By Martha Mugisa

Realisation of the right to health has proven to be a great challenge even though it is provided for in the International Human rights instruments.
Many states have shown more interest to address health inequalities within their countries through the enactment of the legislation. This has done very little to address some of the health inequities that still pose a threat to the realization of the right to health without discrimination.

These health inequities have caused one-third of global deaths nearly 20 million [death] every year. This is intolerable, yet ignored by those who hold the power to redress these inequalities.

A Framework Convention on Global Health (FCGH) could catalyze national and global actions to collectively transform today’s injustices into justice; into the right to health; into a new chance at life and good health for untold millions of people.

This treaty [FCGH] grounded in the right to health is aimed at resolving the vast health inequities between and within states and help to catalyze a new era on global health.

In the bid to address the health inequities, the convention aims at creating norms to ensure the universal conditions required for good health, along with additional proven policies to reduce inequities, an enabling global environment – from sufficient financing to health-promoting trade and investment rules – and people empowered to claim their health rights.

The treaty will catalyze far-reaching legal and policy changes that stand to dramatically improve health, especially for people who have benefited least from recent global health gains. And further address the drivers of health inequities such as the social determinants of health, universal health coverage, accountability, discrimination, global systems and international policies in the provision of health services with a specific focus on the marginalized groups. In addition the Frame Work Convention on Global Health will address other determinants of health.

While the FCGH may not do everything needed to end health inequities, this treaty would be a powerful response to global health inequities. It could help save millions of lives, prevent millions of people from becoming ill, and improve the lives of those living with disease and disability.

It is therefore crucial to acknowledge that the causes of global health inequalities extend beyond the reach of a single treaty. But, enacting the Framework Convention on Global Health would be a landmark in ending health related inequalities.

By Joan Kabayambi MakSPH/CDC follow- CEHURD

Fiona Bakantweka, was 16years when she was expelled from school for becoming pregnant. When time for giving birth reached, she was taken to a birth attendant in the village.Unfortunate Fiona’s labor lasted almost four days that when she finally pushed the baby out, it was dead. This however damaged the reproductive system that she “leaked” and smelled of urine and faeces all day, every day.

Fiona had developed obstetric fistula. Fistula is a preventable and treatable condition which occurs when a girl or woman has an obstructed labor and does not get a Caesarean section in time. The obstruction may occur because the mother’s pelvis is too small, the baby is badly positioned, or its head too big.The protracted labor threatens the life of both baby and mother. If the mother lives, the pressure by the baby against the woman’s pelvis damaged the soft tissues around her bladder, vagina, and rectum and caused holes, or fistulas, to develop. If the fistula is between her vagina and bladder (vesico-vaginal), she has urine leakage, and if it is between her vagina and rectum (recto-vaginal), she is unable to control her bowel movements.

Fistula in Uganda mostly affects young and poor women with little education and limited access to quality health care, including emergency obstetric care. According to the 2003 Baseline Assessment of Obstetric Fistula in Uganda done by WHO, patients lack the knowledge that the condition can be repaired and are too ashamed of their condition to seek help. Those who remain untreated may be shunned by their communities and relatives and must find new ways to support themselves.

“I live in shame,” says Bakantweka. “I am now out of school, and even my family blames me for the pregnancy. They say I am paying for my sins.”
It is risky to have babies in Uganda due to the fact that the maternal mortality ration is 438 per 100,000 live births Uganda Demographic and Health Survey (UDHS) 2011. With little access to health care and information about these kinds of risks, young people begin sexual activity and childbearing at an early age.

The WHO estimates that obstetric fistula affects 50,000 to 100,000 women every year, mainly in sub-Saharan Africa. In Uganda, the survey (Uganda Demographic and Health Survey 2011) shows that 2 percent of women have experienced obstetric fistula, making it 1,900 new cases each year.

Obstetric Fistula is a shameful and stigmatizing condition that very few women declare that they have the problem hence making it difficult to know the number of women with the condition.

In Uganda, the Ministry of Health has developed the National Obstetric Fistula Strategy 2010/2011-2014/2015 that has made Mulago and other government hospitals to start offering free treatment by surgery. There are also 25 fistula trained surgeons in Uganda and in all the referral Hospitals there is a surgeon or two.

However, there is need for raising awareness in communities on prevention and mobilize communities to look out for women with the condition to access treatment from the agonizing obstetric fistula. This can be done by Civil Society Organizations like the Center for Health Human Rights and Development (CEHURD) under Community empowerment programmes.

This can be made easier if the government collaborates with all the relevant stakeholders, such as the existing local initiatives and communities and, ensure that health facilities have the equipment and supplies specialized for fistula surgery, the surgeons are well remunerated, the environment they work in is conducive, and that they are motivated to work even in the not-easy- to- reach areas.

By Lipi (Nakimuli Zam) Mishra

Every year, the McGill University Faculty of Law Centre for Human Rights and Legal Pluralism sends a select group of students to locations around the world to conduct legal work on human rights and development as part of a 12 week internship. Students work on various topics ranging from women’s rights to piracy to aboriginal law (among others). This is the first year in which an intern from McGill was placed at CEHURD’s office in Kampala, Uganda.

I joined the CEHURD team as part of the McGill Human Rights Internship Program in May and the experience has been transformative. During the first portion of my internship, I worked closely with Primah Kwagala, the program Manager for the Human Rights Documentation and Advocacy Program.

I arrived at a particularly exciting time and worked closely on the TRIPS (Trade Related Aspects of Intellectual Property Rights) advocacy work. This particular project led me to meetings at Parliament, proposing the passing of a resolution by the East African Legislative Assembly, and presenting the civil society position to the TRIPS Council representatives at the Ugandan Ministry of Trade.

As I became more familiar with the work and city, I quickly learned that there is never a dull day at the CEHURD office. Mid-way through my internship, I also began to working with the Community Empowerment Initiative where I visited tobacco farms in Kiboga and consulted with community members.

During our consultations and interviews, we quickly learned about the complex connection between Tuberculosis (TB), Human Immunodeficiency Virus (HIV) and tobacco. Tobacco smoking, a modifiable risk factor, is associated with poorer outcomes in HIV-associated opportunistic infections, of which TB is the commonest in developing countries, including Uganda. These connections are rendered even more complex once the involvement of business incentives vis-à-vis farming practices are introduced into the equation.

The trip to Kiboga was enlightening on many levels. Even the car ride to the district with CEHURD’s Executive Director, Mr. Moses Mulumba, proved to be an enriching opportunity to experience life outside of the hustle and bustle of Kampala.

Mere kilometers outside of the city centre, I felt transported to a different way of life; hoards of children walked barefoot to school, farmers lived communally on tobacco farms to sustain operations, and HIV clinics were grappling to figure out effective strategies to deal with TB co-infection. Now, I will be using what I’ve learned to draft grant proposals so that CEHURD can continue to conduct research and advocacy in the area of tobacco control, particularly among vulnerable populations like the ones we met in Kigoba.

Overall, my term at CEHURD has been unparalleled. I’ve learned a great deal, discovered a passion for health and intellectual property law issues, and made some great friends. The CEHURD staffs have been overwhelmingly welcoming and have grown to be great mentors for me. I would like to extend my deepest gratitude to everyone at CEHURD for a wonderful summer and for providing me with the knowledge, experiences, and tools to move forward and continue to advocate for the right to health.

While I arrived in Kampala as a timid second year law student in May, I will be leaving as an advocate with a passion for advancing for the justiciability of the right to health. Wabale nyo, CEHURD!

By Nakibuuka Noor

“At around 11Am, I was in the theatre, for epidural anesthesia. The gynecologist was performing the surgical procedure. Soon as the baby was removed from my womb electricity went off. I heard the doctor saying that my life was in danger. He quickly sent one of his assistants to order for the generator to be switched on immediately.

This indeed saved my life” Evelyn Namukasa, a mother of two.
Electricity is not only increasingly becoming essential in our day today live but also in public health facilities. Constant power supply in public health facilities is an added advantage to saving lives of mothers and children because most of the equipment in electronic

Consequently, interrupting electricity supply particularly through unexpected load-shedding, poses a direct risk to the lives of patients who may be in intensive care, receiving emergency treatment, or undergoing life-saving surgery.

In Developing Countries like Uganda, where functional alternative power sources are limited, unplanned load-shedding in public health facilities is a bigger threat to livelihoods.

Despite all that however, indiscriminate load shedding of health facilities still happens in a number of health facilities and this has denied the citizens of their right to access health care in public
health facilities and in some cases either directly or indirectly led to the death of patients.

A new strategy has however been developed to hold the government accountable for such indiscriminate load shedding and violation of rights. CEHURD lodged a complaint with the Uganda Human rights Commission (UHRC) against UMEME Ltd and the Electricity Regulatory Authority (ERA) for specific declarations on violations of rights when public health facilities continue experiencing load shedding.

The efforts to have this dream come true have however not been realized. In a letter to CEHURD dated 14th March 2013, UHRC recognized that “… the complaint discloses a human rights violation of the right to Health and there can be no legal right without a remedy ..”. However the letter went ahead to dismiss the complaint stating that “.. if the Commission was to take on the complaint it will be overwhelmed”.

The laws establishing and regulating the operations of Uganda Human Rights Commission such as the 1995 Ugandan Constitution, the Uganda Human rights Commission Act cap 24  and the Uganda Human rights complaints procedures of 2008 do not exclude handling of complaints that raise Human rights violations on grounds that the Commission will be overwhelmed and unless the commission comes out to publically pronounce its self on the problem, many more rights will be violated and the progressive realization of the right to health will be a myth.

CEHURD will continue to pursue this complaint and ensure that the Commission holds UMEME and ERA accountable.