Imagine a World Where Social Injustice is a Thing Forgotten

The theme of this year’s World Day of Social Justice is “Achieving Social Justice Through Formal Employment.” However, formal employment is not even enough to aid the end of social injustice, it should rather be gainful employment. Our mothers and sisters still languish on hospital beds and hospital floors simply because they cannot afford to buy Panadol later alone pay for obstetric services. Social justice is a key driver of social development, you and I are part of the wagon where we may be victims anytime.

Victor Ntamugabumwe

“We hold these truths to be self-evident, that all men are created equal, that they are endowed with their creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness.” The US Declaration of Independence. The above statement is what truly embodies or fore-runs what humanity is and envisages a world we would all love to live in. The theme of this year’s World Day of Social Justice is, ‘Achieving Social Justice Through Formal Employment.’’

This day is a global observance that certain principles underly the peaceful and prosperous coexistence within and among us. This includes enjoyment of the highest attainable standard of health in our society. Social Justice is the view that everyone deserves equal economic, political, and social rights and opportunities. That this should not be discriminatory based on economic or political will. That for instance, goods and services in health should be available and accessible to all of us. This does hold us (with the government stakeholders) in obligation to ensure that this is the reality. Therefore, this is the day for reflection on the times there has been social injustice in our society whether meted out individually or collectively. These injustices are among other things, unavailability of social goods and services, sexual and gender-based violence. This is a day of reflection on what we as a people have done collectively or individually to end this societal injustice. All of us cross paths with the victims of such injustice, these may be our family members, friends, relatives, or even colleagues we meet daily.

You and i are the beginning point to end social injustice. The government and its stakeholders are accountable to us as individuals and to all of us collectively. What are some of those things that you can do to join the fight to end social injustice?  Firstly, you have to accept that there is social injustice in our society. Secondly, you are part of the wagon where you may be the victim anytime. Then that you can cause a progressive change in your social circles for a fairer and more peaceful world. This will include hunger for access, free flow and dissemination of information on social justice. Teaching and having a progressive discussion as far as social justice is concerned.

The theme for the day is “Achieving Social Justice Through Formal Employment.”  However, formal employment is not even enough to aid the end of social injustice, it should rather be gainful employment. Our mothers and sisters still languish on hospital beds and hospital floors simply because they cannot afford to buy Panadol later alone pay for obstetric services. We had catastrophes during the recent scourge of covid-19 where oxygen and ventilators were expensive to the extent that they would cost a life. The doctors in private practice charge to empty us of every nickel we have when we visit their health facilities for medical assistance. This is but to avoid the rude tones and sarcastic comments from some nurses and doctors when we express the lack of resources or health insurance as we plead before them to save our lives.

Here is for context, the largest number of Ugandans is either unemployed or employed in the informal sector. These obviously do not have access to full employment benefits such as health insurance. Many of those that are employed are only remunerated to survive and these too do not have access to gainful employment benefits such as health insurance. A friend of mine often remarks that Uganda’s population is a miserable one from top to bottom that is susceptible and one illness whether terminal or not away from pure poverty. Advocating for Gainful employment is one way to address this issue, concepts such as the minimum wage and National Health Insurance should be taken into consideration. It is so sad and this is not a reality in Uganda. Creation of policy or a legal framework that encompasses this would go a long way in ensuring that all Ugandans have access to health insurance and that the health facilities that we end up seeking emergency services are actually capable to deliver these services without doctors and nurses looking at us with scornful eyes for our lack of resources. Social Injustice in relation to health is very impactful on the social and welfare development of any society. Ending such in our society should be a dream all of us should dream while we dare to dream.

Imagine a world where social injustice is a thing forgotten. Where there is no sexual and gender-based violence, where our mothers and sisters walk into a health facility and are welcomed with open hands. Would that world not be a beautiful one? I think such a world would not only be perfect but would as well be prosperous; social justice is a key driver of social development. That world would be such a world that we would all love and envy to live in. Be true to yourself and join the fight against social injustice.

Therefore, as we live this day today – let us be reflective on this day and what the day calls us to do; to acknowledge the presence of social injustice and strategize ways to end the same. To understand that, unlike the legal remedies. The remedies to social injustice are within us as a society. That we are the ones who determine the status of social justice and that with an individual and collective effort the same would end.

The writer is an Intern at the Center for Health, Health Rights and Development (CEHURD).

CALL FOR APPLICATIONS : The JAS Media Fellowship On Sexual And Reproductive Health And Rights

Interested in being part of the JAS Annual Media fellowship on Sexual and Reproductive Health and Rights? Download full details about the fellowship and the Application form below;

Deadline: Wednesday, 2nd March, 2022

Victory Of A Health Worker In A Post-Abortion Care Case

We continue to resound that health workers must operate in a safe environment without fear of being arrested, intimidated or harassed as they provide Sexual and Reproductive Health Rights services. In turn, women should be able to seek care knowing that they will not suffer stigma or be denied service.

CEHURD

On 1st February 2022, the Chief Magistrate of Lugazi Court dismissed the case of Uganda vs Fredrick K (Criminal Case No.56 of 2020) for want of prosecution. 

Mr Fredrick K, a senior clinical officer from Buikwe District was arrested after saving a life – providing a post abortion care service. Two years later, CEHURD, and the Legal Support Network have worked to ensure that he is freed. 
We continue to resound that health workers must operate in a safe environment without fear of being arrested, intimidated or harassed as they provide SRHR services. In turn, women should be able to seek care knowing that they will not suffer stigma or be denied service.
Restricted environment and the misinterpretation of abortion laws restrains health workers from providing post abortion care services for fear of arrest which in turn has led to the inability of women to access the services.
With unsafe abortions contributing to the high maternal mortality rate in Uganda (according to the UDHS 2016), there is need to address the underlying factors that drive these deaths ie the restrictive legal and policy environment, misinterpretation of the law due to inadequate knowledge among others.

Story;
In November 2019, Mr Fredrick K, a senior clinical officer at Mukisa Medical Clinic was approached by a patient who had carried out an abortion in Buikwe District. She was in critical condition. Mr Fredrick K was able to provide Post-Abortion Care to her and thereafter referred her to Lugazi Referral Hospital for an abdominal scan. A few days later, the patient returned to his facility for further therapy. On finding that she had not had the scan as he had recommended, Mr Fredrick referred her back to the hospital.
On April 6, 2020, police officers from Lugazi Central Police Station arrested Mr Fredrick on accusations of having carried out an abortion on the teenager girl, which is a criminal offence under sections 141 and 143 of the Penal Code Act. The Ugandan Constitution does not explicitly prohibit abortion. 
On May 11, 2020, the Legal Support Network applied for bail for Mr Fredrick, basing on the standards and guidelines by the Ministry of Health that permit health workers to provide Post-Abortion Care.

A CEHURD compilation.

Health Service Delivery Needs Financing

”The budget framework papers indicate a number of unfunded priorities which will significantly affect quality healthcare. As a country, we have not been successful in increasing financing for the health sector”

By Peter Eceru

The Covid-19 pandemic has not only painfully exposed the gaps in the health systems and infrastructure, but also the high levels of vulnerabilities of individuals, and households. Most poor and vulnerable people in Uganda have limited resources to cope with the economic and health impacts of the pandemic. Ugandans at the base of the pyramid who are majorly women, experience enormous hardship when out-of-pocket payments, formal or informal, are high in relation to households’ ability to pay for health care. As a result, lack of financial protection reduces access to health care, therefore, undermining the health status and exacerbating health and social-economic inequalities.

With the aim of ensuring access to affordable quality health and reduce out of pocket cost for Ugandans several initiatives have been enforced including the elimination of user fees in 2001 The user fees at health facilities were used as an additional source of revenue to fund health care. Unfortunately, over the last 10 years, government contribution towards health care as a percentage of the national budget has reduced from 8.9% in 2010/11 to 6.1% in 2020/21 and this burden has been shifted to the donor community and households. Similarly, government contribution as a percentage of the national health budget reduced from 74.2% to 57% over the same period. This clearly demonstrates that the health of citizens is being gradually scaled down in terms of government prioritisation. What is even more worrying is that of the 57% government contribution towards the health budget, 53% is spent on recurrent expenditure such as salaries, oils and fuels, allowances and only 4% is spent on capital expenditure.

In the budget Framework Paper for the financial year 2022/23 that was laid before parliament on the 21st of December, 2021, it is evident that there will be no significant change. The budget framework papers indicate a number of unfunded priorities that will significantly affect the quality of health care. The unfunded priorities include; wage enhancement is unfunded to the tune of 47.9Bn, procurement and maintenance of equipment to the tune of 12.3 Bn, the Phased establishment of the national ambulance service- 20.8Bn shillings among others. This means that the health care system will still deal with challenges of unmotivated staff, inability to kick start the national ambulance service, 

The World Health Organisation recognises that there are 3 inter-related domains that are fundamental to achieving and maintaining universal access to health care- raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out of pocket costs and allocating funds in a way that promotes quality, efficiency and equity. Over the last ten or so years government has failed on all the 3 domains. As a country, we have not been successful in increasing financing to the health sector as a percentage of the national budget. The World Health Organisation argues that for a country to be able to achieve Universal Health Coverage, it must allocate about 15% of its budget towards health. Uganda has for most of the last 10 years allocated less than half of that. To be able to achieve our health targets as set out in the NDPIII Uganda, the programme Implementation Plan for Human Capital Development projects an expenditure of more than 9 trillion shillings in the 2021/22 FY. However, in the same financial year, the government allocated only 2. 7 trillion shillings leaving a funding gap of 6.3 trillion shillings.  In terms of pooling resources, parliament passed the National Health Insurance Scheme Bill in 2021, but this was not assented to by the President and in accordance with the ruling of the Speaker of parliament, this was one of those bills that abetted. As a result, out-of-pocket expenditure on health is over 40% which is more than twice the World Health Organisation recommended.

Maternal, reproductive and new-born health is a key determinant of the opportunities that women and their children have in life. The budget must therefore ensure that pregnant mothers are capable of accessing a doctor regardless of where she is, be able to access blood whenever she needs it during childbirth among others. Women should have a right to safely bear children and to freely decide whether to have them, how many to have and when to have.

Peter Eceru is a Programme Coordinator-Advocacy, Health and Human Rights Advocacy at Center for Health, Human Rights and Development (CEHURD)

A version of this article was published in the Daily Monitor Newspaper on Wednesday 2nd January 2022.

Press Statement: Medical Interns Issue Notice to Sue Over Ministry of Health Directive

Kampala – Uganda. Center for Health, Human Rights and Development (CEHURD) on behalf of the Uganda Medical Association (UMA) and the Federation for Uganda Medical lnterns (FUMI), has issued a notice of the intention to sue in response to the Ministry of Health’s directive for medical interns to vacate hospital premises. UMA and FUMI are exercising a constitutional right to carry out industrial action geared at resolving the challenges faced in the day-to-day execution of their work, training, service delivery and welfare. The challenges range from lack of proper supervision, lack of accommodation, poor remuneration and poor working environment, among others.

By virtue of their appointment by the Ministry of Health, medical interns play a vital role as frontline workers in this era of the Covid 19 pandemic. It is therefore inconceivable that the Ministry of Health has resorted to illegally denying the medical interns their constitutional right to practice their trade and complete their medical training.

On 9th August 2021, His Excellency The President of Republic of Uganda following a meeting with the leadership of UMA, directed that the Government addresses the challenges of UMA and FUMI by, among others, enhancing the remuneration of the medical interns.

Unfortunately, instead of fast-tracking the implementation of the presidential directives aimed at resolving the grievances that led to the strike, the Ministry of Health has resorted to irregular, unorthodox and unconstitutional means of resolving a lawful industrial action. Directing medical interns on strike to vacate the hospital premises within one week is not only unacceptable and unjustifiable in a free and democratic society like Uganda, it is also a callous decision.

In light of this, we point out that the directive does not only undermine constitutionally guaranteed fundamental rights and freedoms of medical interns, it also offends the Directive/ Guidance by His Excellency the President of the Republic of Uganda. These actions are also irregular, illegal, arbitrary, high handed and certainly challengeable in the Civil Courts of Law.

Call to action
We call upon the Ministry of Health to recall the directive to the medical interns to leave their stations within two days or else we risk creating a crisis in the delivery of health services.

For more information contact: info@cehurd.org and copy in kenganzi@cehurd.org or call +256 778 723 449

Find the press statement and a copy of this letter attached here.