By, James Zere
All governments have endorsed human rights including the right to health in national constitutions or international law. Yet governments fail to abide by their obligations. We need an international treaty that reinforces and enforces the right to health, builds capacities to realize it, sets up systems to monitor progress, and holds governments accountable. People everywhere need knowledge and support to claim their rights. A Framework Convention on Global Health (FCGH) can transform people’s health and well being by empowering people everywhere to claim their rights (JALI Manifesto, para. 7).

Lack of access to essential medicines is one of the most serious challenges inhibiting access to proper health care services in the Uganda. When medicines are not available, affordable, of assured quality and properly used, health is compromised and lives are lost.

Access to medicines in Uganda is primarily funded by the donor communities together with the Central Government yet the funds from the donors are usually channeled through the government. The government has on several occasions failed to come through on its obligation to provide medicines and this aggravates the loss of lives in a country where thousands of lives of are lost annually to easily manageable diseases like Malaria, HIV/AIDS and Tuberculosis.

A lot of effort has been put into explaining the government’s right to health obligations as provided in the international instruments however the right still remains largely unimplemented across many states in Uganda.
JALI, an acronym for the Joint Action Learning Initiative, is leading efforts to mobilize for the creation of a Framework Convention on Global Health (FCGH) whose purpose is envisaged to be to clarify the international standards on the right to health and to enable a universal level of health care coverage based on the needs of the people.

A FCGH should be able to clarify the obligations of the government as far as provision of basic commodities like essential medicines to the public and would propose accountability mechanisms for the government and other stakeholders to put in place through which the government would be held accountable where it failed to implement its international obligations.

The WTO’s Trips Agreement amongst its principles seeks to foster technology transfer and technical support for developing economies however without an enabling environment these provisions remain largely on paper to be strategically implemented by the member states depending on their national strategic objectives. Funding for procurement of medicines for example is usually conditional and usually involves an obligation to procure medicines from a manufacturer in the donor country and this effectively stifles local manufacturers.

A FCGH should be able create links between the international Intellectual Property aspirations and the Global Health aspirations and foster a reconciled position in which the provisions of both regimes would be fostered both at the national level and the international level to promote access to pharmaceutical products.

By, Florence Nabweteme
More than four in 10 births are not planned leading to unintended pregnancies which on many occasions end up in abortion – according to the 2011 Uganda Demographic and Health Survey (DHS). Over 900,000 of Uganda’s annual 2.2million pregnancies are unintended and unplanned. About 400,000 of the unintended pregnancies end up in abortion. Government spends 7.5 Billion Uganda Shillings of taxpayers’ money on treating complications from unsafe abortion every year, which could be avoided at very little expense.

According to a study carried out by Guttmacher institute “Unintended pregnancy and abortion in Uganda” 2013, one in three never-married women aged 15 to 24 years admitted to having had sex and similarly one in three married women are not using contraceptives even though they do not want to get pregnant, this has resulted into increased numbers of unwanted pregnancies. This has been attributed to limited or sometimes lack of reproductive health choices such as contraception hence resorting to abortion which is mostly unsafe.

Other causes of premarital sex among the adolescents is the secrecy surrounding sex as a topic that has left young people mostly those in problems related to reproduction seeking for this information from social networks like Facebook, YouTube and Twitter. When these adolescents get pregnant they resort to unsafe abortion because of lack of choices.

Abortion in Uganda is widely regarded as illegal and condemned both culturally and religiously. Religious moral codes provide that life begins at conception and should never be terminated and that no circumstance would warrant an entitlement to terminate a pregnancy. However, the Ministry of Health National Policy Guidelines and service standards for Sexual Reproductive Health and Rights provides for circumstances where an abortion maybe permitted like in instances of sexual violence, coercive sex, rape and incest and illnesses which would endanger the health and life of the mother.

According to Dr. Charles Kiggundu, a gynaecologist at Mulago National Referral Hospital while making a presentation during a meeting convened by the Centre for health Human Rights and Development (CEHURD) within the Coalition to Stop Maternal Mortality due to Unsafe Abortion (CSMMUA) pointed out that, “most women resort to aborting as it seems risky giving birth in Uganda as two out of every three pregnancies are high risk and any woman who decides to have a baby has put one leg in the grave and the other is fighting not to join.”

Despite campaigns on abstinence and use of contraception, unsafe abortion remains a big problem and as such, there is need for interventions to save lives of young women. Media plays a great role in dissemination of information, but the question still remains, “What kind of information are they giving the public?”

In response to that question, CEHURD trained and continuously mentor media fellows to report on Sexual Reproductive Health and Human Rights issues with an informed point of view and with objectivity. This fellowship targets all media houses – print, broadcast and social media users. The participants have managed to report and create more awareness of the issue of unsafe abortion and interventions to reduce the incidents among young people, which has changed people’s perception on various issues.

CEHURD also organized a lawyers’ meeting to unpack the legal and policy framework on abortion in Uganda. The meeting was attended by different legal and health professionals.
According to Justice Damalie Lwanga, majority of the judicial officers are conservative and bent on enforcing archaic laws that were imported from the colonial era and are sometimes clouded by their moral values which influence their decisions. Abortion is a complex issue and sometimes needs someone to review the cases with a human rights perspective.

In addition to the commitment by the Ministry of Health to address unsafe abortion with the Post-abortion Care training being rolled out in different health centres, there’s need for legal backing and Sensitization of judicial officers to harmonize the laws in place and interpret them in a progressive manner. The WHO definition of health of the mother includes the mental and physical health of the mother and the Maputo protocol ultimately entitles every woman to a safe abortion if they need one.

As such there is still need for reform in the legal and policy regime to include reproductive health rights and progressively realize economic, social and cultural rights which will in turn increase access to safe abortion as we work towards a Uganda where no woman will suffer or die due to lack of reproductive health choices.

By Ronald Musoke

Two years ago the Center for Health, Human Rights and Development (CEHURD) filed a petition in the Constitutional Court seeking to secure a declaration that non-provision of essential maternal health commodities in government health facilities leading to the deaths of thousands of expectant mothers is an infringement on the right to health of the mothers.

On Sept.20, the Supreme Court met to hear CEHURD’s petition on whether the case merits being heard in the Courts of law. After waiting for months for the Supreme Court to get fully constituted, the appeal could not proceed again because this time, Patricia Mutesi, the Principal State Attorney, was indisposed.

Justice Benjamin Odoki adjourned the case until the next session scheduled for early next year. The CEHURD Executive Director, Moses Mulumba told The Independent’s Ronald Musoke why this case remains important.

In 2011, CEHURD alongside other civil society bodies took the government to court over its failure to provide basic commodities to expectant mothers in government health facilities. Why did you choose to take this course of action?

The value of this petition was to bring forward the judiciary as the third arm of government to address maternal mortality which is not only a public health issue but also a human rights concern.

In our minds, we are sure that the judiciary has a critical role to play in instances where either a government act or omission leads to violation of rights. In addition, much as litigation was happening in many other areas including the right to life, freedom from torture, inhuman and degrading treatment, rights of the children, right to education, the right to health seemed to be one of the isolated areas of litigation and there was hardly any precedents and court pronouncements on the right to health. Thus the petition was filed as an opportunity for the judiciary to clarify on the normative content of the right to health in Uganda.

How is the government’s failure to provide expectant mothers with basic health care an infringement on their fundamental human rights?

The normative content of the right to health creates three obligations on the part of government; including the obligations to respect, protect and fulfill. The obligation to respect for instance requires government to refrain from interfering directly or indirectly with the enjoyment of human rights and this would call for ensuring the provision of services to all the population groups on the basis of equality and freedom from discrimination paying particular attention to the vulnerable and marginalized groups.

On the other hand, the obligation to fulfill requires government to adopt appropriate measures towards full realisation of the rights such as providing appropriate legislative, administrative or budgetary measures towards the full realisation of human rights.

If we apply this framework on providing basic health care to expectant mothers, it means that the government needs to provide a number of things including basic maternal health commodities to enable mothers have safe deliveries. You should note that I am using the word BASIC.

This is because under the human rights obligations we do not expect government to provide beyond what it can afford but it must define the basics and under the Health Sector Strategic Plan, basic maternal health commodities were spelt out as part of the minimum health care package which the citizens of Uganda must receive. Therefore the failure to provide these is an infringement on the fundamental human rights of mothers who die while giving birth.

Of what significance was your petition in the Constitutional Court?

The petition was the first of its kind to engage the court to make declarations on the right to health. The judges went ahead to appreciate the petition and noted that they appreciate the issues raised by the petitioners regarding the unsatisfactory provision of basic maternal health services towards expectant mothers and also highlighted the fact that such issues can be litigated upon through other legal alternatives such as enforcement of rights through the high court.

This is great jurisprudence and as history has shown in other jurisdiction where the right to health is litigated, it’s such small victories that have later turned into major successes. I must also say it again, that not getting into the facts of the petition will be a missed opportunity for the courts to pronounce themselves on this important matter that touches many lives of Ugandans.

The Constitutional Court quashed your petition. What did you make of the verdict?

I think we need to look at the Constitutional Court’s ruling from a number of perspectives. First we never got into the merits of the case but rather the court upheld a preliminary objection. We have since appealed to the Supreme Court and I would not discuss the details of the objection as it would be sub-judice.

All I can say is that by the court upholding this objection; it misses a great opportunity to clarify on the legal status of the right to health broadly and maternal health especially as human rights aspects. Even then, the successes already had on raising more discussion on this issue from a legal/human rights perspective are enormous and I would be more comfortable commenting further once the Supreme Court appeal has been disposed off.

Can litigation bring about change in Uganda’s healthcare system?

Definitely. Litigation is a great tool for social mobilisation and can be a fantastic wake up call on the part of government especially; to act on its obligations which are in the constitution and part of the international and regional legal frameworks the government has committed to respect.

The other issue is to look at the role of the judiciary which relates to the principle of checks and balances which are imperative in holding the executive accountable on its policies, programmes and actions. Indeed the results of just filing this case are very visible as it was the first time we as civil movements had to engage with government more constructively to discuss the issue of maternal mortality as a human rights aspect.

We are seeing a lot of attention towards maternal health more than before. For instance maternal audits are now a major focus and the recruitment of more midwives either directly of remotely are resulting from this action. We therefore think that litigation plays a critical part in a health care system but it’s just one of the many approaches towards changing a health care system.

The rights of other sections of the population (men, children, the elderly, and people with disabilities) have equally been trampled upon by Uganda’s failing health care system. Why do you think women’s human rights are far more significant?

I do not think that women’s rights are far more important. I think all rights of all groups are equally important. There are so many groups addressing these other violations. So our approach just made women’s rights as a case study which can inform other movements working on rights of other groups.

Source: http://www.independent.co.ug/interviews/interview/8345-denying-health-care-basics-to-ugandas-expectant-mothers-is-an-abuse-of-their-human-rights