A total of 63 Health Centre (HC) IVs conducted cesarean sections without blood transfusion services and 38 HC IVs did not provide any emergency obstetric care services in FY 2019/20 because of the inability to access blood or absence of requisite staff.

By Grace Awilli

It is likely that the National Budget Speech will be read today. Incidentally, today also happens to be World Blood Donor Day. The day was first commemorated in 2005 by a joint initiative of the World Health Organization (WHO) and the International Federation of Red Cross and Red Cross societies to raise awareness of the need for safe blood and blood products as well as thank the donors for their voluntary, life-saving gift of blood. It is one of the eleven global public health campaigns marked by WHO as well as the civil society organisations around the world. 

Usually, blood and blood products are essential for the management of injuries, medical illnesses, and childbirth.  However, chronic shortages in blood supply in the country perpetuate the high levels of morbidity and mortality from injuries, maternal loss of blood and treatable diseases. Therefore, a safe and adequate blood supply is crucial in ensuring patients in both emergency and non-emergency situations get access to safe blood to save their lives. According to WHO’s global database on blood safety, a country should be able to collect blood equivalent to one per cent of its population and Uganda with an estimated population of about 48 million collects far below the required amount which in turn leads to a wide shortage of blood in the country and thus loss of lives. In 2021, Uganda Red Cross Society mobilised 152,891 units of blood which were still insufficient in relation to the population of the country.

In Uganda, haemorrhage continues to be the leading cause of maternal death, contributing 42 per cent of all deaths reviewed, with postpartum haemorrhage contributing up to 90 per cent of all haemorrhage cases reported. Thirty-six per cent of maternal deaths occurred among young mothers under 24 years who should have been in school, contributing up to 10 percent of all maternal deaths. It should be noted that a total of 63 Health Centre (HC) IVs conducted Cesarean sections without blood transfusion services and 38 HC IVs did not provide any emergency obstetric care services in FY 2019/20 because of the inability to access blood or absence of requisite staff. It is estimated that 8,400 mothers are being unnecessarily referred to regional referral hospitals because the HC IVs lack the capacity to perform obstetric care due to the lack of blood supplies. Installation of blood fridges at HC IVs would allow these patients to receive on-site care and reduce unnecessary referrals, saving time and effort of the specialised medical staff at the regional hospitals, and reducing transportation costs. The Budget Committee of parliament noted that UBTS collects about 300,000 Units of blood annually yet the actual estimated need stands at about 420,000 Units. This leaves a blood deficit of 120,000 Units annually. In order to meet this gap, UBTS needs to expand its capacity to mobilise, collect and screen enough blood requirements.

It should be noted that low-and middle-income countries frequently have insufficient blood supplies necessary to meet the demand and as a result, patients in low and middle-income countries are frequently unable to access blood units necessary for the transfusion in a timely manner. At times, shortages of blood at hospitals in Uganda, especially in rural areas last for several days and according to statistics from various hospitals, so many people die due to these shortages. Much as Uganda has a national blood transfusion service, there has been a noticeable lack of a steady blood supply available for patients at the different health facilities. The reluctance by the community members to donate blood is attributed to a number of factors including superstition, fear of knowing their HIV status and interruptions in the supply of donor kits and testing reagents. 

Therefore, the WHO recommends voluntary, non-remunerated blood donation and has set a standard of 10 blood donations/ 1000 population as a baseline value for all countries to meet. While on average, high-income counties have 32.1 donations/1,000 population, low-Income countries have only 4.6 donations/1000 population which is really low to meet the high demand for the blood needed by patients. It is estimated that blood donation by only one per cent of a country’s population is needed to meet the basic demand for blood and to achieve this, there is a lot that should be done by Ugandans in order to meet the blood donation standards by WHO and this can only be done by mobilising and encouraging the public to voluntarily donate blood so as to fill the national blood demand. Uganda also needs to improve existing structures for blood collection and enhance allocation to Uganda Blood Transfusion to cater for blood collection and processing.

It is therefore our hope that today’s budget speech will indicate increased funding for blood collection and management in order to save lives. 

The writer is a Lawyer and volunteer in the Campaigns, Partnerships and Networks programme at the Center for Health, Human Rights and Development (CEHURD).

The small grants initiative aims at supporting innovative projects among the membership of the Coalition to Stop Maternal Mortality due to Unsafe Abortion (CSMMUA) working at community level. These small grants will strengthen capacities and enhance the work of these organisations. This initiative is supported by the Wellspring Philanthropic Fund (WPF) and administered by CEHURD.

Download Application details and Application form here;

Does it make business sense, if your product killed 8 million people especially when it is addictive?

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended.

Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco. The government needs to strengthen existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

~ By Esther Dhafa | Lawyer | Programme Officer – Strategic Litigation programme.

Background:
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year, including around 1.2 million deaths from exposure to second-hand smoke (Global Burden of Disease database) Washington DC: Institute of Health Metrics 2009 IHME accessed 17th July 2021.) Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended. It is the single greatest preventable cause of death in the world today, killing up to half of the people who use it.

Tobacco seriously threatens sustainable development in the world’s poorest nations through its impact on human health, high economic costs, and environmental damage due to massive land clearing and extensive felling of trees. In Uganda, tobacco-growing areas are among the poorest regions in the country. Scientific evidence has proved that tobacco farmers suffer from green leaf disease caused by the penetration of tobacco compounds into the skin of farmers while handling the tobacco leaves.

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco use is regulated by the Tobacco Control Act, 2015. Section 16 of the law prohibits the sale of tobacco products in specific public places and within 50 meters of those places, bans electronic cigarettes, waterpipe tobacco delivery systems, smokeless tobacco, and flavored tobacco products, prohibits the sale of single cigarette sticks and bans prominent display of tobacco products at the point of sale. Section 17 of the law prohibits the sale of tobacco products to and by persons below 21 years. Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco.

Commemoration of the World No Tobacco Day (WNTD) 2022:
The World Health Organization (WHO) member states created the World No Tobacco Day (WNTD) to draw global attention to the tobacco epidemic and the preventable death and disease it causes. In 1987, the World Health Assembly (WHA) passed Resolution WHA40.38, calling for 7 April 1988 to be “a world no-smoking day.” In 1988, Resolution WHA42.19 was passed, calling for the celebration of World No Tobacco Day, every year on 31 May.

The Center for Health Human Rights and Development (CEHURD) joins Uganda and the world to celebrate World No Tobacco Day and to mark 35 years since its inception in 1987. We are committed to informing the public about the dangers of using tobacco, the business practices of tobacco companies, what the World Health Organization (WHO) is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations.
Given that this 2022 year’s theme is “Tobacco: Threat to our environment”, we need to be more environmentally conscious as a country, choose more sustainable products, and step up our legislation including implementing and strengthening existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

The fact that the cost of tobacco use in Uganda exceeds the benefits, justifies government intervention to control and combat tobacco use in the country and protect youth from industry manipulation. We call upon the Government to further prevent the future generation from tobacco and nicotine use and enforce Uganda’s Tobacco Control Act 2015’s stringent measures that need enforcement.

Call to action:
“Does it make business sense, if your product killed 8 million people especially when it is addictive??? Wouldn’t you be targeting a new generation each year to face the consequences of using the harmful product???”
As advocates for tobacco control in Uganda, we implore the government this World No Tobacco Day in its non-delegable duty- that cannot be outsourced to a third party to:
• Continue to support the implementation of the Tobacco Control Act 2015, the Tobacco Control Regulations, and the WHO Framework Convention on Tobacco Control (FCTC).

•Support activities that promote healthy lifestyle choices and encourage the public to avoid the use of tobacco and related products.
• Educating members of the public themselves to support the Tobacco Control cause through complying with the tobacco control and public health measures in place.
• Create within the National budget a vote to finance the implementation of nationwide tobacco control programming.
• Establish a Tobacco Control Fund that sources funds from development partners and taxes from the Tobacco industry.

Does it make business sense, if your product killed 8 million people especially when it is addictive?

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended.

Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco. The government needs to strengthen existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

~ By Esther Dhafa | Lawyer | Programme Officer – Strategic Litigation programme.

Background:
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year, including around 1.2 million deaths from exposure to second-hand smoke (Global Burden of Disease database) Washington DC: Institute of Health Metrics 2009 IHME accessed 17th July 2021.) Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended. It is the single greatest preventable cause of death in the world today, killing up to half of the people who use it.

Tobacco seriously threatens sustainable development in the world’s poorest nations through its impact on human health, high economic costs, and environmental damage due to massive land clearing and extensive felling of trees. In Uganda, tobacco-growing areas are among the poorest regions in the country. Scientific evidence has proved that tobacco farmers suffer from green leaf disease caused by the penetration of tobacco compounds into the skin of farmers while handling the tobacco leaves.

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco use is regulated by the Tobacco Control Act, 2015. Section 16 of the law prohibits the sale of tobacco products in specific public places and within 50 meters of those places, bans electronic cigarettes, waterpipe tobacco delivery systems, smokeless tobacco, and flavored tobacco products, prohibits the sale of single cigarette sticks and bans prominent display of tobacco products at the point of sale. Section 17 of the law prohibits the sale of tobacco products to and by persons below 21 years. Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco.

Commemoration of the World No Tobacco Day (WNTD) 2022:
The World Health Organization (WHO) member states created the World No Tobacco Day (WNTD) to draw global attention to the tobacco epidemic and the preventable death and disease it causes. In 1987, the World Health Assembly (WHA) passed Resolution WHA40.38, calling for 7 April 1988 to be “a world no-smoking day.” In 1988, Resolution WHA42.19 was passed, calling for the celebration of World No Tobacco Day, every year on 31 May.

The Center for Health Human Rights and Development (CEHURD) joins Uganda and the world to celebrate World No Tobacco Day and to mark 35 years since its inception in 1987. We are committed to informing the public about the dangers of using tobacco, the business practices of tobacco companies, what the World Health Organization (WHO) is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations.
Given that this 2022 year’s theme is “Tobacco: Threat to our environment”, we need to be more environmentally conscious as a country, choose more sustainable products, and step up our legislation including implementing and strengthening existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

The fact that the cost of tobacco use in Uganda exceeds the benefits, justifies government intervention to control and combat tobacco use in the country and protect youth from industry manipulation. We call upon the Government to further prevent the future generation from tobacco and nicotine use and enforce Uganda’s Tobacco Control Act 2015’s stringent measures that need enforcement.

Call to action:
“Does it make business sense, if your product killed 8 million people especially when it is addictive??? Wouldn’t you be targeting a new generation each year to face the consequences of using the harmful product???”
As advocates for tobacco control in Uganda, we implore the government this World No Tobacco Day in its non-delegable duty- that cannot be outsourced to a third party to:
• Continue to support the implementation of the Tobacco Control Act 2015, the Tobacco Control Regulations, and the WHO Framework Convention on Tobacco Control (FCTC).

•Support activities that promote healthy lifestyle choices and encourage the public to avoid the use of tobacco and related products.
• Educating members of the public themselves to support the Tobacco Control cause through complying with the tobacco control and public health measures in place.
• Create within the National budget a vote to finance the implementation of nationwide tobacco control programming.
• Establish a Tobacco Control Fund that sources funds from development partners and taxes from the Tobacco industry.

About a quarter of the world’s population is infected with TB. For the first time in over a decade, tuberculosis (TB) deaths increased in 2020 with 16 cases per 100,000 people. The Government should ensure access to TB care, services and policy making guided by human rights standards and principles.

We continue to educate the public about the impact of TB around the world. A tuberculosis free world for all is the way to go! “Invest to end tuberculosis, save lives” 

in commemoration of the World Tuberculosis Day 2022.

By Tracy Rita Achola & Dhafa Esther

Background:

Every year, the world commemorates and observes the World Tuberculosis Day on the 24^th March aimed at raising and building public awareness about the global epidemic of tuberculosis and efforts made to eliminate the disease. This year, the World TB Day is being commemorated under the theme “Invest to End TB, Save Lives” conveying the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders.

Context:

Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Until the coronavirus (COVID-19) pandemic, TB was the leading cause of death from a single infectious agent, ranking above HIV/AIDS. Uganda is one of the 30 World Health Organization (WHO) designated countries with a high burden of TB.

According to the World Health Organization (WHO) Global Tuberculosis report 2021, TB is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air (e.g., by coughing), and the disease typically affects the lungs (pulmonary TB) but can also affect other sites. Most people (about 90%) who develop the disease are adults, with more cases among men than women, and about a quarter of the world’s population is infected with M. tuberculosis.

Also, according to the World Health Organization (WHO) Global Tuberculosis report 2020, an estimated 88,000 people fell ill with TB and an estimated 156,000 people died of TB in 2019, with men make up majority of the cases in the country (56%) and children accounting for 13%. It was estimated that each day 4,100 people lose their lives to TB and close to 28,000 fall ill with this preventable and curable disease.

COVID-19 and TB:

The Covid 19 pandemic has reversed years of progress made in the fight to end TB due to reduced access to TB diagnosis and treatment during the pandemic. For the first time in over a decade, TB deaths increased in 2020 with 16 cases per 100, 000 people. According to the WHO, the COVID-19 pandemic has put the previously encouraging global progress and gains on TB control at stake, by not only posing an increased risk to people with TB but also causing severe disruption to services.

Amidst the challenges of the pandemic, it has taught us that health is indeed a human right and not a luxury for only those who can afford it, hence investing in the health system and Universal Health Coverage (UHC) is key. To defeat both COVID-19 and end the TB epidemic, countries need to have solidarity, determination and equitably use the available tools and systems in place, as well as redoubling efforts and investments to urgently close widening gaps in access to much-needed prevention and care for the millions affected by the disease.

Global Commitments on TB:  

The struggle to end TB has not started just now, and it is not only a struggle against a single disease but also the struggle to end poverty, inequity, unsafe housing, discrimination and stigma, and to extend social protection and universal health coverage to all. Different global commitments have since been made on TB and its important that countries assess themselves on whether these are being fulfilled accordingly or not.

On this World TB Day, we call upon the Government of Uganda through the Ministry of Health to invest resources in TB prevention, treatment and control in order to ramp up the fight against TB but also aim at fulfilling and achieving the commitments to end TB made by the global leaders. These commitments include;

• The SDG Target 3.3: By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases, and combat hepatitis, water-borne diseases and other communicable diseases.
• WHO End TB Strategy: 80% reduction in the TB incidence rate (new and relapse cases per 100, 000 population per year) by 2030, 90% reduction in the annual number of TB deaths by 2030, and no households affected by TB face catastrophic costs by 2020.
• UN high-level meeting on TB, 2018: 40 million people treated for TB from 2018 to 2022.

Call to action:

The Government of Uganda, through the Ministry of Health and the Ministry of Justice and Constitutional Affairs, is committed to promoting and protecting the right of all Ugandans to attain the highest attainable standard of health.

We recognize the efforts of the Government of Uganda in promoting the right to health for all and doing their best to ensure that TB services are in place and sought for by the people in need of them. Nevertheless, more efforts can be undertaken to ensure 100% access to the TB care and services.

To achieve the set milestones and targets on ending the TB pandemic both in Uganda and beyond, it is critical to deal with the current violations being faced by people living with tuberculosis.

Some of the violations include among others; Inability to access health care services due to high treatment costs, Stigma & discrimination, Shortage of qualified staff in some health facilities to respond to the needs of patients, Inadequate/stock out of medicines, Inadequate supplies and medical equipment, Treatment without informed consent, Isolation and exclusion of people living with TB, and barring some travelers with a history of TB from having access into some countries.  

In order to effectively deal with these issues and in a bid to realize the global TB commitments, strategies and targets, for this World TB Day the Center for Health Human Rights and Development (CEHURD) calls upon the Government of Uganda to;

• Take on immediate action to put together resources, to support TB screening at the entrances of health facilities both private and public.
• Restore and support access to and provision of comprehensive care, treatment and essential TB services. The services should be made available, accessible, acceptable and of good quality.
• Emphasize the Human Rights based approach to health, where health policy making and programming for TB is guided by human rights standards and principles.
• Emphasize a multi sectoral approach with all stakeholders playing their roles towards ending the TB pandemic in Uganda.

Conclusion:

As we commemorate the World Tuberculosis (TB) Day 2022, we light a candle in remembrance of those whose lives were lost due to Tuberculosis.

More investment and commitment towards ending the TB pandemic will definitely save billions of lives, smoothen the end of the TB pandemic and enable us to achieve the World Health Organization (WHO’s) drive towards achieving a TB free world.

This Article is written by the Strategic Litigation team at Center for Health, Human Rights and Development (CEHURD).