEHURD Executive Director and an applicant in the case said,
following the court hearing.

On March 11th, 2020 the World Health Organisation declared the novel Coronavirus (COVID-19) a global
pandemic. Uganda registered its first confirmed COVID-19 case on March 21st, 2020, and the country was put
under lock down shortly thereafter. The lock down was relaxed when the reported number of COVID-19 cases
came down.

In May 2021, the Minister of Health, Dr Ruth Aceng announced that Uganda was reporting a significant increase
in COVID-19 cases, signalling the second wave of COVID-19 infections, with a preponderance likely being the
much more transmissible and aggressive “delta variant” of COVID-19. The Minister warned that the second wave
is usually more aggressive that the first. Ugandan hospitals are currently overwhelmed with COVID-19 patients
requiring intensive management, including Oxygen in order to beat the virus. The few Intensive Care Units in the
country are overwhelmed and stock out of oxygen has become routine.

A survey of media reports in June 2021 revealed that a day in the Intensive Care Unit (ICU) at a private hospital
in Kampala will cost a COVID-19 patient between Shs2 million to Shs10 million per day depending on the facility.
A patient with moderate symptoms is likely to pay between Shs1.5 million and Shs5 million daily, depending on
where they go. Treatment typically lasts weeks, resulting in medical costs too exorbitant to bear.
Uganda is currently under 42 days of a strict lock down. As the effects of COVID-19 continue to ravage the
country, more people are going to require treatment and management of the virus. Since there is no regulatory
framework to rein in hospitals, these high changes will continue.

Today’s High Court decision is a remedy for this crisis. We are ready to work with the government, the Medical
council and the Health Minister to ensure that the Court’s orders are implemented urgently and those responsible to heed the High Court orders and regulate the rates charged for the management and treatment of COVID-19. This will give Ugandans a fair chance to access COVID-19 treatment.

For more information, contact Ibrahim Nsereko 0702245536 or email and copy