The Constitutional Court of Uganda on 30^th September, 2019 formally heard Constitution Petition No. 16 of 2011. This case was filed in 2011 by the Center for Health Human Rights & Development & others against the Attorney General, challenging the unavailability of basic maternal commodities, the unethical conduct of health workers in public health facilities and failure of government to provide emergency obstetric care services among others.

On 2^nd October, 2018, the President of the Republic of Uganda, His Excellency, Yoweri Kaguta Museveni officially commissioned the Mulago Specialised Women’s and Neonatal Hospital which was constructed to offer specialised services to women and children. On 18^th September, 2018, Dr. Ruth Acheng, the Minister for Health made a ministerial statement on the operationalization of Mulago Specialised Women’s and Neonatal Hospital wherein she stated that there will be user fees charged for the services offered at the Hospital. The pay policy put in place categorised services offered at the hospital as Standard, VIP and VVIP services.  Furthermore, a waiver committee to determine who qualifies to access free services at the facility was to be put in place. This is an act of retrogression in the progressive realisation of the right to health and access to medical services. This prompted the Center for Health, Human Rights & Development to file Miscellaneous Cause No. 235 of 2019 against the Attorney General challenging inter alia the act of turning a public service into a private hospital at the Mulago Specialised Women’s and Neonatal Hospital.

It is over eight years since Constitutional petition No. 16 of 2011 was filed but there has been no redress from Court. Maternal deaths continue to happen in both public and private health facilities; some of these deaths are reported, others are concealed especially those happening in private health facilities.

In private health facilities, the vice is on rise leading to high maternal deaths; there are several instances of maternal deaths due to negligence and we highlight a few in this article. On 28^th September, 2018, a mother admitted at St. Charles Lwanga Hospital in Buikwe District died along with her baby because of the hospital administration’s failure to refer her to another hospital for better management. The medical personnel supposed to attend to her were not on duty and the cashier tasked to provide the medical bill for payment before the discharge and referral of the mother was absent.

On 13^th March, 2019, a mother lost her child at Alshafa Modern Hospital in Jinja District because the doctor supposed to attend to her reached the hospital late and the insistent requests by her to be referred to another facility were rejected. On 12^th July, 2019, another maternal death occurred following the actions of a doctor at Butiru Chrisco Hospital in Manafwa District who failed to refer an expectant mother for better management because that referral would cause his hospital to lose funds which were being paid by USAID under the Uganda Voucher Plus Activity. On 20^th October, 2018, a mother admitted to Kibuli Hospital underwent a cesarean section and spent over four hours in the theater; she was wheeled out of theater and placed in the ward while still unconscious. She was unattended to for more than 6 hours despite the fact that she was bleeding and eventually died.

These continuous maternal deaths raise the big question on who bears responsibility for all these deaths. Under Objective XX of the National Objectives and Directive Principles of State Policy of the Constitution of Uganda provides that the state shall take all practical measures to ensure the provision of basic medical services to the population.

The right to life is guaranteed under Article 22(1) of the Constitution of the Republic of Uganda. Clause 4 of the Uganda Medical and Dental Practitioners Council Code of professional ethics states that a practitioner shall not violate the human rights of a patient, the patient’s family or his or her caregiver. Furthermore, a practitioner is not to carry out any specific actions that constitute a violation of bill of rights enshrined in the Constitution of Uganda and international human rights law. Are health workers really aware about the provisions in the bill of rights or other international human rights laws in respect to health?

In Uganda, the health profession has many bodies that regulate the different medical professions; the Medical and Dental Practitioners Council is a body corporate established by an Act of Parliament – the Medical and Dental Practitioners Act, Cap 272 responsible for licensing, monitoring and regulating the practice of medicine and dentistry in Uganda. The Nurses and Midwives Council established by the Nurses and Midwives Act, Cap 274 mandated to train, register, enroll and discipline nurses and midwives of all categories in Uganda. The Allied Health Professionals Council is established under the Allied Health Professionals Act, Cap 268 mandated to regulate, supervise and control allied health professionals (Clinical officers). When a violation of human rights in respect to health particularly through medical negligence arises, complaints ought to be lodged with the appropriate bodies.

How then do these bodies that regulate the health profession and other stakeholders contribute to the reduction in maternal deaths in Uganda? The Uganda Law Society has partnered with the Uganda Medical Association in a number of activities for example on 30^th August, 2019, the Uganda Law Society organized the first ever  Health Awareness Day for lawyers and invited the President of the Uganda Medical Association who came along with a team of doctors to speak to the lawyers that had gathered. This partnership is a strong partnership and an avenue for lawyers, medical professionals and other stakeholders to learn and embrace a human rights-based approach to tackling issues that arise in respect to the right to health.

The Ministry of Health is a key stakeholder in respect to health-related matters since it bridges the gap between the people and the medical profession since it supervises both government and private health facilities within the country.  Many public health facilities in the country have no medicines, basic services, no trained health workers to attend to people seeking health services including women seeking maternity services. In the absence of immediate intervention by medical professionals, the rates of maternal mortality continue to increase and issues surrounding maternal mortality are not addressed or resolved.

In light of the above, there is a wide gap that needs to be filled by different stake holders to fight this vice and reduce maternal mortality in Uganda so as to achieve social justice in health.

Namaganda Jane Kibira and Ajalo Ruth

Center for Health Human Rights and Development. (CEHURD)

Health and the law is an emerging area of legal practice beset with a visible lack of national jurisprudence. The relationship between the law and health starts from the definition of the two terms; The World Health Organization (WHO) defines ‘health’ as a ‘state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity’ and the law is defined as ‘the system of rules which a particular country or community recognizes as regulating the actions of its members and which it may enforce by the imposition of penalties’. The marriage of the two gives us Health and the law which refers to those enforceable laws established by government and applied to people for the purpose of building a healthy society.

In Uganda, health and the law did not exist as an independent area of practice until recently. It was largely embedded within the law of tort under medical negligence, constitutional law under quarantines for reasons of public health and safety and in criminal law under imposing sanctions on health workers for committing negligent acts. Health and the law has slowly garnered force in India and South Africa as seen in the 1998 case of Soobramoney v the Minister of Health (KwaZulu Natal), the Constitutional Court said that the government was justified in restricting access to kidney dialysis, because of the high cost of this type of care, and the need for the government to have reasonable plans for spending its health care resources.

In the 2002 case of Minister of Health v Treatment Action Campaign, the Court stated that the government was wrong to restrict access to the antiretroviral medicine, nevirapine, that is effective in reducing the risk of mother-to-child HIV transmission and ordered the government to make the medicine available to pregnant women living with HIV.

The principal legislation informing health and the law in Uganda is found in the Constitution of the Republic of Uganda, 1995 which creates an obligation on the State to ensure that all Ugandans enjoy opportunities and access to health services and ensure provision of medical services to the population. It can also be found in acts of Parliament which include the Public Health Act Cap 281, Insurance Act 6 of 2017, the Medical and Dental Practitioners Act Cap 272, the Nurses and Midwives Act Cap 274, the Allied Health Professionals Act Cap 268, Mental Treatment Act Cap 279, Venereal Diseases Act Cap 284, National Medical Stores Act Cap 207 and National Drug Policy and Authority Act Cap 206.

Health and the law has also seen a slow but sure growth in the courts of law where the Courts have set precedent in several cases such as the cases of Joyce Nakacwa vs. Attorney General Constitutional Petition No. 2 of 2001 which was unfortunately not heard on its merits, there is also Sarah Watsemba Goseltine and Baby David Goseltine vs. Attorney General High Court Civil Suit No. 675 of 2006 which discusses medical negligence. Medical negligence contributes to death, damage, injury of patients.

Although the legal framework provides for redress against medical negligence in form of civil and criminal law, these laws are inadequate because it is hard for a victim to prove medical negligence against a medical professional let alone extract payment of damages from the government.

The case of CEHURD vs AG Constitutional Petition No. 16 of 2011 challenges inter alia the non-provision of basic indispensable maternal health commodities in government health facilities but the Petition was struck out for raising political questions but this decision was overturned by the Supreme Court in Constitutional Appeal No.1 of 2013 and the petition was forwarded back to the Constitutional Court to be heard on its merits. On 30^th September, 2019, the Constitutional Court heard arguments for and against this matter which was adjourned for a ruling which will be delivered on notice. There is also a growing connection between medical negligence and the right to health as seen in the cases of CEHURD & 3 ORS vs Nakaseke District Local Administration Civil Suit No. 111 of 2011 and CEHURD & 2 ORS vs Attorney General Civil Suit No. 212 of 2013 which discuss the right to health and medical negligence.

Health and the law has now expanded with the growing subscription to medical insurance and the increase of private actors in the health sector and some of the issues presented before Court now include; rights of persons with mental disabilities, tobacco control, sexual reproductive health, access to medicines, access to health information, quality of health care in private health facilities, businesses in the health sector among others.

There are also issues of professional misconduct/unethical behavior by health professionals, medical negligence, unhealthy and unsafe working environment in health facilities which jeopardize patient safety. The non-appreciation of the distinction between rights violations, ethics and medical negligence have also been prominent.

AJALO RUTH

ajalo@cehurd.org

Centre for Health, Human Rights and Development (CEHURD)

Suicidal behavior has existed throughout human history, but due to several complex factors, it has increased gradually in all parts of the world and, in the past few decades, has reached alarming statistical levels. Close to 800 000 people die due to suicide every year, this is one person every 40 seconds.

It is important to emphasize that it is a topic that has attracted the interest of most fields of study for centuries, which is why it has been explored by philosophy, religion, medicine, sociology, bioethics, law, and psychology, among other fields. It is often believed that it is only adults who exhibit suicidal behaviors, but it should be made known that many children and young people engage in this kind of behavior as a result of violence, sexual abuse, bullying and cyber bullying.

A student in his final year pursuing Medicine at Makerere University this year committed suicide for losing his savings from his first year over 15 million shillings. Well most of you are wondering why a university student in his final year can decide to commit suicide for just 15 million shillings, it is very possible. A lot of focus is put on the adults forgetting that young people too face psychological torture that can mentally perturb them. Assume this student had someone to talk to about this, maybe he would be among those that are to graduate. Let us help society learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention because the effects of suicide go beyond the person who acts to take his or her life: it can have a lasting effect on family, friends, and communities.

Suicide is a global public health problem that deserves the attention of all the actors in the field of mental health, including scientific and professional organizations, organizations for mental health users and their families, and universities. It deserves particular attention from government and national health authorities, since it is their responsibility to craft policies and directives aimed at establishing strategies to prevent suicide and promote the public’s mental health. Not leaving out the role of both print and audiovisual communication media and of social media, their participation can have positive as well as negative effects, depending on how they address this subject.

There are numerous complex factors that contribute to suicide, but what is most important is that all of our actions must be geared toward prevention. Accordingly, it is important that trans-sectoral and interdisciplinary action be taken by all of the actors involved.

Getting people to talk about a subject that tends to be a taboo and about which many hold mistaken and prejudiced ideas will help the community to learn about the risk factors so that they can identify and learn to address them.

Suicide is preventable and can therefore be avoided, which is why all of our efforts and public policies should focus on prevention. However, oftentimes, people who suffer from mental illness lack access to mental health services, sometimes because there are no services in their community and sometimes because they must wait months to be seen.

By: Faith Nabunya

Communication Associate at CEHURD

28^th November, 2019

FOR IMMEDIATE RELEASE

Infants put in Harm’s way in a bid to prove a scientific belief!

Center for Health, Human Rights and Development (CEHURD) and Partners have today filed a case in the High Court of Uganda challenging the act of subjecting helpless children between 28 days to 12 years of age to cruel, inhuman and degrading treatment in a bid prove a scientific belief.

This research allegedly seeks to establish whether the use of oxygen is necessary in the treatment of Oxygen deficiency in children. This research process deliberately denies oxygen to these vulnerable children suffering from breathing complications (oxygen deficiency) and in some cases subjected to very low levels of oxygen which is highly life threatening.

It is reported that this trial has led to allegedly 41% deaths in Mulago National Referral Hospital alone, but the research is still being carried out in Mbale, Soroti and Jinja regional referral hospitals.

As Human rights activists, we believe that this infringes fundamental rights including the right to life and yet children are protected under Article 34(2) of the constitution which states that children should not be denied basic needs due to a belief. We believe that the nation has to pick interest in these life threatening scientific trials and the state should invoke its duty to protect citizens subjected to such harsh trials.

The clinical trial is conducted way below the ethical standards for research and contravenes the constitution and laws of Uganda. Worse still, the research did not seek for a Certificate of Approval from National Drug Authority (NDA) which is a requirement prior to conducting any clinical trial on pharmaceuticals in Uganda. 

Such clinical trails are against the set clinical practice guidelines and guidelines of medical practice and research both locally and internationally, given the fact that the doctors swear an oath to do no harm.

We therefore ask the high Court for declarations, interim orders, and permanent relief to stop the conduct of this clinical trial which we deem unethical and falling below the constitutional values of this country. We further ask the Uganda Medical and Dental Practitioners’ Council (UMDPC) and the Uganda human rights commission to investigate the human rights and ethical implications of the clinical trial.

FOR MORE INFORMATION please call 0414532283 or write to info@cehurd.org and copy nsereko@cehurd.org

By Jacqueline Twemanye

On an eventful Thursday evening of 7th November 2019, Center for Health, Human Rights and Development (CEHURD) had its 10 years’ celebrations at Sheraton Kampala Hotel in a memorable event for not only making 10 years of existence but for emerging as a key player in the field of advancing human rights and social justice in health; with a reputation for using bold strategies to realize and expand the right to health.

Clearly this milestone could not have been achieved overnight, it has taken 10 years of persistence, hard work, focus, determination and a clear vision to come this far in pursuit for justice in the health sector. This is backed by Prof. Joe Oloka Onyango, the day’s Keynote speakers’ description of CEHURD as “a vibrant, vivacious and vigorous organisation”.

For years, CEHURD has trodden dusty roads to reach far-end vulnerable communities as well as high-end policy making levels driven by a passion to bridge health gaps.

“What inspired me to embark on this journey was my Mother-a retired nurse and the challenges she went through while practicing, secondly the people who were of great influence in my walk of life and lastly the question of how Lawyers could use the constitutional language to demand for an improved health system” – Mr. Mulumba Moses, Executive Director CEHURD.

It is of no wonder that CEHURD has transformed the advocacy environment around the right to health, communities have become more aware of their right to a proper health care system and in turn demand for it. CEHURD not only deals in legal practice but also translates the theoretical and conceptual health issues into research and advocacy.

“I do not take the 10 years of CEHURD for granted, when two of my former students came to my office and said they had started an organisation aimed at promoting the right to health and human rights, as a founding teacher of Health & the Law and Health law and Policy at Makerere University, I was excited.” – Prof. Ben Twinomugisha, Board Chairperson CEHURD.                                                                                

It was on this day (7th November), that CEHURD launched its Strategic Plan (2020-2024) –Rebound | Innovate | Sustain, which is a compass to the five years ahead.

“It is not only a celebration for the past, it is a celebration for the future now that the strategic plan has been launched. We very much look forward to working closely with CEHURD in these coming years especially in areas of Sexual Reproductive Health Rights” –Mr. Ola Hallgren, Head of Cooperation Embassy of Sweden.

Congratulations CEHURD! To more years of impactful existence.

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