Countrymen and Countrywomen,

Greetings to you all.

Today, I have come to address you on the issue of the Corona virus, abbreviated as Covid19.  They call it corona because, under the micro-scope, it looks like a crown (ekiruunga, engure).  This is a new virus but it belongs to the family of the common-cold (Senyinga, Rubyamira) group of viruses. It makes some people very sick because, being a new virus, all of us do not have immunity against it because we had never been exposed to it.

Fortunately, after listening carefully to our scientists and after watching commentators in the countries where it is already active, it seems to have two characteristics that will help us to survive it and defeat it.  Characteristic number one, is that it does not kill many of the people it infects.  Out of the approximately 150,000 people that have been infected world-wide, only about 5,000 have died, which works out at 3%.  With Ebola in Uganda, the percentage of the people dying was 67%.  Secondly, this virus enters the body only through the soft parts of the body: the nose, the eyes and the mouth. 

It cannot go through an intact skin like some of the diseases used to: yaws, leprosy, etc. 

This, therefore, means that even when you get near a person with the virus in his/her body, he/she can only infect you if he/she sneezes (Okwetsyamura) or coughs (Okukororra) near you so that the tiny and invisible bimira (mucous from the nose) or spittle (machwaante) enter your nostrils or those infected materials from the body land on a surface (a table, a chair, a door handle, a hand kerchief, etc.) where the virus can stay alive for 3 hours and you, then, touch it and, then, touch your soft parts of the body (the eyes, the mouth and the nose). It is this characteristic that makes it very infective.

The Cabinet, under my Chairmanship, on Monday, the 16^th of March, 2020, sat and decided as follows:

Although the kill ratio of the virus is not very high compared to, for instance, Ebola, this is if the victims are in perfect health. With the healthy young people, for instance, some information says that an infected person may not even know that he/she has any problem. 

She/he may defeat the virus without even knowing that it ever attacked him or her.  The real danger to society, however, is for old people, 70 years and above and people with other diseases they have been surviving with.  Such diseases are like: TB, HIV, diabetes, hypertension, etc. It is these that will be very sick or even die. Since we have a very large number of people living with HIV (1.4 million), having diabetes (800,00), hypertension (4.8m), TB (100,000 per year), we must do everything possible to ensure that this enemy does not come here, does  not find plenty of dry grass piled up and ready for flaming.  What is the dry grass that can help to start and sustain fire of a corona-virus epidemic? It is the big masses of people, gathered together and in close proximity.

What are these masses of people that are gathered in groups that can easily aid the spread of the virus? They are the following:

1.   The students. The NRM has promoted education.  As a consequence, today, there are 10.7million children in the Primary Schools; 2m children in the Pre-Primary Schools; 2 million students in the Secondary Schools; 314,548 students in the Universities and Tertiary Institutions.  This is a total of almost 15 million young Ugandans, distributed in 36,285 Primary Schools (Government and Private), 7,308 Pre-Primary Schools (Government and Private); 5,553 Secondary Schools (Government and Private) and 49 Universities and 1,543 Tertiary Institutions (Technical Schools, Teacher Training Colleges, Vocational Schools), etc., etc.  This is a total of 50,688 points with concentrations of 1,000 or more persons each.  When I visited Masaka SS in Masaka Town, it had 4,000 pupils without counting the other non-student people staying in that compound. It is wise that we temporarily remove these concentration points by closing all the Primary and Secondary schools as well as all the Universities and Tertiary Institutions for one month, starting with Friday, the 20^th of March, 2020, starting at mid-day.  All these institutions, without exception, should close so that we deny this virus those concentrations.  The 42 million Ugandans are divided into about 8million homesteads. Once the Educational Institutions population goes home, they will disperse into these 8million homesteads that have much less concentrations.  If the 15million were to disperse equally into the 8million homesteads, each homestead would take one and a half students. Since we cannot have a half a student, let us correct to the nearest whole number and we end up with 2 students per each homestead.  It is a smart way of avoiding these concentrations in the face of this danger. I have decided to close the Educational Institutions even before the occurrence of a single corona incident because I have observed the situation in other countries.  Once the epidemic breaks out, there is so much stampede that the first suspect to be affected is transport.  You have seen how Airports were clogged with people.  That crowding is perfect ground for new infections.  Let us, therefore, move early to avoid the stampede.

2.   Once we deal with the concentrations in the Educational Institutions, the next concentrations that we must deal with are the religious gatherings: prayers in Churches, in Mosques, open air prayers and services on Fridays, Saturdays and Sundays. In the interests of our people’s health, these should be suspended for a month with immediate effect.  Why with immediate effect?  The answer is, a question of logic:  “What if a person that is not yet infected today with the virus is infected tomorrow, Thursday the 19^th of March, 2020, was to be infected in the last Service that had been called “to pray for the last time?” How would God forgive us and how would we forgive ourselves?”  When it comes to health, it is better to be a coward and be on the side of caution.  If there is no danger after one month, that will be good. If there was danger, we would have avoided it. The Prayers will continue but in homes. The Religious leaders can use the TVs, Radios stations to continue preaching. His Holiness, Pope Francis, as usual set a good example of enlightenment on this by abandoning his customary preaching in St. Peters’ Square and is instead, using the TV.

3.   Then the next category of mass meetings are the political or cultural ─ Public rallies, conferences, elections, etc.  All these are hereby forbidden for 32 days with immediate effect.

4.   Up to today, the 18^th of March, 2020, Uganda, by the mercy of God, has been spared by not having even one case confirmed of the corona-virus. There has been many false alarms that our laboratories have proved false. However, there are countries in the world that have had many cases. We describe these countries as category one countries in terms of the epidemic.  These countries are: Italy, France, South Korea, China, USA, United Kingdom, Netherlands, Switzerland, Sweden, Belgium, Germany, Spain, Norway Austria, Malaysia, Pakistan and San Marino. We, with immediate effect, ban all out-bound movement by Ugandans to or through these countries, again, for 32 days.  Foreigners going to those countries are free to do so provided they do not intend to come back within the prohibited time.  We extend our sympathies to those countries and commend them for fighting on the behalf of the human race.

5.   We cannot stop Ugandans coming back from abroad, even from the category one countries that I read above.  However, such Ugandans will be put in a mandatory quarantine in a designated place but they will pay the cost for their institutional quarantine ─ food, etc.  If they want to avoid that inconvenience or cost, they can sit out the storm in the country of their temporary abode.

6.   The next points of mass concentrations are the non-agricultural work places: factories, hotels, large plantations, markets, taxi-parks, etc.  These should continue functioning but with SOPs (Standard Operating Procedures) put out by the Ministry of Health. These will include: compulsory hand-washing by all persons who enter or exit those work places, anybody with symptoms of sickness should not be allowed access for any reason, by the employers installing temperature monitors. The Ministry will publish the detailed SOPs as part of the Statutory Instrument to be signed by the Minister of Health with immediate effect.

7.   Then, the issue of Uganda-style weddings that bring together a pentagon of groups: the clan members of the bridegroom (Kishweera); the clan members of the bride (Kishwerwa, Omugore); the maternal clans of the two couples (Obukojja – Obwihwa); the school alumni of that couple; and the neighbours and friends. These tend to be big gatherings of people coming from the 6 points of the compass. This multi-directional source of the Mbagga attenders, can be as source of great danger. It is, therefore, decided that the wedding of this type should be postponed for 32 days from today. If, however, the couples intending to marry are really in a hurry, they could go for a purely scientific wedding, only involving the core stakeholders who are: the bride-groom, the bride, the best-man, the assistant to the bride (matron), the Priest (or the CAO), etc., as long as the number is less than 10 people.  The scientific marriage could, then, later, at an appropriate time, be followed by the Uganda-style one. Maama Janet and myself, used the scientific one in 1973 and we have not regretted.  The “Corona-virus” that time was the Amin regime. Much, much later, with adult children and grand-children, Janet and myself, were able to celebrate the 40^th anniversary of our marriage the Uganda-style with the whole Rwakitura compound full of people, with our grand-children as the brides-maids. The impatient intending couples could look at this model.

8.   The other occasion that gathers alot of people is a funeral.  Again, relatives, friends, associates, neighbours, etc., turn up in big numbers.  Again, with this virus, this is a danger point.  Many people could be infected there.  We cannot ban or post pone burials for 32 days. It would not be rational.  We, therefore, recommend that the burial is done by the relatives who are nearby.  They should be the ones to Kuziika (to bury).  Then the mourning (the kukungubaga – ekyosi) could be later when the rituals could be done. This may combine both science and culture.  Most importantly, it would be safe for the participants. If the deceased is, however, suspected of dying from the corona-virus, the State will take over and bury the person in the scientific way without the involvement of the family as we did for the Ebola victims. We should not replicate the lack of enlightenment that was exhibited in West Africa where the ritual of washing dead bodies was maintained even when people were dying from Ebola.  The consequence was that the “bathers of the dead bodies” ended up dying themselves in service of a non-scientific cultural practice. By confronting this disease with enlightened, scientifically based actions, we shall defeat it as we did with Ebola three times, with Marburg and with AIDS.

9.   The other big category of Ugandans are the farmers ─ the crop people, the cattle keepers and the fishermen. These account for 10million families according to the 2014 Census, with a population of 33 million people.  These, however, may not be a problem by themselves because they live in scattered homesteads and do not allow much concentration of persons.  If they are not pulled by the Churches and Mosques or by politicians for political rallies, they will go about their most useful activities in their dispersed form that is not a danger to themselves or to others.  However, they should all observe the hygienic practices recommended in this and subsequent communications. The Technical Committee on Health should, however, study more the issue of the fishermen. Although they fish separately, they live in concentrated landing sites. The Technical Committee will evolve the appropriate SOPs.  With the other category of farmers (cattle keepers and cultivators), the other danger area are the monthly markets. These should also be suspended for the 32 days. Buying of crops and livestock (cattle, goats, chicken, etc.), can go on but from the homesteads. They do not have to congregate.

10. The next frontline with this virus is public transport ─ the boda-bodas, the taxis, the buses, the mini-buses and the trains.  Everybody can see, the clear danger here, is of many people sitting next to one another in the confined space of the vehicle from Lira to Kampala etc.  Therefore, the advice here is: “Do not travel unless it is absolutely necessary, if you are using public transport”. Additionally, the companies that operate these means of transport should be given mandatory SOPs by the Ministry of Health: hand-washing, not allowing sick people on board, temperature monitors etc.  With these pre-cautions, public transport will continue.  However, in the event of an outbreak in a given locality, public transport in that area will be forbidden and the area will be isolated.

11. The next frontline of fighting the virus is to stop the merry-making ─ the discos, the dances, bars, sports, music shows, cinemas and concerts.  These are very dangerous gathering points with the virus around. Drunkards sit close to one another.  They speak with saliva coming out of their mouth. They are a danger to themselves.  All these are suspended for a month.

12. With these measures taken to deny the virus mass concentrations of Ugandans, the next area to look at is Hygiene.  The virus, according to the facts known so far, spreads by okwetsyamura (sneezing) and kukorora (coughing) whereby, through your micro-mucous (ebimira) or your spittle (otuchwante), you pollute the air around you and the virus can now enter the nose of the nearby people through breathing.  That is why it is important that anybody with a cough or cold should not go into public. You should self-isolate yourself or be isolated by force, if you are not responsible enough to govern yourself for the general good.  Even at home, always cough or sneeze into a handkerchief which you should frequently wash, dry and iron with a hot flat-iron or use a disposable tissue which you should then, either flush in the toilet or incinerate in a Sigiri. Do not spray the public or your family with your mucous or spittle through primitively sneezing or coughing without precautions or blocking your output in the manner suggested.  Once the individuals control coughing and sneezing, then the next danger point is touching surfaces with infected hands: tables, door-handles, telephone hand-sets etc. Here, the answer is to cough and sneeze into the tissue which you destroy so that your hands are not contaminated.  In any case, you regularly wash these hands. Therefore, your hands do not pollute the surfaces.  With money in markets and Banks, the Ministry of Health will publish SOPs governing that aspect, including disinfecting the coins, using mobile money, using online purchases etc.  Once you avoid open coughing and sneezing and you wash your hands regularly, then you will not contaminate the surfaces ─ the tables, the door handles etc.  That will protect the public. The virus, even if you have it, will remain with you until you get healed. It is good that for some time now, we have stopped the practice of shaking hands and hugging. There is also the side of everybody protecting oneself.  As you heard, the virus only enters the body through the soft parts of the body: the mouth, the nose and the eyes.  Even if the surfaces are contaminated with the virus and you touch those surfaces, yes the virus will be on your hand.  However, it will not enter your body unless you touch yourself in the soft parts of your body before washing.  These soft parts are: the eyes, the mouth and the nose. If you wash with soap, before you touch those soft parts, the virus will die.

13. Then, there is the issue of nutrition so as to eat foods that strengthen our body soldiers (the immune system) to fight the enemy.  Apart from ensuring a balanced diet which the District Medical Officers, through fortnightly addresses to all of you, should inform you about, in the particular fight against this virus, there is the need to take in good quantities of Vitamin C, through eating oranges and lemon and also eating ripe bananas to get folic acid and Vitamins B6. The folic acid and the Vitamins B6 help the nervous system of the body.  Ascorbic acid from the oranges helps your body to produce blood cells and build immunity.  Therefore, apart from de-congesting population concentrations so as to deny the virus big bodies of our citizens to easily infect and spread, the other important measure is the one who is having a cold not to spray the innocent with okwetsyamura (sneezing) or coughing into the open air.  Block your sneezing with the tissue, if you are the rich type that can afford tissues or into handkerchiefs that you frequently wash, dry and iron. Wash your hands with soap so that you remove the virus on your hands so that you do not contaminate the surfaces.  Then, on the defensive side, make it a habit never to casually touch your mouth, your nose or your eyes with unwashed hands, in case you touched contaminated surfaces. Eversince 1959, at Mbarara High School, when I attended my confirmation course (Kitebwaho emikono), the Reverend Yustus Ruhiindi advised us to use our left hand to receive the bread for the Holy Communion because the right hand would have been contaminated with the greeting of people.  It is now 61 years since. In all that time, my right hand is for greeting, opening doors, handling pens etc.  The left hand is reserved for myself ─ blowing my nose, etc.  This was long before these diseases ─Ebola, Corona-virus, etc.  It was a wise advice.  The Ugandans could look at it.  I never allow my right hand to touch my left hand before washing.  That is why I never clap hands.  I normally bang the tables with the same right hand that I donated to the public long ago. I never want my right hand to contaminate my left hand which is strictly for myself.

Otherwise, Uganda is prepared. We have isolation centres. We have long had the testing capacity within the country eversince the first Ebola days.  We have some factories providing hand sanitizers and we are going to have more.  Some factories will start producing face masks of the different types.  There is even some talk of treatment using the old choloroquine.

However, prevention is better than cure. On the side of the economy, there is no doubt that some sectors like tourism, hotels, sports, entertainment, etc., will be hit by the phenomenon of this disease.  However, others like the manufacturing sector will get a boost.  The countries of the World, by their selfish actions, are, again, waking up Africa that that it is ─ suicidal to depend on others.  I have warned our people to stop talking like the selfish foreigners by trying to stop the little we have, being exported to other African countries.  We can keep abit for ourselves but we shall share with the others whatever we have.  The blocking of imports should, therefore, get the long-sleeping Ugandans to wake up and use the huge amount of money they long earned by turning our market into a dumping point for foreign goods to build our own manufacturing capacity.  Through the BUBU, we shall help those groups.  Everything you have been importing, except for petroleum products for now, now make here. The US$7bn you have been using to import, keep it here.  Turn misfortune into an opportunity.

On Saturday 21^st March, the 41^st Anniversary of the defeat of Idi Amin’s forces at Rugando by the TPDF Force of 80 KJ and Task Force BN and Fronasa Forces, I have invited the top leaders of the Faiths for National Prayers at Entebbe State House. The few of us will pray for the whole country together. All of you pray in your homes, God will hear us.

In order to synchronize the dates with the closure of the schools on Friday, the actions of suspending the other activities that are starting immediately will run for 32 days not 30 days.

Source: The State House of Uganda.

After 7 years of Litigation, Mr. Mubangizi Michael and Musimenta Jennifer have received their full compensation for damages after they gave birth to twins but only got one! In this case we sought to challenge Baby theft at Mulago hospital.

“While this compensation will not bring back our child, it will go a long way in helping me provide a better life for my family. I am immensely grateful for CEHURD for relentlessly walking this journey with us.” – Mr. Mubangizi

At CEHURD we believe that this case should be a wake up call to Health facilities, Courts of law, the Civil society and the State to be mindful of Human rights’ violations that affect the most vulnerable in our communities.

CEHURD is going to continue engaging the beneficiaries to ensure that this compensation is of impact in their lives.

For Details about this case; see links below;

http://bit.ly/3cAZGSJ

We are pleased to welcome Ms Grace Kenganzi to Centre for Health Human Rights and Development (CEHURD) as our Communications Manager.
Ms Grace Kenganzi has worked in media and communications for nine years. Before she joined us, she was an editor with Monitor Publications Limited. She brings with her, experience in journalism, strategic communication, stakeholder engagement and management. Her skills fits into our work in making an impact through CEHURD’s five-year strategic plan, 2020 – 2024.

The Center for Health, Human Rights and Development (CEHURD) with support from the Office of the prime Minister under the DINU initiative wishes to conduct a baseline study aimed at collecting initial data on project indicators against which project results will be measured. The results from the baseline survey will later be utilized to track the project implementation progress. This baseline therefore seeks to document the following;
• Vital project indicators to measure change and impact of intervention.

• Level of awareness and knowledge of various stakeholders’ roles and responsibilities in Koboko and Maracha district.

• Gaps in decentralization operations in Koboko and Maracha districts.

For Details see download;

Gender-based violence is defined as ‘any harmful act that is perpetrated against a person’s will، and that is based on socially-ascribed (i.e. gender) differences between males and females. Gender based violence manifests in form of Sexual violence (rape، sexual assault، sexual harassment), Physical violence (hitting، slapping، beating), Emotional violence (psychological abuse), Economic violence (denial of resources) and Harmful traditional practices (forced marriages، female genital mutilation).[1]

Gender based violence is  one of the most severe forms of gender inequality and discrimination in Uganda and remains a critical Public health global health problem and one of the most pervasive human rights violations of modern time. It is an issue that affects women disproportionately, as it is directly connected with the unequal distribution of power between women and men thus, it has a profound effect on families, communities, and societies as a whole[2]. These Gender inequalities limit the ability of women and girls to fully participate in, and benefit from development programmes while formal and informal institutions, such as religion, family, marriage as well as social and cultural practices play a major role in perpetuating gender inequalities in Uganda.[3]

Gender based violence undermines the health, dignity, security and autonomy of its victims, yet it remains shrouded in a culture of silence. Violence often remains hidden, as survivors fear for their safety or are stigmatized. Victims of violence can suffer sexual and reproductive health consequences, including forced and unwanted pregnancies, unsafe abortions and miscarriages, traumatic fistula, sexually transmitted infections (STIs), preterm birth and stillbirth. ^[4] It is also associated with mental health outcomes, including posttraumatic stress disorder, anxiety and depression, and an increased risk of ideated or attempted suicide, or suffer other health consequences.

Physical, sexual, or psychological harm by a spouse or partner is a major factor in maternal and reproductive health^[5]. Women suffering from intimate partner violence are less likely to adopt contraception and are 46 to 69 percent more likely to have an unintended pregnancy. Abusive partners are 83 percent more likely to coerce a pregnancy, through forced intercourse or birth-control sabotage, and women in abusive relationships are 2.7 times more likely to seek an abortion.[6] Women suffering from abuse are twice as likely to have a miscarriage and their children are 3.9 times more likely to have a low birth weight, while infant diarrheal diseases are 38 to 65 percent more common in children born to mothers suffering from abuse.^[7] As CEHURD, we believe that Improving the equity and value of women and girls is a very important means of improving population health.

According to the UDHS for 2011 and 2016, the trends show that sexual violence is higher among the women. While Current husbands were found to be the leading perpetrators of both physical and sexual violence. Major improvements in GBV are attributed to increased awareness campaigns by both state and non-state actors in enforcement of the GBV policy. However, more needs to be done to further fight both sexual and physical violence (DFID, 2016).^[8]

STATE PROGRESS

Uganda is a state party to nearly all international human rights conventions as well as relevant regional protocols with explicit provisions for gender equality and recognize Gender based violence as a form of discrimination. The 1995 constitution and broader normative and legal and policy frameworks reflect global standards, are strongly supportive of Gender Equality (GE) and, within recent policy documents, address gender-based violence (GBV) explicitly.

Uganda was active in the post 2015 development process; it was one of first countries to integrate the principles and goals of the Sustainable Development Goals (SDGs) into its National Development Plan (NDP) even before the global documents had been finalized. Both gender equality and GBV are featured in Uganda’s second NDP and evident in diverse sectoral plans. The government signed onto, endorsed and ratified principles which are enshrined in the UN convention on elimination of all forms of discrimination of women (CEDAW), The Beijing platform for action, Global Agenda 2030 Sustainable Development Goals (SDGs). The women’s access to SRHR is integrated in Uganda’s vision 2040, and it adopted the National GBV policy and Action plan 2016, and the national male engagement strategy in 2017.

The National Health Sector Plan reflects a rights-based approach and acknowledges international conventions. The National Action Plan on Elimination of Gender Based Violence in Uganda (2016-2020) frames the issue of GBV as an urgent development priority and factor to address in achieving Uganda’s development goals for 2020. Similarly, the interconnected work on ending child marriage and teenage pregnancy is framed by the new dialogue on leveraging for development the demographic dividend of a large, youthful population.[9]

The government of Uganda has developed   the National SRHR/HIV/GBV Integration and Linkages Strategy to guide integrated programming and resource mobilization. The strategy highlights opportunities and entry points for SRH/HIV/GBV integration. An Assessment and studies on integration including the National SRHR/HIV/GBV Linkages and Integration Rapid Assessment; a facility assessment on SRHR/HIV /GBV integration and an assessment on SRHR/HIV/GBV integration in Global Fund programming. Results of these assessments are being used to inform resource mobilization efforts, revision of the national SRHR/HIV/GBV Integration and Linkages Strategy and development of standard tools and job aides to support service delivery.

 GAPS IN INTERLINKING GBV AND SRHR

However, despite the strong normative framework on Gender inequality, including regulations, guidelines, protocols and even district level laws and ordinances, actual implementation of the policies has been challenging. The SDGs can only be achieved if Uganda as a state understands and accepts their ultimate responsibilities to fulfil obligations to international treaties and agreements and must performs them in good faith, state obligations entails compliance by government units across different sectors. Eliminating gender based violence requires the obligation of states on the principles to Respect rights of women, Protect rights of women, Promote rights of women, Fulfil rights of women and  Obligation of means and results.

There is a challenge in implementation of existing laws and policies, several laws remain pending while others require amendment and other development of comprehensive implementing policies and regulations. To more effectively protect the rights of women and girls, address discriminatory implementation of laws and ensure effective SGBV /SRHR integration.

1. Marital rape is not criminalized under the laws of Uganda due to delays in passing the marriage bill 2017 which bill was initially the marriage and divorce bill 2009.
2. The laws of evidence and penal code provide that for any allegation of sexual assault there must be corroboration by the third party making it very hard for women to prove husbands assault of his wife in the private space like bed rooms. 
3. The HIV prevention and control act requires all victims of sexual violence, pregnant women and the partner of a pregnant woman to undergo routine HIV testing, which is a barrier to many women accessing SGBV and SRHR services and can expose women to increased violence particularly intimate violence.

Allocation of resources to implement laws policies and regulations, institutional and staff capacity and accountability mechanisms remain weak. The development of the social development sector plan (SDSP) provided a framework or all ministries, departments and agencies including health, justice, police among others to priorities integration of gender equality issues in their annual plans and budget reinforced by gender and equality certificate. However ministries departments and agencies and the decentralized structure ^[10]do not adequately priorities financial resources for GBV SRHR integration and there is a gap in the budget allocations for gender equality.  

The national SRHR guidelines and service standards were revised but were recalled at ministerial level. While the national sexuality Education framework does not cater for girls outside of formal education and resources for its implementation have not yet been secured.

There is a Gap in the legal literacy capacity of ministries, departments and agencies and the sub national governments to engage in participatory –planning and gender – responsive budgeting and to implement GBV legislation and services. The lack of multi –sectorial mechanisms, with linkages to civil society, to oversee financing and accountability for GBV /SRHR programming hinders implementation.

There is a weak implementation of the right based approaches and insufficiencies in programming and implementation of gender responsive interventions for access to justice.  Health and police personnel at sub national level are still not aware of the changes to the PF3 form, and lack training in filling of the form  yet in many service points, the police forms 3A and 24  are not available

State actors working around GBV prevention and response remains under funded, with further work needed to build capacities of institutions to deliver GBV response and prevention programmes and integrate SRHR services. This lack of capacity continues to hamper efforts to implement legislation and policy. Funding is often allocated at the national level and does not trickle down to sub national levels. This has been evidenced by police officers being constrained with fuel to facilitate arrest or investigate GBV cases. Health workers running out of emergency contraceptives and cotton swabs to facilitate examination of SGBV survivors   yet still the long distance from communities to courts of law is often prohibitive to the optimal access to these services.

While coordination and referral mechanisms exist, they are often in operative and unfunded at sub national level and ineffective in ensuring continuum of support for survivors of Gender based violence. The district chain- linked committees (DCC) coordinate action within the JLOS sector, including cases of Gender based violence, but are often in active at the district level due to insufficient funding.

Stock out of SRHR commodities and Lack of access to SRHR services and essential medical services for survivors of Gender based violence. Most up country health facilities across the country lack necessary medical supplies and capacity to treat survivors of violence, particularly sexual violence. This includes shortage of rape kits, PEP, emergency contraception and pregnancy kits, and medication for treatment for STI.  Yet  girls and Women and girls usually lack access to information and experiences on the barriers and stigmas which exclude the from receiving essential services which leaves them and adolescent girls vulnerable to unwanted pregnancies, unsafe abortions and exposure to other sexually transmitted infections.

Structural weaknesses within the health sector and lack of human resources make it difficult for it to fulfil the requirement under the law. Few licensed medical practitioners are willing to appear in court as expert witnesses yet still they are a rarity in rural and urban Uganda and they have so far generally been unprepared and unforthcoming to fulfil their new additional duties as expert witnesses before the Courts. There is a lot of bureaucracy in terms of facilitating the health workers to court to testify and the burden is shifted to the poor survivors who cannot afford such charges leading to frustration of cases.

The country has few operational GBV shelter homes for rehabilitating victims of gender-based violence (GBV).and worse still those available are facing financial constraints and closing temporary.  In the shelters, survivors get legal aid, psychosocial services, temporary accommodation and referral to GBV survivors’ services. Government through the MGLSD should recommend for should CFPU reception centers to upgrade to shelters and allocate budget for the same to have them furnish and offers services to GBV survivors.

Recommendations

• Ensure the implementation of the various legislation and policies on GBV and SRH at the national and sub national levels. This requires joint actions between non-state actors addressing the links between gender-based violence and SRH working together with state institutions to advocate for the implementation of the same all levels.
•  Social, economic and legal gender inequalities in Uganda need to be addressed in line with the Bill of Rights as provided for the constitution of the republic of Uganda. Doing so would reduce the disproportionately high levels of GBV affecting the reproductive health of women in Uganda.
•  Government response should be more strategic and holistic in order to safeguard the lives of Ugandans with effective early warning systems. The mitigation strategies should include the health sector and provision of psychosocial support to the survivors. Mechanisms to rehabilitate the perpetrators of violence should be defined, tested and evaluated for feasibility and sustainability. The government should take the lead in implementing these measures.
• Safe houses for GBV survivors to recover or as transitional stops have been reported to respond to the immediate needs of survivors. One-Stop-Centers such as those found in Rwanda, Malawi and South Africa which include a police station, hospital and a safe house for survivors all under one roof should be emulated.
• Incorporate a health sector response within the inter – sectorial response to gender-based violence. A health sector response that is comprehensive and based on women`s rights is an essential and strategic delivery point to respond to gender based violence. This will enable early screening and detection of gender based violence and quicker intervention.
• Provide treatment and care for victim- survivors who are at the crisis point and reduce maternal deaths and the burden of disease caused by gender based violence. Health sector responses to gender based violence can be systematic within health facilities. Every health service provider should under g a regular and consistent gender sensitization to appreciate issues of gender based violence
• The government should ensure universal access to family planning information and services and invest in a country wide sensitization program on reproductive information.
• The state should remove all legislative barriers that prohibit young people especially unmarried young women from accessing sexual and reproductive health services and family planning.
• The state should come up with concrete plans for training health service providers and implementing the Standards and Guidelines for the Reduction of Maternal Morbidity and Mortality from Unsafe Abortion in Uganda

CONCLUSION

Prevention campaigns on GBV/SRHR conducted in Uganda often do not adequately consider the reality of the daily lives of Ugandan women and the difficulties they face in gaining control over their own sexual lives. The rampant spread of HIV/AIDS and the high prevalence of GBV can only be stemmed if the subordinate position of women is acknowledged and addressed. The study results indicate that adolescents and women, among other sub-groups are more vulnerable to GBV.  Inefficiencies within the supply chain system which limit effective delivery of both GBV and SRH commodities, with frequent stock outs of commodities experienced across health facilities, Inadequate training of health workers and Community Health Extension workers in integrated SRHR/ GBV services delivery, Socio-cultural barriers including harmful cultural practices and value systems which over look violence against women and girls, limited coordination and effort by health workers to offer services beyond what clients seek for at health facilities and inadequate referrals, Inadequate Human resource to support GBV/SRHR integration should be addressed to effectively integrate GBV and SRHR

The relation between Sexual reproductive health and GBV is mainly through intimate relations that are influenced by socio-cultural factors including gender power imbalances. It is evident that social factors such as the unfavorable economic position of women, and the inability to insist on condom use make Ugandan women unable to negotiate the timing of sex and the conditions under which it occurs. Thus, they are rendered powerless to protect themselves against HIV infection and other sexually transmitted infection, unwanted pregnancies.

 REFERENCES

1. The national male involvement strategy for the prevention and response to gender based violence in Uganda. https://uganda.unfpa.org/sites/default/files/pub-pdf/15_03_18_%20MALE%20INVOLVEMENT%20STRATEGY%2024%20JULY%202017.pdf
2. Understanding the critical linkages between Gender based violence and sexual reproductive health rights. www.arrow.org.my .
3. The World Bank. Pp 219-244. 3. Amuyunzu-Nyamongo, M. & Kiragu, K. (2005) Gender roles and sexual behavior in Africa. AIDS in Africa: Scenarios for the Future, UNAIDS.
4. Bourdieu, P. (1998). La domination masculine. Paris: Editions du Seuil.
5.  Cornell, R. W. (1995). Masculinities. Cambridge: Polity Press.
6.  Cornwall, A. & Lindisfarne, N. (1994). Dislocating masculinity: gender, power and anthropology. In A. Cornwall, & Lindisfarne (Eds.), Dislocating masculinity. Comparative ethnographies (pp. 11-47). London and New York: Routledge.
7. Spotlight initiative to eliminate violence against women and girls. country programme document.
8. WHO/UNAIDS/UNICEF (2010) ‘Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector the country- Progress Report 2010.
9.  WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011.
10. The state of sexual reproductive health and rights in Uganda emerging issues JS8_UPR26_UGA_E_Main.pdf.

Compiled by Nakalembe Judith Suzan

Community Empowerment Programme

CEHURD.

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[1] https://www.unfpa.org/sites/default/files/pub-pdf/-Facilitator1s_Guide_English_InDesign_Version.pdf

[2] ASIAN PAIFIC RESOURCE AND RESEARCH CENTER FOR WOMEN .WWW.ARROW.ORG

[3] (World Health Organization، Global and Regional Estimates of Violence against Women، 2013، http://bit.ly/1oTfGVG ).

[4] Ibid

[5] https://www.wilsoncenter.org/event/the-impact-violence-against-women-maternal-health

[6] Ibid

[7] Ibid

[8] https://www.ubos.org/wp-content/uploads/publications/03_2019UBOS_Gender_Issues_Report_2019.pdf

[9]

[10] The government decentralized policy and local government act (1997) transfers responsibility and authority for delivery of many public services to the district local government including health.

By Judith Nakalembe – Programme officer and Lawyer at Center for Health, Human Rights and Development (CEHURD).