PRESS RELEASE: January 20, 2014

For more information, contact: Nakibuuka Noor Musisi, CEHURD, +256782496681

The High Court starts the hearing of a case on access to Patient information; Civil Suit No.212 of 2013

The Center for Health, Human rights and Development (CEHURD) together with Mubangizi Micheal and Musimenta Jennifer filed a human rights case against the Executive Director of Mulago National Referral Hospital and the Attorney General in the High Court for Violation of fundamental human rights guaranteed in the Constitution of the Republic of Uganda of 1995.

The plaintiffs state that by denying the couple access to their medical records, opportunity to nurture and bring up their child, taking away their child without permission coupled with the daily mental anguish and agony they are going through because of denial to access their child or its body is a violation of their Constitutional rights and the defendants are answerable.

“I gave birth to two girls, but I was only given one. I was denied my child or its body. I requested for my medical records but they refused to give me a copy. I am traumatized and psychologically tortured every day of my life every time I look at my other child. I know my child isn’t dead, she is alive. I am afraid of giving birth in hospitals”, says Musimenta Jennifer, the mother to the missing child.

With the uncertainty as to the whereabouts of their Child or its body, the Couple tirelessly searched for their child but only to be given a fresh body after three days. They resorted to undertaking a DNA test which revealed that the child was not related to any of them.

“I searched for my child in the entire Mulago hospital for three days but I failed to discover my child or his/her body. I was only called after the three days and given a fresh body of the child. I looked at the body but I was sure that this was not my child since the body was fresh. I requested for a copy of mortuary records to see when the record of the body of my alleged child was made but they did not give any, despite several requests. I decided to report the matter to police which advised me to undertake a DNA test. This test revealed that the components were negative. I approached CEHURD to file a Human rights case for the human rights violations my family suffered and we are still going through” Says Mubangizi Michael, father to the lost child.

Access to patient information is a key component of the right to health. Although the legal and policy framework in Uganda allows access to patient information and the Ministry of Health has developed good policies such as the Patients Charter, access to patient information is still illusory. A considerable number of patients visiting health facilities have been denied access to their health information and most of these cases go unnoticed since the patients are not aware of their rights guaranteed under the Constitution and Regional and International Human Rights Instruments, says Mulumba Moses, the Executive Director of CEHURD.

We believe that the Judiciary has a critical role to play to cub these violations and we hope the parties will get justice.

By Mugisa Martha
More than 50 years ago, the 1961 Single Convention on Narcotic Drugs was adopted by the United Nations (UN) member states, declaring the medical use of narcotic drugs indispensable for the relief of pain and mandating an adequate provision of narcotic drugs for medical use. The International Narcotics Control Board (INCB), charged with monitoring the implementation of the UN drug conventions, clarified in 1995 that the Convention ‘establishes a dual drug control obligation: to ensure adequate availability of narcotic drugs, including opiates, for medical and scientific purposes, while at the same time preventing illicit production of, trafficking in and use of such drug’.

Pain medications such as morphine and codeine have been added to the list of essential drugs by World Health Organization in its Model List of Essential Medicines. Other international bodies, such as the UN Economic and Social Council and the World Health Assembly, have also called on countries to ensure adequate availability of opioid analgesics. Despite this lucid consensus that pain treatment medications should be available, approximately 80% of the world population has either no, or insufficient, access to treatment for moderate to severe pain.

Worldwide there is unequal distribution of pain medical treatments. Much of these medications are consumed by the greater north and a lesser percentage by the south which consumes only 6%. Myriad reasons have been advanced as barriers to access to pain treatment globally which include the failure of governments to put in place functioning drug supply systems, the failure to enact policies on pain treatment and palliative care, poor training of healthcare workers, the existence of unnecessarily restrictive drug control regulations and practices, fear among healthcare workers of legal sanctions for legitimate medical practice; and the unnecessarily high cost of pain treatment.

These reasons have had and continuously impact on the right to the highest Standard of physical and mental health and the freedom from cruel, inhuman degrading treatment or punishment that is inherent to all. One of the most major causes of suffering and disability in the world is chronic pain. Pain whether chronic or not has a profound effect on the quality of life and can have physical, psychological and social consequences. It can lead to reduced mobility and a consequent loss of strength, compromise the immune system and interfere with a person’s ability to eat, concentrate, sleep, or interact with others.

Pain relief medications were initially reserved for cancer patients who experience severe pain in the advanced stages as well as HIV/AIDS patients. However, a much wider cycle of health conditions has evolved in need of pain relief medications such as renal diseases, cardiac vascular diseases, kidney related illnesses, epilepsy and diabetes to mention but a few. And as such there is greater need for access to pain relief medications to prevent and relief pain.

Worldwide, Uganda, Jordan and Columbia have been considered as model examples for the provision of palliative care services that seek to prevent and relieve pain and other physical, psychosocial and spiritual problems. In Uganda sixty one districts are currently receiving a home based palliative care service which is a good step towards access to pain relief medication.  In addition, the government has put in place undergraduate and postgraduate programs aimed at training nurses to administer the pain relief medications particularly morphine. Though in its initial stages, the programs are attracting a number of participants in different countries.

While National Drug Policy and Authority Act Chapter 206 of Uganda places morphine as one of the classified narcotic drugs only to be administered and distributed by those authorized to do so under the Act, the Ministry of Health guided by the Act developed guidelines under which morphine as a drug could be administered by specialized nurses in palliative care from the previous restrictions of a medical doctor

Even with the wide distribution of Palliative care services in the country and the various initiatives taken by the government to provide access to pain relief medications, only 10% of the Uganda population has access to the service. This is mainly due to a number of challenges. For example the procedure that a patient and their attendants have to go through to acquire the medicine.  Patients are required to have a prescription from medical personnel qualifying them as candidates for morphine use yet there is little awareness of palliative care services. These and many more pose a threat to access to pain relief medications hence denying a patient the right to health and freedom from cruel or ill- treatment.

The right to the highest standard of physical and mental health is inherent to all.  And such as governments are obligated to protect, respect and fulfil their obligations under the international human rights instruments. The right calls upon governments to provide medical services such as access to pain relief medication despite the limited resources to all specifically the vulnerable populace. It is therefore the duty of the government to ensure that there are policies and laws in place that enable access to pain relief medications. It is a right to pain relief.

By Nakibuuka Noor Musisi

The campaign to prevent maternal mortality in Uganda is increasingly challenged with the factors that unfold daily. As different stakeholders fight to prevent maternal deaths, expectant mothers continuously run away from the health facilities that are expected to provide basic services to them.

Massive shortage of trained, motivated and equitably deployed professional health workers to attend to births, lack of access to emergency obstetric care, lack of access to quality antenatal care, and lack of access to family planning services, haemorrhage, sepsis among others have been identified as some of the leading causes of maternal mortality in the country. But, today safety of new-born babies within the public health facilities can also be attributed to the maternal mortality rate.

Musimenta Jennifer is one of the few outspoken women that came up to report her case. Many more have suffered the same fate but never come out to speak. Musimenta delivered two children on the 14th day of March 2012 and was informed that one child died but she never saw the body of her child. She demanded for her medical records all in vain. She moved up and down with the mortuary attendant looking for her child in vain. Up to present day, she has one child even though her discharge form shows that she delivered twins.
“We looked for the body of the second child for three days and on the third day, the nurse gave us a fresh baby wrapped in a box. I refused to take the body because it was wrapped in clothes different from what we had given the nurse that helped my wife deliver. The body looked so fresh yet the nurse claimed she had put it in a box immediately after delivery. I went to police and was advised to take a DNA test which I took and the test revealed that the DNA component from the sample of the dead child was not related any of us” Michael Mubangizi the husband to Musimenta Jennifer narrated.

The couple approached the Centre for Health, Human rights and Development (CEHURD), whose Vision is to realize social justice in public care systems in East Africa. CEHURD decided to institute a case in the High Court of Uganda for rights violation (Civil suit No.212 of 2013). Just as CEHURD was in the final stages of filing the case (Case was filed on 18th July 2013), the Uganda Medical and Dental practitioners council passed a ruling (10th July 2013) in which it “barred Dr. Asinja Kapuru from carrying out any form of medical practice in Uganda for a period of two years” Page 5, last paragraph of the ruling. Dr. Kapuru had been reported by Mr. Bukenya and Ms. Navbakiibi in 2006 for loss of a baby at mulago national referral hospital. The couple delivered a baby boy by cesearean and was given a dead baby girl despite the fact that medical records showed the reverse.

The council did not leave it at that but took note of the fact that “there is poor customer care at the hospital and there is poor communication between the hospital and staff and the consumers of their services” Page 6 of the ruling. It was also concerned with the attitude of the Hospital administrators towards patient complaints that it noted to be deplorable. The Council recommended that “Mulago administration puts in place a system that ensures timely and effective healing of clients concerns”

This system “failure” has and will largely contribute to maternal mortality. Instead of women going to facilities for safe delivery they will shun them for fear of the safety of their new born babies. This is coupled with many other complications including fistula.
There is need to sensitize not only the community but also health workers and the public on their rights and responsibilities. Health workers need to be reminded of their obligations towards patients and that they swear before being licensed to practice.

By, James Zere,
The Ugandan health sector has recently taken a new dimension driven especially by the low levels of resources committed by the government to the sector. Innovators have moved to harness the potential in the rapidly developing mobile communication network to bring health services closer to the people and in other instances to place health services in the hands of the people themselves.

Also referred to as teleHealth or mHealth, eHealth has recently been piloted across the country by various stakeholders in health sector as the country struggles to realise Universal Health Coverage. EHealth itself has been defined severally depending on the context in which it has been applied however, it can simply be understood as the use of electronic, information and communication technology in the provision of health services. EHealth in Uganda today consists of a cross-range of activities including the most basic like calling into the local radio station to get medical advice from the doctor’s show to the more complex like personally using a phone application to diagnose your health condition.

UNICEF Uganda under its ICT for Development program has taken the lead in implementing various innovations aimed at supporting the health sector; Sateliffe has also developed the Uganda Health Information Network for collection and communication to health information between the health workers at the community level and those at the higher levels of the health sector; students of Makerere University in 2011 developed WinSenga a mobile application to promote maternal health status of babies in their wombs using just a smart phone and followed this in 2012 with Matibabu, an application for taking a malaria test using just a phone and without using a needle at all; and the Uganda National Drug Authority has also developed an SMS based initiative for checking the authenticity of medicines by sending a unique code attributed to the medicines to a designated number for verification.

The government has caught up with the tide and commissioned the development of the National eHealth Policy. However, due to several legal issues pertaining to eHealth implementation, the Ministry of Health also issued a Moratorium in January 2012 vide Reference No. ADM 45/273/01 halting the implementation of any new eHealth initiatives or projects subject to certain administrative approval measures until the Ministry develops comprehensive policy guidelines for the same in Uganda.

The moratorium was a timely intervention for a rapidly developing highly unregulated sector which has the capacity to impact several people in different ways. Despite the potential of eHealth as demonstrated by this pilotitis map developed by UNICEF, there is need to define the regulatory and administrative framework in which eHealth is being implemented. Pertinent issues like data protection and governance which arise in eHealth implementation therefore need to be addressed if most of these very timely interventions are to cross the pilotitis threshold into actual solutions that make the lives of the everyday Uganda better to live.

By, Serunjogi francis.
Following of the constitutional court’s ruling that constitutional petition No. 16 of 2011 raised a political question which the constitutional court had no power to determine, CEHURD appealed to the Supreme Court asserting that the petition was fully with in the mandate of the constitutional court. The first hearing of the Appeal was scheduled for Friday September 20, 2013 at Supreme Court in Kololo.  Human Rights Advocates and legal experts point out that the appeal of this erroneous ruling addresses not only for the right to health, but also the human rights of all Ugandans.

As a means of enforcing the justiciability of the right to health, on 3 March 2011, Petition Number 16 of 2011 was filed in Uganda’s Constitutional Court by the Centre for Health, Human Rights and Development (CEHURD) and others. This ground breaking case argued, among others, that by not providing essential health services and commodities for pregnant women and their new-borns, Government was violating fundamental human rights guaranteed in the Constitution, including the right to health, the right to life, and the rights of women. However, court dismissed the case on grounds of the political question doctrine.

Legal experts argue that the Constitutional Court has the mandate to interpret the Constitution on the matters raised by this case on maternal mortality such as the right to health, the right to life and the rights of women, and all other human rights. This therefore means that if the Supreme Court overturns the ruling by the Constitutional Court, Petition Number 16 of 2011 will be heard on its merits and Constitutional Court will have the chance to play a constructive role in correcting the preventable crisis of 16 pregnant women dying every day in Uganda.

Imagine the frustration therefore when after the hustle and bustle of securing a hearing date in the Supreme Court, the state failed to show up forcing to the Supreme Court to grant an adjournment. The hearing could not be started because the government was not represented in court, counsel for the appellants conceded to the adjournment which could well be heard in the new year (2014) since all of the dates for this year have been committed to other cases. This however doesn’t deter the spirit of the maternal rights movement and very soon the Supreme Court will make a ruling and the government will be obliged to provide for the rights of the mothers.